Eli Reshef MD February 23, 2015
Several times a month, I encounter infertile couples in whom the male is on testosterone treatment by injection, pellets, or gel. Most of these males are unfamiliar with the adverse effects and side-effects of testosterone treatment. Quite frequently, the couple is infertile because of significant reduction in sperm performance directly due to testosterone treatment.
Here is how testosterone treatment harms sperm: the testicles produce two major commodities- sperm and testosterone. When testosterone is given to a male, the brain, specifically the pituitary gland that regulates testicular production of sperm and testosterone, gets a signal that there is adequate amount of testosterone. Consequently, the pituitary gland shuts down its production of hormones that stimulate testosterone and sperm production. Sperm production then shuts down and infertility due to male factor ensues. This harmful effect of testosterone on sperm production is temporary but may last 3-12 months after stopping testosterone treatment.
In this age of improved communication and the search for immediate gratification, “Low-T” commercials are abound. Symptoms of low energy and low libido, common with the rapid pace of modern life, often drive males to their doctor’s office to seek diagnosis, then treatment, of presumed low testosterone. When low blood level of testosterone is confirmed, the simple solution is testosterone treatment.
Here are some of the pros and cons of testosterone treatment:
1. “Easy fix”- rather than changing lifestyles that are harmful to testosterone production, especially obesity, taking testosterone may result in improving immediate issues (low libido, fatigue) and a false sense of well-being but harm in other areas (prostate health; cardiovascular health; fertility).
2. Reduced male fertility– many physicians prescribing testosterone do not ask beforehand about conception attempts by their male patients. Many male patients do not realize that testosterone treatment may harm male fertility, at least temporarily, and unknowingly harm the couple’s attempts to have a child.
3. Prostate health– testosterone treatment may result in prostate enlargement and possibly with small increased risk of prostate cancer. Prostate enlargement may lead to bothersome urinary symptoms and increased frequency of visits and urological procedures.
4. Cardiovascular health– especially with high doses of testosterone, there is an increase in blood clots in the lower extremities and lungs; and worsening of cholesterol levels (which may result in increase in heart attacks and strokes).
5. Cost and inconvenience: testosterone treatment is costly, and requires daily application of gel or frequent injections.
1. Improved feeling of well-being and stamina
2. Improved libido, reduced erectile dysfunction
3. Improved bone density
4. Increased muscle mass.
So what’s wrong with feeling better? Not much, unless it comes at the expense of long-term health risks! One should strongly consider weight loss and increased exercise instead of testosterone treatment- this may accomplish improvement in stamina and well-being, possibly also with increased libido and sexual performance, along with greater success in conceiving.