Low testosterone is a sensitive issue, especially in a patient who is hoping to start a family. Providers should understand the realities of the condition, as well as what steps a patient will need to take after diagnosis. A multidisciplinary approach to care involving collaboration between healthcare providers and fertility specialists can help ensure that patients receive the comprehensive care and support they need.
What Is Low Testosterone?
Low testosterone, also called male hypogonadism, is a condition where the testicles don’t produce sufficient quantities of the sex hormone testosterone. The condition is characterized by deficient testicular production of testosterone, with or without changes in receptor sensitivity to androgens. It may affect multiple organ systems and can result in significant health consequences and a negative impact on quality of life.
The prevalence of testosterone deficiency (TD) varies between populations and is difficult to determine in the absence of widespread, routine testing, which is currently not the standard of care. The crude Canadian prevalence of biochemical TD is estimated to be approximately 25 percent among men aged 40–62 years. The rate of TD increases with age.
Adults may seek treatment for low testosterone after experiencing symptoms, including:
- Reduced sex drive
- Erectile dysfunction
- Loss of armpit and pubic hair
- Shrinking testicles
- Hot flashes
- Decrease in energy
- Trouble with concentration
- Loss of muscle mass or muscle tone
Another significant concern for patients is difficulty conceiving a child. Individuals who have been trying to conceive may seek out medical advice about hormone levels and solutions to fertility problems.
Diagnosing Low Testosterone
When a patient arrives asking for help finding the cause of infertility, a primary care provider (PCP) can help with the initial diagnosis. It’s appropriate to conduct an exam to assess general health as well as ask questions about medical history, recent changes in health, and the patient’s reproductive history. A PCP can order blood work to check testosterone levels, luteinizing hormone (LH) blood test, and prolactin blood test to check for pituitary issues.
Discussing the Effects of Low Testosterone
Low testosterone can be an impediment to fertility, but it doesn’t mean that an individual cannot conceive children. Understanding the effects of low testosterone on fertility can help providers offer a realistic prognosis to patients with fertility concerns. Patient education can be a first step in easing fears about fertility and low testosterone.
Testosterone is only part of the complex process of creating the sperm that are crucial to conception. The pituitary gland produces follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These chemicals signal the testes to produce testosterone. A combination of testosterone and FSH leads to the production of sperm.
Low testosterone may reduce the amount of sperm produced, but it seldom leads to a total lack of viable sperm. A low sperm count, reduced sex drive, or erectile dysfunction associated with low testosterone can make conception more challenging, but there are options to help couples overcome some of these obstacles.
Causes of Low Testosterone
There are a variety of reasons for low testosterone. Congenital conditions such as Klinefelter syndrome or Noonan syndrome can cause testosterone deficiency, as can physiological issues such as undescended testicles. Low testosterone can be a side effect of cancer treatment, infection, autoimmune disease, or injury to the testicles.
The most common causes of low testosterone include:
- High blood pressure
- High cholesterol
- Use of certain medications, such as antidepressants and narcotic pain medications
Addressing Low Testosterone
Research shows that testosterone replacement therapy is not appropriate for couples trying to conceive. Supplementation will not increase the level of testosterone in the testicles. In some cases, testosterone supplements can further reduce sperm count, thus exacerbating fertility issues.
Some patients may be able to improve their testosterone levels with lifestyle changes such as:
- Managing chronic illnesses by making changes to diet and exercise
- Improving sleep hygiene
- Quitting smoking
- Avoiding illegal drugs
- Limiting alcohol consumption
Primary care providers may also be able to coordinate treatment with injections of human chorionic gonadotropin (HCG), which can increase sperm production.
Referring to Fertility Specialists
Couples dealing with emotional issues related to fertility troubles may benefit from working with a fertility specialist. They can manage the physiological issues associated with decreased fertility, and have experience helping with the psychological effects that struggling to conceive can create.
You may suggest that patients see a mental health professional as well. Both individual counselling and couples therapy can help couples communicate during tough times.
A trusted primary care provider can remain a resource to offer advice and support for patients with low testosterone, even when a patient’s medical needs are best managed elsewhere. The most important fact is to listen and show compassion to patients dealing with complicated physical and emotional challenges.
Explore our many related courses and join the MDBriefCase community to stay current on guidelines. Courses include Family Planning with Testosterone Deficiency: Understanding a Patient’s Needs and A Patient-Centric Approach to Managing Testosterone Deficiency in a Patient with Comorbidities.