The Politics Of “Fertility Fog” Ctd

Andrew Sullivan —  Jan 20 2015 @ 4:52pm

A reader summarizes his email upfront:

Testosterone doesn’t boost sperm count like your one reader hinted.  It’s quite the opposite  (see here). At the very least, please clear that issue up so others aren’t misled.

Also, below is my story of how testosterone replacement made me sterile and almost left my wife and me needlessly childless.  It’s a story worth sharing so others aren’t disappointed when they decide to have kids.  Testosterone is given way too freely without mention of the fertility side effects and without dealing with underlying conditions.

I have read with interest your posts on fertility, especially the recent comments from men.  Regarding the 42-year-old fellow with low sperm count, he noted the issues of stress and other factors that impacted sperm quality – this is all very true.  He also mentioned that the doc said “to keep trying and come back in 8 months…If we weren’t pregnant, he’d give me a shot of testosterone to boost my system as another step in fixing my sperm count issues. “  Testosterone does NOT boost sperm count – it can actually reduce it.  In fact, testosterone is a prime candidate for what some hope will be the first male-oriented hormonal contraceptive. He’s probably thinking HCG or human chorionic gonadotropin, which is used to boost male fertility.  Why do I know this?  I was given testosterone but never told the impact it could have on fertility – until it was almost too late.

About 5 years ago I presented to my doctor with erection and low energy problems.  He tested and found I had low testosterone and prescribed testosterone gel, which I used for a few years.  After grad school and at the ripe old age of 40, we decided it was time.  After a few months of trying I tested my sperm with a home test kit.  It’s pretty cool; it comes with a microscope, slides, and everything else you need to do a basic test.

There was nothing moving on the slide.  A visit to a fertility clinic confirmed that I was 100% sterile.  It was then that I did some research and discovered that a side effect of testosterone replacement is infertility.  An endocrinologist switched me to HCG, which has the dual benefit of boosting testosterone AND sperm production.  Today I am 43 and have a 12-week-old daughter at home.

Turns out doctors prescribe testosterone all the time without considering the root cause and without explaining the fertility impact.  In my case, I actually had sleep apnea that was only discovered after yet another endocrinologist insisted I check it to rule it out before continuing HCG after my wife got pregnant.  I’m fit and otherwise healthy – sub 1:50 half marathoner – and yet I still have sleep apnea.

Bottom line, if a man wants to get his significant other pregnant, stay away from testosterone.  And if a doctor suggests testosterone, insist on a full workup to rule out apnea, pituitary problems, and other issues before taking the stuff.  You might find yourself infertile otherwise and, perhaps, overlooking a more serious medical condition.