A common assumption is that taking in more testosterone increases sperm production and improves sperm quality. The counterintuitive truth, however, is that supplementing with testosterone medication or boosters actually inhibits sperm production. For sperm production to occur, the available testosterone must be made naturally in the testicles.
The majority of male testosterone is produced and found in the testicles. The testicles produce high concentrations of testosterone, some of which enters the bloodstream and travels to different areas of the body. The benefits of increased testosterone levels include improved sexual well-being, increased energy levels, mental clarity, improved mental health, and increased muscle growth. When it comes to sperm production, however, the concentration of testosterone found in the testicles specifically is what’s key.
Sperm, just like testosterone, is produced in the testicles. In order for sperm production to occur, there must be a very high concentration of testosterone in the testicles, which only happens when the testosterone is made in the testicles themselves.
Testosterone production occurs when the pituitary gland, a pea-sized gland at the base of the brain that regulates the production of multiple hormones, releases luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH stimulates the testicles to make testosterone, while FSH aids in the production of sperm.
When men use testosterone replacement therapy, the excess testosterone molecules circulating in the blood sends a signal to the pituitary gland that no additional testosterone is needed. Testosterone boosters contain agents that very closely mimic testosterone, resulting in the same signal being sent to the pituitary gland. The pituitary then begins shutting down production of LH. Lower LH levels means a weaker signal to the testes to produce testosterone. If the testicles stop testosterone production, then the concentration of testosterone in the testicles drops dramatically. This drop in testicular levels of testosterone happens even if there are good levels in the bloodstream from testosterone replacement therapy or testosterone boosters.
When the concentration of testosterone in the testicles drops, sperm production drops accordingly. Often, this drop in sperm production is dramatic, and in many cases, complete. Fortunately, for men that are not on high doses of testosterone for long periods of time, this drop in sperm production is almost always reversible with medical intervention.
TREATING LOW TESTOSTERONE WHILE PRESERVING SPERM PRODUCTION
For men who have symptoms of low testosterone, but still want to preserve sperm production, the best way to proceed is to use treatment options that preserve the production of sperm in the testes. The two primary medications that can accomplish this are clomiphene citrate and human chorionic gonadotropin (hCG). Clomiphene citrate is a tablet, usually taken every other day, that stimulates the pituitary gland to make more LH, which then signals the testicles to produce more testosterone. The increase in testosterone production can then increase sperm production. HCG, on the other hand, is an injection administered 3 times a week in the fat beneath the skin. It mimics LH directly and similarly signals the testes to make more testosterone, which in turn can induce sperm production. A third treatment option for men with symptoms of low testosterone and interest in future fertility may be Natesto, a testosterone nasal gel. Although this treatment does directly increase testosterone levels in the bloodstream, studies have shown that the short acting nature of Natesto results in less suppression of FSH and LH, resulting in preservation of some degree of sperm production. Consultation with a specialized provider is the best way to find out what treatment is best for you.
For men with low testosterone or symptoms of a low testosterone, it is crucial that they see a specialist, typically a urologist specializing in andropause and male infertility. Although low testosterone can severely impact quality of life, fertility doesn’t need to be sacrificed to feel better. With the right treatment course, testosterone levels can be increased without having a negative effect on sperm production.
If you are taking testosterone or testosterone boosters for lifestyle or symptomatic improvement, let us help. Call Maze at (646) 380-2600 to schedule an appointment, contact us for more information, or arrange a free phone consultation.