Low Testosterone – Trying To Initiate Pregnancy

Men with low libido, chronic fatigue are getting checked for low testosterone levels. There is no agreement what constitutes a normal testosterone level – in most reference labs values range from 300 – 1200. Men complaining of decreased libido, chronic fatigue are being treated with a variety of different testosterone preparations. What is not being made clear to these individuals is that exogenous testosterone in any form suppresses sperm production. The higher the dose and the longer the duration of administration, the greater the suppressive effect. If sufficient doses are given for long enough atrophy of the cells that make sperm occur resulting in permanent sterility.

There is an alternative option to increase testosterone levels that does not suppress sperm production – human chorionic gonadotropin (hCG). While hCG raises testosterone levels they do not reach the same levels as testosterone administration. Symptoms can usually be ameliorated until fertility concerns are not an issue. Men who do not get sufficient relief with hCG may continue testosterone and choose to cryopreserve sperm to use as backup should severe or permanent sperm suppression occur. Men with total motile sperm counts in the 5 million range are potential candidates for intrauterine insemination, below these numbers most couples will require ICSI in vitro fertilization where literally only a handful of sperm are needed.     

Kevin L. Winslow, M.D.
Director for Florida Institute for Reproductive Medicine