Navigating Male Fertility: Understanding Influences, Testosterone Replacement Therapy Considerations, and Lifestyle Optimization

Male fertility is a vital aspect of reproductive health, yet it often receives less attention than female fertility. By understanding the factors that influence sperm health and the impact of aging and modifiable lifestyle factors, men can take proactive steps to optimize their fertility.

Testosterone Replacement Therapy (TRT): An Overview

Testosterone Replacement Therapy (TRT) is a treatment aimed at supplementing testosterone levels in men with hypogonadism, a condition characterized by low testosterone (1). Steroid use often increases the likelihood of hypogonadism (2). Symptoms of low testosterone include reduced sex drive, erectile dysfunction, fatigue, and depression (1). TRT aims to restore normal testosterone levels to alleviate these symptoms and improve quality of life (1).

While TRT can effectively manage low testosterone symptoms, its impact on fertility is actually quite counterintuitive. TRT is paradoxical to fertility because it disrupts the hypothalamic-pituitary-gonadal axis by reducing the production of GnRH, FSH, and LH, which are essential for sperm production. This suppression leads to significantly lower levels of these hormones, impairing the body's ability to produce sperm (1). Testosterone has even been used as a form of male birth control (3). At Fab Fertile, we focus on identifying and addressing the reason for the low testosterone instead of immediately resorting to treatments like TRT. These treatments can have harmful side effects and often serve as a temporary solution rather than a permanent fix.

Age, Sperm Quality, and Reproductive Health

It is a common myth that men’s sperm quality remains constant throughout their lives. In reality, sperm quality declines with age, though not as dramatically as female fertility. Studies indicate that sperm motility (the ability of sperm to move efficiently) and morphology (sperm shape) deteriorate over time, affecting fertility outcomes (4). As men age, the DNA fragmentation rate in sperm increases, potentially leading to conception difficulties, higher miscarriage risks, and genetic abnormalities in offspring (4). Early miscarriages can often be linked to DNA fragmentation, highlighting a crucial factor in reproductive health. Beyond aging, modifiable lifestyle factors like environmental exposures and dietary habits are increasingly contributing to male infertility at younger ages (5).

Testing for Male Infertility

Addressing male infertility requires identifying root causes through comprehensive testing. Functional labs offer a range of tests to provide insights into various factors affecting male fertility, including:

1. Hormone Panels: Assess levels of testosterone, FSH, LH, and other hormones involved in sperm production and overall reproductive health.
2. Semen Analysis: Evaluates sperm count, motility, and morphology to determine sperm health.
3. Seminal Microbiome Test: A seminal microbiome test analyzes the microbial composition of the penis and seminal fluid to better understand its impact on individual and partner health.
4. DNA Fragmentation: Measures the level of DNA damage in sperm, which can impact fertility.
5. Nutritional Deficiencies: Identifies deficiencies in essential nutrients such as zinc, selenium, and folate that are critical for sperm health.
6. Heavy Metal Testing: Detects the presence of toxic metals like lead and mercury, which can impair sperm production and function.
7. Oxidative Stress Assessment: Measures the body's balance between free radicals and antioxidants, as oxidative stress can damage sperm cells.
8. Microbiome Analysis: Examines gut health and its impact on overall well-being and fertility.

Recommendations for Improving Male Fertility

1. Stop Harmful Habits: Stop tobacco use, reduce alcohol consumption, and consult your physician about any medications that may impact sperm health (6,7).  

1. Avoid Heat: High temperatures from prolonged laptop use and sitting can increase testicular temperature, leading to higher rates of sperm apoptosis (8). Both thermal and non-thermal effects, such as radio frequency exposure from mobile phones and laptops, have been linked to decreased sperm motility and morphology (8). Additionally, avoid the frequent use of saunas and hot baths (9).

1. Nutrition is Key: Diet significantly affects sperm quality. Reduce consumption of processed meats, soy products, and full-fat dairy, which are linked to poorer sperm health (10). Instead, focus on a diet rich in fruits, vegetables, and fish, like the Mediterranean Diet, which has been associated with improved sperm parameters and overall health (11, 12).

1. Reduce Caffeine Intake: High caffeine intake can negatively impact male sperm by reducing sperm count and motility and potentially increasing DNA fragmentation in sperm cells (8).

1. Engage in Regular Exercise: Regular physical activity not only improves your overall health but also has the potential to enhance your sperm count and motility (12). By incorporating exercise into your routine, you're taking a proactive step towards improving your fertility.

1. Avoid Toxins: Reduce exposure to environmental toxins such as pesticides, heavy metals, and endocrine disruptors like plastics and parabens (13, 14, 15, 16).

1. Stress Management: Manage chronic stress through techniques like meditation, yoga, and regular relaxation to maintain healthy hormone levels and sperm production (17).

1. Supplement Accordingly:

• Zinc: Zinc plays a crucial role in enhancing sperm health (18).
• Probiotics: Probiotics, known for promoting gut health, are also linked to enhancing sperm quality and reducing oxidative stress (19).
• Maca: This Andean root vegetable can increase sperm counts and motility (20).
• Ashwagandha: This herb is linked to hormonal balance in men, with studies showing increased DHEA-S and testosterone levels after eight weeks of use (21).

Closing Thoughts

Balancing testosterone levels and maintaining reproductive health becomes increasingly complex as men age. While the provided recommendations are general, achieving the best results in improving male fertility requires comprehensive testing to develop and implement a personalized treatment plan. By collaborating with knowledgeable healthcare providers and addressing lifestyle factors, men can optimize both their testosterone levels and reproductive health. For a deeper dive into male infertility, check out our podcast episode here.

Let’s connect and talk about how the Fab Fertile Program could help you and your partner achieve pregnancy success! Book your free 15 minute call here.

References:

1. Patel, A. S., Leong, J. Y., Ramos, L., & Ramasamy, R. (2019). Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility. The world journal of men's health, 37(1), 45–54. https://doi.org/10.5534/wjmh.180036

2. Rasmussen, J. J., Selmer, C., Østergren, P. B., Pedersen, K. B., Schou, M., Gustafsson, F., Faber, J., Juul, A., & Kistorp, C. (2016). Former Abusers of Anabolic Androgenic Steroids Exhibit Decreased Testosterone Levels and Hypogonadal Symptoms Years after Cessation: A Case-Control Study.PloS one, 11(8), e0161208. https://doi.org/10.1371/journal.pone.0161208

3. Contraceptive efficacy of testosterone-induced azoospermia in normal men. World Health Organization Task Force on methods for the regulation of male fertility. (1990).Lancet (London, England), 336(8721), 955–959. 

4. Harris, I. D., Fronczak, C., Roth, L., & Meacham, R. B. (2011). Fertility and the aging male.Reviews in urology, 13(4), e184–e190. 

5. Marić, T., Fučić, A., & Aghayanian, A. (2021). Environmental and occupational exposures associated with male infertility.Arhiv za higijenu rada i toksikologiju, 72(3), 101–113. https://doi.org/10.2478/aiht-2021-72-3510

6. Bundhun, P. K., Janoo, G., Bhurtu, A., Teeluck, A. R., Soogund, M. Z. S., Pursun, M., & Huang, F. (2019). Tobacco smoking and semen quality in infertile males: a systematic review and meta-analysis.BMC public health, 19(1), 36. https://doi.org/10.1186/s12889-018-6319-3

7. Finelli, R., Mottola, F., & Agarwal, A. (2021). Impact of Alcohol Consumption on Male Fertility Potential: A Narrative Review.International journal of environmental research and public health, 19(1), 328. https://doi.org/10.3390/ijerph19010328

8. Ilacqua, A., Izzo, G., Emerenziani, G. P., Baldari, C., & Aversa, A. (2018). Lifestyle and fertility: the influence of stress and quality of life on male fertility. Reproductive biology and endocrinology : RB&E, 16(1), 115. https://doi.org/10.1186/s12958-018-0436-9

9. Garolla, A., Torino, M., Sartini, B., Cosci, I., Patassini, C., Carraro, U., & Foresta, C. (2013). Seminal and molecular evidence that sauna exposure affects human spermatogenesis.Human reproduction (Oxford, England), 28(4), 877–885. https://doi.org/10.1093/humrep/det020

10. Pecora, G., Sciarra, F., Gangitano, E., & Venneri, M. A. (2023). How Food Choices Impact on Male Fertility.Current nutrition reports, 12(4), 864–876. https://doi.org/10.1007/s13668-023-00503-x
11. Ferramosca, A., & Zara, V. (2022). Diet and Male Fertility: The Impact of Nutrients and Antioxidants on Sperm Energetic Metabolism.International journal of molecular sciences, 23(5), 2542. https://doi.org/10.3390/ijms23052542

12. Rosety, M. Á., Díaz, A. J., Rosety, J. M., Pery, M. T., Brenes-Martín, F., Bernardi, M., García, N., Rosety-Rodríguez, M., Ordoñez, F. J., & Rosety, I. (2017). Exercise improved semen quality and reproductive hormone levels in sedentary obese adults.Nutricion hospitalaria, 34(3), 603–607. https://doi.org/10.20960/nh.549

13. Knapke, E. T., Magalhaes, D. P., Dalvie, M. A., Mandrioli, D., & Perry, M. J. (2022). Environmental and occupational pesticide exposure and human sperm parameters: A Navigation Guide review.Toxicology, 465, 153017. https://doi.org/10.1016/j.tox.2021.153017

14. He, Y., Zou, L., Luo, W., Yi, Z., Yang, P., Yu, S., Liu, N., Ji, J., Guo, Y., Liu, P., He, X., Lv, Z., & Huang, S. (2020). Heavy metal exposure, oxidative stress and semen quality: Exploring associations and mediation effects in reproductive-aged men.Chemosphere, 244, 125498. https://doi.org/10.1016/j.chemosphere.2019.125498

15. Tarapore, P., & Ouyang, B. (2021). Perfluoroalkyl Chemicals and Male Reproductive Health: Do PFOA and PFOS Increase Risk for Male Infertility?.International journal of environmental research and public health, 18(7), 3794. https://doi.org/10.3390/ijerph18073794

16. Sharma, A., Mollier, J., Brocklesby, R. W. K., Caves, C., Jayasena, C. N., & Minhas, S. (2020). Endocrine-disrupting chemicals and male reproductive health.Reproductive medicine and biology, 19(3), 243–253. https://doi.org/10.1002/rmb2.12326

17. Dhawan, V., Kumar, M., Deka, D., Malhotra, N., Dadhwal, V., Singh, N., & Dada, R. (2018). Meditation & yoga: Impact on oxidative DNA damage & dysregulated sperm transcripts in male partners of couples with recurrent pregnancy loss.The Indian journal of medical research, 148(Suppl), S134–S139. https://doi.org/10.4103/ijmr.IJMR_1988_17

18. Akbari, H., Elyasi, L., Khaleghi, A. A., & Mohammadi, M. (2023). The effect of zinc supplementation on improving sperm parameters in infertile diabetic men.Journal of obstetrics and gynaecology of India, 73(4), 316–321. https://doi.org/10.1007/s13224-023-01767-7

19. Lv, S., Huang, J., Luo, Y., Wen, Y., Chen, B., Qiu, H., Chen, H., Yue, T., He, L., Feng, B., Yu, Z., Zhao, M., Yang, Q., He, M., Xiao, W., Zou, X., Gu, C., & Lu, R. (2024). Gut microbiota is involved in male reproductive function: a review.Frontiers in microbiology, 15, 1371667. https://doi.org/10.3389/fmicb.2024.1371667

20. Lee, M. S., Lee, H. W., You, S., & Ha, K. T. (2016). The use of maca (Lepidium meyenii) to improve semen quality: A systematic review.Maturitas, 92, 64–69. https://doi.org/10.1016/j.maturitas.2016.07.013

21. Lopresti, A. L., Drummond, P. D., & Smith, S. J. (2019). A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha ( Withania somnifera) in Aging, Overweight Males.American journal of men's health, 13(2), 1557988319835985. https://doi.org/10.1177/1557988319835985