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Expert Guide to Male Fertility and Hormonal Health

What You Should Know About Male Fertility

The male role in conception fundamentally revolves around producing a single healthy sperm capable of reaching the female egg. Achieving this seemingly simple goal involves numerous intricate steps in the production and maturation of sperm. Any disruption in these steps can lead to male factor infertility.

According to the National Institute for Health and Care Excellence (NICE), about 1 in 7 heterosexual couples in the UK face infertility issues. In approximately 30% of these cases, the cause is related to male infertility, while around 40% involve both male and female factors.

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The Role of Hormones in Male Fertility

Hormones are crucial messengers that coordinate various biological processes throughout the body. In terms of male fertility, three main hormones are pivotal: Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH), and Testosterone.

Follicle Stimulating Hormone (FSH)

Produced by the pituitary gland in the brain, FSH plays a vital role in promoting sperm production. Low levels of FSH can lead to a reduced sperm count, often due to damage to the pituitary gland caused by trauma, tumours, congenital issues, or treatments like radiotherapy. Certain medications, including testosterone replacement therapy, can also lower FSH levels by suppressing the body’s natural production.

Luteinising Hormone (LH)

Also produced by the pituitary gland, LH stimulates testosterone production. Consequently, low LH levels lead to reduced testosterone. As with FSH, low LH typically results from pituitary gland problems.


Testosterone is essential for sperm maturation and male sexual function. Low testosterone levels can result in a lower quantity of healthy sperm, decreased libido, and erectile dysfunction. Testosterone is produced in the testicles, and damage to these organs from injury, surgery, or infections can impair testosterone production. Conditions like mumps (leading to orchitis) and sexually transmitted infections such as gonorrhoea can also affect sperm production.

Man having blood taken

Medications and Medical Conditions Affecting Fertility

Certain medications, including antidepressants, antipsychotics, and opiates, can reduce testosterone levels. Treatments for prostate cancer and chemotherapy can also impact male fertility. 

Lifestyle factors such as obesity, lack of exercise, and alcohol consumption can further lower testosterone levels. Prolonged sitting, tight clothing, and conditions like varicocele can overheat the testicles, reducing sperm count.

Medical conditions like haemochromatosis and Klinefelters syndrome can impair testosterone production. Haemochromatosis leads to excess iron storage, damaging the testicles and pituitary gland, while Klinefelter’s syndrome is a chromosomal abnormality causing underproduction of testosterone.

The Role of Other Hormones

Beyond FSH, LH, and testosterone, other hormones also influence male fertility:

  • Oestrogen: Although primarily a female hormone, men produce small amounts of oestrogen, which plays a role in erectile function, libido maintenance, and sperm development. High levels of oestrogen, often due to obesity, alcohol consumption, certain medications, or adrenal/testicular tumours, can contribute to male infertility.

  • Thyroid Hormones: Both hyperthyroidism and hypothyroidism can reduce fertility.

  • Prolactin: Elevated prolactin levels, due to pituitary tumours, kidney disease, hypothyroidism, or certain medications, can impact male fertility.
Male hormone blood tests

Hormonal Testing for Male Fertility

Testing hormone levels is straightforward and typically involves blood tests. These tests provide insights into potential causes of male infertility, erectile dysfunction, or low libido, enabling targeted treatments. Ideally, blood samples for testosterone testing should be taken between 8 am and 10 am when levels are highest to avoid misleading results. Abnormal hormone levels usually necessitate confirmatory follow-up tests.

It is important to interpret hormone levels in the wider context of any symptoms you are experiencing, other health issues, and lifestyle. As discussed above, several lifestyle factors will impact hormone levels and, whatever other causes of hormonal abnormalities are looked for, it is always worth addressing lifestyle factors to give you the best chance for optimum fertility.

The other key test that these hormone levels should be interpreted alongside is the semen analysis. This assesses the number, health, and quality of the sperm that men produce and a healthy semen analysis is the end product of everything discussed above working as it should.

Comprehensive Approaches to Enhancing Male Fertility

The journey to conception can be stressful, and understanding the factors influencing male fertility is crucial. Blood tests for hormone levels and other health assessments are vital in diagnosing and addressing infertility. By combining hormonal testing with lifestyle modifications and semen analysis, men can improve their chances of achieving successful conception.

Frequently Asked Questions

How do I know if I’m fertile?

Knowing that you’re fertile either comes from the result of a successful conception or undertaking a semen analysis demonstrating that you are producing normal numbers of healthy sperm.

What is a low sperm count?

The normal range for the sperm count is between 15 and 200 million sperm per mL of semen. A number lower than 15 million would be defined as a low sperm count but it is worth remembering that only one sperm needs to reach the egg for conception. A low sperm count does not necessarily mean that you can’t conceive naturally.

What are the signs of low sperm count?

There are usually no outward signs of a low sperm count. Difficulty conceiving may suggest there is a problem which is confirmed by undertaking a semen analysis.

Can you increase male fertility?

The main way to increase your fertility is by making healthy lifestyle choices. Alcohol, smoking, illicit drugs such as cocaine and marijuana, and being overweight all reduce your fertile potential. There is some evidence that sperm production is inhibited when the testicles are too hot, for example, if clothing is too tight or you regularly sit for prolonged periods.

What age are men the most fertile?

Men are at their most fertile in their late 20s. After the age of 30 sperm quality begins to decline and, as men age, testosterone levels gradually fall which impacts sexual function and sperm production.

What decreases male fertility?

Many factors might decrease male fertility including medical problems (such as infections or previous operations to the testicles), environmental factors (such as exposure to radiation or certain industrial chemicals), and lifestyle factors (such as smoking, alcohol, overweight or obesity, and the use of illicit drugs).

What are the signs of poor fertility in men?

The sign of poor fertility in men is simply difficulty conceiving.

Are there any fertility treatments for men?

Treatment for male infertility varies depending on the cause. Surgical procedures, like treating a varicocele, and hormonal treatments can be effective. Lifestyle changes, such as reducing alcohol consumption, quitting smoking, and losing weight, often improve fertility.

In some cases, intracytoplasmic sperm injection (ICSI) may be used. This involves selecting and injecting a single sperm directly into the egg, which is beneficial for very low sperm counts, high levels of abnormal sperm, or when sperm must be harvested directly from the testis or epididymis due to previous vasectomy or structural issues.

What vitamins increase fertility?

There are many vitamins marketed as being helpful for male fertility but the evidence supporting these claims is variable. In many cases, there is no published evidence to support their use. A large review of previous studies found some evidence to support the use of vitamin C, vitamin E, CoQ10, L-carnitine and zinc. Nevertheless, a healthy diet that includes a wide range of micronutrients is a sensible part of any plan to improve fertility. 

How can I check how fertile I am?

The only way to check this is with a semen analysis.

How do male hormones affect fertility?

The hypothalamus in the brain produces Gonadotrophin Releasing Hormone (GnRH) which stimulates the pituitary gland to produce Luteinising Hormone (LH) which stimulates testosterone production (primarily in the testicles) and Follicle Stimulating Hormone (FSH) which stimulates sperm production. A problem at any step in this chain can affect fertility.

How does my fertility affect my partner?

Trying to conceive can be very stressful and sometimes male factor infertility causes strain to both people in the relationship.

How does age affect my fertility?

Male fertility usually peaks between the ages of 25-29. After the age of 30 sperm quality starts to decline. As men age, testosterone levels also gradually fall which impacts sexual function and sperm production.

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