If your semen analysis comes back abnormal, your TFC physician may order a test for low testosterone.
If your semen analysis comes back abnormal, your physician may ask you to obtain a blood test in order to evaluate the hormones involved in sperm production. One of these tests is a testosterone level. If your testosterone level is low, then further testing should be done to try to determine the cause. In this case, you may be referred to a urologist for a physical examination and additional blood work. A low testosterone level may be due to a problem in the brain, specifically the pituitary gland. Alternatively, a low testosterone level may be due to a problem in the testicles. Blood work will help us determine where the problem lies and also decide what treatments are most likely to produce a successful outcome.
Infertility and the pituitary gland
A low testosterone level combined with a low sperm count may be due to abnormal production of follicle stimulating hormone (FSH) and lutenizing hormone (LH). These hormones are made by the pituitary gland, a pea sized gland located behind your nose at the base of the brain. They stimulate the production of both sperm and testosterone by the testicles. Low FSH and LH levels typically lead to low sperm and testosterone production. Some men with low FSH and LH levels may be treated with medications like Clomiphene citrate (Clomid), letrozole (Femara), or human chorionic gonadotropin (hCG) to stimulate both testosterone and sperm production. Prior to starting treatment with these medications, our physicians will want to have you evaluated by a urologist to make sure that there are no other problems that would make these medications less effective or less safe.
A low testosterone level may also be due to testicular failure. This means that even though the pituitary gland is making FSH and LH to stimulate sperm and testosterone production, the testicles are not responding. Typically additional tests may be performed to evaluate why testicular failure has occurred. Options for treatment depend on the semen analysis results, but often necessitate IVF with or without ICSI.
Testosterone replacement should only be taken once conception has occurred. Long term, the testosterone level should be kept within normal levels to improve well-being, maintain a normal libido, and prevent against osteoporosis. However, testosterone treatment will usually reduce sperm counts, sometimes completely eliminating sperm from the ejaculate. Therefore testosterone replacement should be discontinued while you are trying to conceive. Once pregnancy has been achieved, then testosterone replacement can be administered.
Contact us to arrange for a new patient consultation with Dr. James or Dr. Munch. If you have been trying to get pregnant, and suspect the cause may be male infertility, Our doctors have the experience and the skill to help most men successfully overcome a diagnosis of male infertility, so they can go on to have healthy children.