Testosterone and Male Fertility

Testosterone is one of the most important male sex hormones that plays a vital role in the development of the penis and testes, body fat distribution, muscle size & strength, bone mass, sex drive, and red blood cell production. This hormone is responsible for the initiation of primary and secondary sexual characteristics in men. If the levels of testosterone become low or high, it can lead to infertility in men. Testosterone levels can be checked through blood tests. Physical examination, bone densitometry, and karyotyping are other indirect tests for checking the adequacy of testosterone production. The right diagnosis and treatment at the right time can increase the possibility of conception.  

Low Testosterone and Infertility

Low testosterone level in men leads to a condition called Hypogonadism. Some of the symptoms of hypogonadism are low sperm count, erectile dysfunction, brittle bones, decreased sex drive, less body hair, decreased energy, etc. Hypogonadism can happen at any age in a man’s life either before the onset of puberty or after puberty at an older age. Two types of hypogonadism are observed namely, Primary Hypogonadism and Secondary Hypogonadism. Primary hypogonadism (Hypergonadotropic Hypogonadism) occurs when sex glands produce low testosterone while secondary hypogonadism happens when there are issues in the pituitary gland or hypothalamus. Secondary hypogonadism is also called Hypogonadotropic Hypogonadism.  

What causes Hypogonadism?

Low testosterone can happen due to a variety of reasons like: 

  • Testicular injury 
  • Genetic diseases like Klinefelter Syndrome, Kallmann’s Syndrome, etc.  
  • Obesity 
  • Diabetes 
  • Aging 
  • Infections 
  • Brain surgery 
  • Cancer treatments like chemotherapy, radiation 
  • Injury to the pituitary gland 

Treatment for Hypogonadism:

Many male infertility treatment options are available to increase testosterone levels in men with hypogonadism. The earlier the detection and treatment, the better the results. 

  1. Hormone Replacement Therapy (HRT): 

Hormone Replacement Therapy (HRT) is used to improve testosterone levels in these men. Through HRT, men can achieve fatherhood without going for donor sperm.  

  1. Injection: 

Testosterone injections can be given at 2-week intervals to improve the level of testosterone. 

  1. Gel: 

Men with low testosterone can apply testosterone gel to arms or shoulders. However, some precautions are necessary while using the gel as it can get transferred to others via contact. 

  1. Skin patch: 

Skin patches can be used on the abdomen, thigh, or upper arm at night. The patch can be placed in different parts of the body for several weeks.  

Some lifestyle changes like regular exercise, weight management, intake of nutritious food, reduced usage of gadgets, etc. can also improve testosterone levels.  

Advanced extraction procedures like TESA, micro-TESE are used for men with low sperm count following which IVF/ICSI can be carried out to achieve pregnancy.  

High Testosterone and Infertility

Some have the misconception that an increased level of testosterone means increased virility. But that is not true. Higher levels of testosterone in men may lead to Hypergonadism. Balance in hormones is essential for the proper functioning of the system. Some of the symptoms of hypergonadism are impotence, low sperm count, high blood pressure, etc. 

What causes Hypergonadism? 

  • Autoimmune disorders 
  • Tumors in the testicles 
  • Kidney problems 
  • Injury 

Treatment for Hypergonadism:

Hormonal treatment is given to reduce the level of testosterone. Finding the right dose and mix of hormones can balance the level of hormones. Men with low/high levels of testosterone can attain parenthood if and only if they take the assistance of an andrologist/fertility specialist at the proper time.

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