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When you’re in the throes of a fertility journey, it can be easy to forget that around half of all infertility cases are due to the male, not female, partner. You may be the one undergoing ovarian stimulation, trigger shots, egg retrievals, embryo transfers – and ultimately carrying a pregnancy – for reasons that could have nothing to do with your body.
One of the reasons why you and your male partner might have difficulty conceiving is a condition called low testosterone (also known as male hypogonadism or low T), where the testicles don’t produce enough of the male sex hormone. Low T symptoms include a reduced sex drive, erectile dysfunction, loss of armpit and pubic hair, shrinking testicles, and hot flashes.
Low T can also have an impact on a couple’s attempts to conceive: “Testosterone is one of the key hormones for sperm production, and so when it is low, sperm production can be affected,” says Jessica Ryniec, M.D., a reproductive endocrinologist and infertility specialist at CCRM Fertility in Boston.
So, yes, low testosterone can indeed cause a low sperm count – which just means there are fewer sperm than normal in the semen that the penis releases during orgasm. This, in turn, can significantly affect a couple’s path to pregnancy. If your male partner has less than 15 million sperm per millimeter of semen, that is considered a low sperm count.
To learn more about low testosterone, how it affects a couple’s fertility, and potential treatment options, read on for Dr. Ryniec’s insights on how best to approach this condition.
TTC with low testosterone
A low sperm count isn’t the only fertility side effect of low T: “Low testosterone can impact fertility through low sperm count, but also through decreased libido,” says Dr. Ryniec. A reduced sex drive equals fewer instances of intercourse, and that means fewer opportunities for conception. Plus, adds Dr. Ryniec, “a lower sperm count means there’s a lower chance of the sperm making it to the egg, causing infertility.”
Here’s a quickie primer on how exactly sperm is produced, and the major role testosterone plays in its creation:
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The pituitary gland (aka the part of the brain that controls hormone release) produces follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
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LH tells the testes to make testosterone.
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Testosterone and FSH work together to produce sperm. Since a significant amount of testosterone is necessary to create sperm, having low T can result in far fewer sperm than normal. Fewer sperm = a decreased chance of conceiving.
Low T causes
There are two types of low testosterone: primary hypogonadism and secondary hypogonadism. Primary hypogonadism occurs when there’s a physical issue that doesn’t allow the testicles to make normal levels of testosterone. This can include testicular damage or removal, says Dr. Ryniec. Secondary hypogonadism occurs when there’s a dysfunction involving the pituitary gland and hypothalamus. “[These both] control hormone production,” explains Dr. Ryniec. Additional low T causes include “aging, medication, chronic or acute medical issues, increased weight, or taking exogenous testosterone.”
My male partner might have low testosterone. What should we do?
The first step is for your partner to make an appointment with his healthcare provider to confirm if he has low T. “Testosterone can be checked with bloodwork, and a semen analysis can tell you the sperm count,” says Dr. Ryniec. “These tests need to be ordered by a healthcare provider.”
If your partner is diagnosed with low testosterone, there are several treatments available. “Treatment typically depends on the cause of low testosterone,” explains Dr. Ryniec. It also depends on whether you and your partner are trying to conceive. If expanding your family is part of the plan, then you’ll likely want to see a fertility specialist about your options.
“One thing we know is to avoid giving testosterone if fertility is desired,” says Dr. Ryniec. “There are other hormone medications like Clomid or hCG that may be considered if the issue seems to be coming from the brain.” Fertility treatments such as IUI or IVF are also possibilities if low sperm count has resulted from low T.
Treatment plan options
Above all, “It’s always important to define your goals when you’re seeing your provider,” says Dr. Ryniec, reiterating that the male partner should “not take testosterone” if pregnancy is the preferred outcome.” This is because taking synthetic testosterone will not increase testosterone in the testicles, where it’s needed the most for sperm production.
If you and your partner are not trying to conceive, however, then testosterone replacement therapy may be a viable option for low T. These treatments come in various forms, including gels, injections, patches, pellets, and pills. Your healthcare provider can guide you toward an option that works for you.
While it never hurts to maintain a healthy lifestyle (exercise, eat lots of fruits and vegetables, don’t smoke, don’t do illegal drugs, limit your alcohol intake, etc.), the best course of action for treating low T and/or a low sperm count is a customized plan from your healthcare provider.
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram, BlueSky, or Threads.
