Male factor infertility is generally under-diagnosed and treated, partly because many men avoid testing, and partly because the treatment for male infertility usually lands couples in a fertility clinic, where a test tube or a syringe eliminates most of the “problems” couples have with sperm.
Most couples undergoing fertility treatment have a simple sperm test to assess the total health and fertile potential of the male partner. Subtle hormonal imbalances are often the culprit for low sperm counts, and must be measured and addressed as part of a complete male fertility assessment.
Testing and treating male infertility serves two purposes. It can help couples achieve a natural pregnancy without resorting to IVF or other invasive (and expensive) treatment options, and also may help men live longer healthier lives, by addressing underlying hormone deficiencies that predict early disease and death. Naturopathic Doctors excel at evaluating and treating endocrine (hormone) disruptions in men, and can offer simple solutions to restore testosterone levels for better health and better fertility.
Testosterone levels are at risk of early decline, even in young men, who are slightly overweight for their height(1,2), have issues with blood sugar balance, or who are chronically stressed(3). Testosterone can be easily turned into Estrogen in fat tissue, which creates a snowball effect on male hormones, leading to reduced muscle mass, more fat gain, and infertility. Comparing testosterone and estrogen levels can predict fertility, and be a marker for overall health. If the ratio between the two numbers is less than 10, we expect men to struggle with reduced fertility(4,5).
High estrogen levels also send a mixed signal to the male brain to ‘turn off’ testosterone production (sounds backwards, but the brain knows that estrogen is made from testosterone, so with elevated estrogen, it assumes that testosterone levels must be fine and turns down production). A complete hormone panel including estrogen, testosterones (free, and total), SHBG (hormone-binding protein), insulin, cortisol, and pituitary hormones can help us differentiate between the causes of low testosterone, and encourage men to make changes to improve it(6). Interestingly taking testosterone supplementation may actually worsen fertility in some men(7), pointing to the need for a whole-body approach to restore hormone levels to enhance fertility.
Simple diet changes, specific exercise patterns and a few key nutrients can improve sperm health indirectly by improving testosterone levels. Unfortunately most men never complete a thorough case assessment or lab work to understand their hormones, and can have yearly declines in testosterone as a result. We recommend that men have a hormone panel in their 30s and 40s to better predict not only their fertility, but their overall health risks(8). Testosterone deficiency is a preventable anti-aging strategy for men that is best supported through diet and lifestyle with an experienced Naturopathic Doctor.
- Wu FCW, Tajar A, Pye SR, Silman AJ, Finn JD, O’Neill TW, et al. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab. 2008 Jul;93(7):2737–45.
- Oliveira PF, Sousa M, Silva BM, Monteiro MP, Alves MG. Obesity, energy balance and spermatogenesis. Reprod Camb Engl. 2017 Mar 10;
- Whirledge S, Cidlowski JA. Glucocorticoids, Stress, and Fertility. Minerva Endocrinol. 2010 Jun;35(2):109–25.
- PAVLOVICH CP, KING P, GOLDSTEIN M, SCHLEGEL PN. EVIDENCE OF A TREATABLE ENDOCRINOPATHY IN INFERTILE MEN. J Urol. 2001;165(3):837–41.
- Raman JD, Schlegel PN. Aromatase inhibitors for male infertility. J Urol. 2002 Feb;167(2 Pt 1):624–9.
- Esteves SC, Miyaoka R, Agarwal A. An update on the clinical assessment of the infertile male. Clinics. 2011 Apr;66(4):691–700.
- Crosnoe LE, Grober E, Ohl D, Kim ED. Exogenous testosterone: a preventable cause of male infertility. Transl Androl Urol. 2013 Jun;2(2):106–13.
- Shores MM, Smith NL, Forsberg CW, Anawalt BD, Matsumoto AM. Testosterone treatment and mortality in men with low testosterone levels. J Clin Endocrinol Metab. 2012 Jun;97(6):2050–8.