If you are taking exogenous testosterone and wish to preserve fertility, you must combine it with HCG (250-500 units twice a week) and maintain at least 95% compliance. Unopposed testosterone, especially injections, will suppress sperm production in 95% of men.
When discontinuing exogenous testosterone, never stop suddenly to avoid severe fatigue and discomfort. Instead, taper the dose over approximately six weeks (e.g., halve the dose for two weeks, then halve again for two weeks, then off for two weeks) to allow the body’s natural production to reactivate more smoothly.
To aid recovery after stopping testosterone, consider using Clomid or Enclomiphene to stimulate pituitary function, or more aggressively, HCG and Clomid, which can accelerate the return of natural testosterone and sperm production.
If you take exogenous testosterone, you are at risk for polycythemia (blood thickening). Monitor hemoglobin and hematocrit, as levels above 17 and 50 respectively, increase the risk of adverse events like blood clots.
To mitigate the risk of polycythemia from testosterone injections, consider daily microdosing (e.g., 10-15 milligrams daily) instead of less frequent, larger doses, as this avoids high peaks that stimulate red blood cell production.
Submerging the testicles in hot water significantly impairs sperm quality. Spending 20 minutes in a 104-degree hot tub three times a week can reduce sperm count to zero, primarily affecting motility. Eliminate or severely limit exposure to hot tubs and hot baths.
While less severe than hot tubs, saunas can still negatively impact sperm quality, with an effect estimated to be one-quarter to one-third as profound as hot water submersion. Consider reducing sauna time if trying to conceive.
Chronic stress significantly lowers testosterone levels and, consequently, sperm production. Engage in stress-reducing activities like running, walking, or other physical activities to decompress and support hormonal balance.
Marijuana (THC) is a ‘bad actor’ for male fertility, negatively impacting sperm count, motility, and morphology. It also has a depot effect, remaining in fat for weeks, leading to chronic low-level toxicity, and is associated with an increased risk of testicular cancer.
Alcohol is a direct toxin to the testicles, affecting sperm count, motility, and morphology. Excessive alcohol use also increases estrogenization, leading to lower testosterone. Limit intake to less than two glasses per day.
Nicotine, whether synthetic or from tobacco, is a ‘bad actor’ at high doses, negatively affecting sperm count and motility. It is believed to act as an oxidant, damaging sperm.
Obesity and a ’lousy diet’ are significant lifestyle factors that negatively impact male fertility, primarily through endocrine system disruption and other metabolic issues. Focus on improving metabolic health through diet and lifestyle.
While moderate exercise is beneficial, chronic extreme exercise (e.g., two hours daily at 80% VO2 max) can significantly reduce sperm counts and testosterone levels. Ensure exercise intensity is balanced if trying to conceive.
If struggling with infertility, ensure both partners are evaluated simultaneously. For men, a thorough workup should include a detailed history (including exposures), physical exam, at least two semen analyses, and hormone checks (LH, FSH, Testosterone, Estradiol).
Semen analysis parameters can vary by 50-100%, so never make a diagnosis or treatment decision based on a single sample. Always obtain at least two semen analyses, typically three weeks apart, for accurate assessment.
To optimize the chances of conception, engage in sexual intercourse before ovulation (e.g., days 9, 11, 13 of a cycle if ovulation is day 15). Sperm can survive for days in the female reproductive tract, while an egg is only viable for about eight hours post-ovulation.
For couples trying to conceive, having sex every other day is generally recommended as the optimal interval to ensure a fresh supply of sperm is available for ovulation.
For diagnostic semen analysis, abstain from ejaculation for two to four days. Longer abstinence may increase sperm count but decrease motility due to older sperm, while shorter abstinence may yield lower counts.
If a varicocele (varicose veins in the scrotum) is identified and is contributing to infertility, surgical repair is a common and effective treatment, with two-thirds of men improving and many conceiving naturally post-procedure.
Be wary of exposure to ‘smelly solvents,’ airport fuels, machine shop oils, and benzene derivatives, as these environmental toxins can negatively impact male fertility. Take steps to reduce or eliminate such exposures.
Infections, particularly those causing pus cells (pyospermia) in semen or the urinary tract, can be destructive to sperm and significantly lower motility. Prompt diagnosis and treatment of such infections are crucial for fertility.
If you experience pelvic numbness while cycling, invest in a better saddle. The ideal saddle should be flat or gel in the back, cut out in the middle, and designed to support the sit bones rather than putting pressure on the perineum, to prevent erection issues.
Any male undergoing chemotherapy or radiation for cancer should strongly consider banking sperm, regardless of age or perceived fertility. This is a crucial precaution as cancer treatments can severely impair or eliminate future sperm production.
While not as dramatic as female age, paternal age (especially over 40, and significantly over 60) is associated with increased risks to offspring, including miscarriages, birth defects, and neurodevelopmental issues like autism. Banking sperm at a younger age can mitigate these risks.
For sperm banking, aim for at least three ejaculates if normal, which is typically sufficient for one child using IUI. Ten ejaculates can provide enough sperm for multiple children using IUI or many IVF cycles.
Understand that male fertility is a biomarker for overall health and longevity. Men with normal semen quality tend to live longer, providing an opportunity for preventative medicine and early detection of other health issues.