The condition of low testosterone, also known as hypogonadism, is often accompanied by numerous hypogonadic symptoms such as: increased body fat; reduction in muscle and/or bone mass; changes in the size of, or lumps in the breasts, testes, or scrotum; difficulty sleeping; loss of peripheral vision often indicates the presence of a pituitary tumor; depression, anxiety, or irritability; excessive sweating and night sweats; loss of body, facial and pubic hair; increased breast tissue (gynecomastia); poor concentration and/or memory; insulin resistance; loss of bone mass (osteoporosis); muscle weakness and/or the inability to gain muscle mass or increase strength; irregular or cessation of menstruation; and hot flashes. However, probably the most pronounced hypogonadic symptom of all, and certainly the one that most often prompts sufferers to seek medical attention is sexual dysfunction among which are: erectile dysfunction or impotence – the inability to develop or maintain an erection of the penis during sexual performance; diminished libido or the reduction in the desire for sexual activity; and conception difficulty or infertility due to a severe reduction in either sperm count, sperm motility (ability to move spontaneously and actively), or both. Of these sexual dysfunctions, the only one that has zero chance of being remedied by testosterone replacement therapy is infertility. This unique condition requires a rather unique solution, which is best understood by first learning about fertility itself.
Testosterone and Fertility
The role testosterone plays in the production of sperm cells is a central one, and the Continue reading below…relationship between testosterone and sperm production is part of an internal monitoring system called the negative feedback loop. Such a system works with the brain to coordinate and maintain standardized levels or set points within the body. For example, heartbeat, blood pressure, and respiration (breathing rate) are all part of the autonomic nervous system for which the body has desired set points. Although specific stimuli can change (usually increase) each of these, i.e. fear can raise heart rate, running can raise respiration, and certain foods can elevate blood pressure, after the stimulus ends these levels tend to return to normal (a process called homeostasis). This is managed by the negative feedback loop, an elaborate relay system that alerts the brain of changes to which it in turn sends messages to other organs and cells to (based on the situation) to begin restoring normalcy. Several other bodily systems are also managed by the autonomic nervous system’s negative feedback loop among which are bodily temperature, metabolism, body fat percentage, the secretion of chemical messengers called hormones, which include thyroidal hormones and sex hormones (testosterone and various estrogens). More specifically, the brain makes special hormones, called gonadotropin-releasing hormones (GnRH) that signal the testes to produce testosterone a key component of healthy sperm count. This is all part of a very complex and delicate system often referred to as the Hypothalamic-Pituitary-Testicular Axis (HPTA) – the relationship between these glands and their production of testosterone. The Hypothalamic-Pituitary-Testicular Axis plays a critical role in the development and regulation of several of the body’s systems with special emphasis on the reproductive and immune systems. Fluctuations in the levels of some hormones can cause changes in the production of other hormones, which can have various negative localized and widespread effects on the body. Although there’s much interaction, for the most part specific glands produce specific hormones, i.e., the hypothalamus is largely in charge of the production of gonadotropin-releasing hormone, the anterior portion of the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and the testes or ovaries produce testosterone and estrogen in gender-specific amounts. Low testosterone levels and low sperm count may be due to a problem anywhere along this system. For example, if there’s a problem with the pituitary gland the production of follicle stimulating hormone and luteinizing hormone may be diminished. Since these two hormones directly stimulate the production of testosterone (and subsequently sperm cell production) within the testicles, such a condition will cause a subsequent reduction in both thereby hindering fertility.
Male subfertility, as infertility is often called, is actually fairly common but varies sometimes idiopathic (unknown) reasons for the failure of spermatogenesis – the process of sperm cell development whereby rounded immature sperm cells undergo successive mitotic and meiotic divisions (spermatocytogenesis) and a metamorphic change (spermiogenesis) to produce spermatozoa or actual sperm cells. Fertility is so sensitive a process that even the slightest imperfection in conditions can throw it off such as: insufficient amounts of FSH, LH, testosterone, or estrogen; a bodily temperature (or scrotal region temperature) that is too hot or too cold; the use of a some (even over-the-counter) drugs or prescribed medications; dietary factors; conditions such as obesity or diabetes; and a host of other variables.
Testosterone Replacement Therapy Causes Infertility
Although it seems somewhat counterintuitive, testosterone replacement therapy has a profoundly negative impact on a man’s reproductive potential, and has actually been studied as a method of birth control. Some researchers approximate that as much as 90% of men experience substantial declines in sperm count (to varying degrees) while on testosterone replacement therapy, which uses synthetic testosterones to support deficient endogenous (natural) levels. These types of synthetics are interpreted by the brain as the real thing, which initiates the negative feedback loop’s signaling of the testes to slow or possibly halt endogenous testosterone production, depending on the amount, dosage, and frequency of the therapy.
Fortunately, a significant percentage of male subfertility is medically treatable, and wholly reversible. However, unlike many sexual dysfunctions, infertility/low sperm count is not remedied by testosterone replacement therapy. Endocrinologists have a high success rate with treatable causes of subfertility including ejaculatory dysfunction, endocrinopathies (a disease marked by dysfunction of an endocrine gland), obesity, sexual disorders, drugs, etc. Foremost in their arsenal and possibly the most important aspect is a diagnostic study performed by means of seminal fluid analysis wherein at least 2 samples are analyzed.
Patients with low sperm count, concentrations below 10 million/mL, due to unknown spermatogenic defects are often scheduled for genetic counseling and karyotyping – a test that can help identify genetic problems as the cause of a disorder or disease by examining the chromosomes in a sample of cells. This test counts the number of chromosome, and looks for structural changes within chromosomes. Karyotyping can be performed on almost any bodily tissue, including amniotic fluid, blood, bone marrow, and placenta (tissue from the organ that develops during pregnancy to feed a growing fetus). Most experts also recommend that these patients be tested for Y chromosomal microdeletions – losses of tiny pieces of chromosome that may be too small to be readily seen through a microscope. The majority of low sperm concentrations is due to gonadotropin deficiency, and can be easily remedied via gonadotropin therapy, which effectively increases spermatogenesis. A good endocrinologist will be able to recognize when to use a specific medical therapy to stimulate spermatogenesis, and when to refer the patient out for assisted reproductive technology.
Since gonadotropin injections stimulate the production of sperm, it is also a good way to improve sperm count if low testosterone is the problem. Generally, when infertility presents, it’s standard practice to first check sperm count. If sperm count is determined to be low, the next step is to measure testosterone levels. When testosterone levels are below normal, the administration of gonadotropin injections literally signals the testes to produce more testosterone, which usually resolves the problem.
Natural Ways to Increase Low Testosterone
Unfortunately, a relatively large percentage of men faced with infertility are also suffering from low testosterone. Recent studies have demonstrated that at approximately 30 percent of men who sought treatment for male infertility were discovered to have low testosterone levels, and a far greater percentage were substantially below optimal testosterone levels.
There are other to naturally increase testosterone secretion, i.e., improve low testosterone levels which include improving one’s lifestyle with changes such as regular exercise, natural supplements, a healthy diet, and more or higher quality sleep. Weight gain seems to be inherent to aging, as people appear to naturally lose muscle and gain fat, if all other lifestyle factors remain the same. However, this is a myth, the real reason people (both men and women) gain weight is a combination of primarily (there are certainly other factors involved) two interrelated components namely diminishing sex hormone levels (testosterone in men, and estrogen in women), and a less active more sedentary lifestyle that’s centered around work and/or family rather than activities. This is why when diet gets better compared to teenage years and the twenties and thirties flab still increases. These two primary factors often impact several others as well. For example, diminished sex hormones and reduced physical exercise/activity cause the body to require less energy, which when coupled with the principle that energy begets energy, a lessened activity load requires less metabolic output. In this way, the body responds to the reduced need, by secreting less triiodothyronine (also known as thyroid hormone 3 or T3) and less thyroxine (thyroid hormone 4 or T4). T3 is used by the body to stoke the furnace of the metabolism, so to speak, it (along with T4 which readily converts to it) keeps the metabolic furnace burning optimally, and a limited amount of T3 reduces metabolic output. The consequence of which is metabolic slow down, or stall, resulting in a sluggish low burning (especially body fat) metabolism and ultimately to flab.
EXERCISE – Excess belly fat converts testosterone to estrogen (a female-oriented hormone), thus obesity tends to lower testosterone levels. As a result, losing extra weight is a very good strategy for increasing testosterone, which in turn improves fertility. Plus, the added motivation contributed by both couples in hopes of pregnancy goes a long way in increasing weight/fat loss success.
Routine exercise is a central to good health. Reducing body fat, increasing lean muscle tissue, and improving the physique as well as body image builds confidence, which results in a healthier libido. The generally accepted best types of exercises for increasing testosterone secretion include those which work larger muscle groups, thus one should focus on multi-muscle strength-training such as bench presses, dumbbell rows, and squats.
NATURAL SUPPLEMENTS – Several natural supplements can also aid increased testosterone secretion. Those highly touted as possessing the ability to positively impact testosterone levels include DHEA, yohimbine, ginkgo, and ginseng. Additionally, being sure to get enough vitamins and minerals is also important, especially vitamins C & E, zinc, and folic acid.
FOODS – Specific foods contain various nutrients that research has deemed capable of increasing testosterone secretion; among these foods are zinc rich brown rice, vitamin B rich eggs, and vitamin E rich asparagus and almonds.
SLEEP – A lack of sleep can wreak havoc on the body, as well as decrease testosterone secretion. Most experts including the world famous Mayo Clinic agree on a the need for a good seven to eight hours of quality sleep per night for the optimization of sleep’s recuperative properties, and for proper hormonal level adjustments. Also of importance is the quality of sleep, which should consist of a dark, quiet, uninterrupted environment.
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- Low Testosterone and Infertility
- By Matt McMillen
- WebMD Feature
- Reviewed by Brunilda Nazario, MD
- Low Testosterone
- Texas Fertility Center
- San Antonio, TX
- The “Male” Hormone
- Aaron Spitz, MD
- American Fertility Association