Is your man too buff?

by Dr. Peter McGovern

We are experiencing an epidemic of iatrogenic male factor infertility.  “Iatrogenic” is defined as: “caused by the diagnosis or treatment of a physician”.  We are seeing large numbers of men whose wives/female partners cannot become pregnant.  The men are being treated with either androgen replacement therapy or with HCG injections for “low serum testosterone”.  Many went to a primary care provider – not an endocrinologist or male fertility specialist – with vague symptoms of lower interest in sex (libido), feeling less energy, etc.  We find almost all of them have had a serum testosterone level which was slightly low.  These levels are almost never repeated, and were usually drawn in the afternoon, when natural levels are lowest.

Of course the men feel better, and no one wants to stop taking the meds.  Who would not want to have a 16 year old’s testosterone level and libido?  You lose fat and change it into muscle with minimal effort.  You have nice strong muscles and a better physique.  But then there are the side effects: elevated lipids/cholesterol, possible polycythemia (your blood count gets so high your blood gets too thick and you can have blood clots or a stroke), mood changes or difficulty controlling your temper (ever wonder why you see 20 year old guys fighting in bars and never 60 year old guys – that is partly wisdom and partly hormone changes), benign prostatic hypertrophy or BPH (it may get very difficult to urinate), possible prostate or liver cancer, shrinking testicles and azospermia (that means no sperm in the ejaculate or “shooting blanks”).  And many doctors prescribing these androgens fail to ever check levels or look for seriously risky side effects, like very high cholesterol or a blood count (hematocrit over 45).

You see, giving a man too much testosterone suppresses sperm production, much like a birth control pill can suppress egg production in women.  Testosterone and other androgens (similar male hormones like androstenedione or DHEA) have been studied for decades as possible male contraceptive pills.  So a man taking androgens or HCG (an injection which can stimulate testosterone production to very high levels) would be similar to a woman taking birth control pills and going to a fertility specialist asking why she cannot conceive!

Even worse, since everyone feels great on these drugs, no one ever wants to stop.  I have had men tell me they are OK with their wives using a sperm donor, because they refuse to stop testosterone to allow a resumption of sperm production.  Can you imagine a woman telling her husband to use an egg donor and a gestational carrier because she felt great on birth control pills and refused to stop to allow conception?

The real problem with all this is that testosterone deficiency is a true diagnosis, albeit pretty rare.  Men who actually have it really need testosterone replacement, and in those men it may actually help restore sperm production.  So if it is prescribed unnecessarily,  testosterone will hurt male fertility, but if it is actually truly needed,  it may help.  Sounds bewildering, but it is true!

Men with true testosterone deficiency will usually have extremely low testosterone levels whenever they are drawn, and they will be persistently low over multiple repeats.

So guys, remember:

Never start a medical treatment based upon a single blood test

If a hormone deficiency is suspected, best to consult with an endocrinology specialist (or a urologist specializing in male fertility) before starting any treatment

Make sure the doctor knows you and your partner are planning a family soon

Remember, just because something makes you feel good, it may not be good for your health! (Think extra whipped cream on everything every day!)