All too often we will see a man with infertility, a low testosterone, and perhaps symptoms of hypogonadism such as:
- Decreased sexual desire
- Erectile dysfunction
- Decreased energy
- Depressed mood
- Difficulty losing weight
- Difficulty focusing
Typically, he has been told that going on testosterone replacement therapy will help. It seems to make sense, right? If testosterone is a male hormone, and if a man’s testosterone is low, then wouldn’t one think that increasing a man’s testosterone with replacement therapy would help? Nope. It actually will decrease sperm production, with often to no sperm found in the ejaculate.
The pituitary gland makes LH (leutinizing hormone) and FSH (follicle stimulating hormone) which go to the testicle and stimulate it to make sperm and testosterone. There is then a negative feedback to the level of the pituitary to keep the gonadal access in check.
If you give a man testosterone – in any form – a gel, injectable, implantable, the pituitary gland doesn’t know the difference between the medication or the man’s personally produced testosterone. As a result, the pituitary glands starts to decrease its production of LH and FSH, and then turns off production of these hormones. The gland doesn’t think it needs to stimulate the testicle anymore, and therefore stops doing so. The testicle stops making its own testosterone, as well as sperm, and starts to shrink and atrophy.
Fortunately, most of the time we can reverse the damage the testosterone has done, and also effectively treat the low testosterone by use human chorionic gonadotropin injections (HCG). This medication acts like LH and stimulates the testicle to make more testosterone, and does not adversely affect sperm production.
Read more about male fertility.