Take ownership of your overall health, as comorbid conditions like obesity, hypertension, and hyperlipidemia are linked to a decline in testicular function, including lower testosterone and sperm quality.
Maintain a healthy body weight, as there is a strong link between a man’s reproductive function and body weight, with obesity potentially contributing to declining sperm quality and testosterone.
Aim for 7 to 9 hours of sleep per night, as both too little and too much sleep can lead to lower semen quality and negatively impact broad testicular function.
Increase your daily physical activity, such as step count, as being more active is associated with higher testosterone levels and improved testicular function.
Dissolve one packet of Element (electrolytes) in 16-32 ounces of water first thing in the morning and during physical exercise to ensure proper hydration and electrolyte balance, which is critical for optimal brain and body function.
Avoid exposure to chemicals like phthalates and BPA, as preclinical studies suggest they may harm reproductive function in both men and women.
Do not smoke, as numerous studies link smoking to lower sperm quality across all measures and a longer time to achieve pregnancy.
Avoid illicit drug use, as it can negatively affect semen quality.
Limit or avoid daily cannabis use, as studies show it can lead to significantly lower sperm concentration, motility, and morphology.
Moderate alcohol intake, as very high levels (above 20 drinks a week) have shown some negative effects on semen quality, though the association is less strong than with smoking.
If you experience skin flushing when consuming alcohol, be aware that alcohol may have more harmful effects on your sperm parameters due to genetic variations in alcohol metabolism.
Avoid external heat sources to the scrotum, such as hot tubs, saunas, and potentially seat warmers, as testicles need to be cooler for optimal sperm production.
If using a hot sauna for 20 minutes or more, consider using a cold pack in the groin area to cool the scrotum and potentially mitigate negative effects on sperm production, being careful to avoid frostbite.
Place laptops on a desk rather than directly on your lap to minimize heat exposure to the testicles, as heat can negatively impact sperm production.
Limit cycling to less than five hours a week and stand up in the saddle periodically to dissipate heat, as prolonged saddle time can lower sperm counts.
If experiencing pain, numbness, or sexual dysfunction from cycling, consider changing saddles or riding style to minimize pressure on blood flow and nerve supply to the penis.
Get screened for testosterone levels and semen quality, as these are important barometers of overall health and cannot be predicted by appearance alone.
Do not assume your sperm are healthy simply because you can ejaculate; a formal test is the only way to know sperm concentration, movement, and shape, as many men have low or absent sperm without knowing.
Consider getting a sperm analysis in your 20s or 30s to establish a baseline, as more information is always good and it can serve as an early indicator of overall health.
If you are an older father (e.g., over 40) or plan to delay conception, consider freezing sperm due to potential age-related genetic and epigenetic changes that may increase risks for offspring.
Be aware that testosterone therapy can significantly lower sperm production and should be considered carefully, especially for men of reproductive age, and discuss this with your provider.
If on testosterone therapy and concerned about fertility, a low dose of HCG (500-1000 units every other day) can be used to stimulate endogenous sperm production.
Clomiphene, an off-label selective estrogen receptor modulator, can augment the body’s own testosterone production without suppressing sperm production, making it a worthwhile treatment for reproductive-age men with symptomatic low testosterone.
Follicle-stimulating hormone (FSH) can increase sperm production and is a more logical treatment than HCG for this purpose, but its high cost ($2000-$3000/month) often limits its use.
Exercise extreme caution when considering finasteride or dutasteride for hair loss, as these drugs can cause sexual dysfunction, low libido, and a potentially permanent ‘post-finasteride syndrome’ in some men, even after cessation.
Monitor estrogen levels, especially if obese, as excessive aromatization of testosterone to estrogen can lead to issues like gynecomastia.
If experiencing symptoms of low testosterone, sexual dysfunction, or very low sperm production, get prolactin levels checked, as hyperprolactinemia can be a rare but treatable cause.
If experiencing abnormal sexual function (e.g., not getting normal erections) or bothersome urinary symptoms (e.g., frequent night urination, weak stream), consult a physician for evaluation.
If experiencing erectile dysfunction, even if resolved with medication, see a primary care doctor to be screened for underlying vascular issues like high blood pressure, abnormal lipid levels, and fasting blood glucose, as ED can be an early marker for broader cardiovascular disease.
For erectile dysfunction (ED) primarily caused by blood flow issues (not hormonal), first-line treatment often involves oral PDE5 inhibitors like sildenafil (Viagra) or tadalafil (Cialis), which help 60-70% of men.
For men bothered by urinary symptoms, low-dose tadalafil (2.5-5mg daily) can help improve these symptoms and also offers the added benefit of improving erectile function.
To manage urinary symptoms related to prostate enlargement, avoid drinking a lot before bed, and be aware that spicy foods, acidic foods, caffeine, and alcohol can irritate the bladder and increase urination frequency.
If you consistently experience a split urine stream, consult a physician for evaluation, as it could signal a urethral or prostatic issue that can be improved.
If experiencing infertility, scrotal discomfort (worse at end of day or with activity), or if a varicocele is present, get evaluated as it’s a common cause of infertility and can cause progressive damage to testicular function.
If experiencing penile curvature or deformity due to Peyronie’s disease, be aware that treatments like collagenase injections, stretching devices, or surgical options are available to correct the issue.
While national guidelines discourage routine testicular self-exams due to potential anxiety, if you are concerned, perform self-exams and consult a physician if you identify any firm, painless masses or changes in testicular size.
For severe erectile dysfunction, surgical penile implants (non-inflatable or inflatable) are available options to achieve a rigid erection when desired.
Consult a pelvic floor physical therapist if you have specific needs like prostate cancer rehabilitation or if you have an overly tense pelvic floor, as Kegel exercises are not universally beneficial and can be harmful if misused.
Engage in yoga nidra or non-sleep deep rest (NSDR) sessions, even for just 10 minutes, to greatly restore levels of cognitive and physical energy.
Consult your primary care physician or a urologist to explore options for getting male reproductive health tests, such as hormone profiles and sperm analysis, covered by insurance.
Advocate for increased insurance coverage for male reproductive health testing, as men lack the automatic feedback of menstrual cycles and often need testing to identify potential issues.