In men, low testosterone is a potential cause of infertility. However, you may be surprised to hear that abnormally high testosterone levels can be a problem as well. In women, high testosterone levels can signal a potential fertility problem. Women can also have low testosterone levels, but this typically occurs after menopause and not as commonly during the childbearing years. What causes high or low testosterone levels in men and women? Moreover, what can be done about it, especially if you are trying to conceive? “Free” testosterone is the testosterone molecules in your blood stream that are not bound to any other biological molecule. Your “total testosterone” is the combination of free testosterone as well as testosterone molecules bound to proteins and sex hormone binding globulin (SHBG). Symptoms of low testosterone in men may include:
Free testosterone level is below 9 ng/dLTotal testosterone level is below 240 ng/dL
Decreased beard and body hair growth Decreased muscle mass Depression Difficulty with concentration Enlarged or sensitive breasts Erectile dysfunction Fatigue Hot flashes Infertility Low sex drive Reduced strength
Primary male hypogonadism is when the trouble originates in the testes. This may also be referred to as primary testicular failure or male menopause. In fact, some of the symptoms are similar to female menopause. Secondary male hypogonadism is when the trouble originates in the pituitary gland or hypothalamus. These glands in the brain produce the hormones FSH and LH, which signal the testes to produce testosterone.
Age: Once men reach age 50, testosterone levels begin a natural decline. Male fertility does decline with age, though not as drastically as it does in women. Obesity: Obesity may have an even bigger impact on testosterone levels than age. Research has found that increases in weight are directly related to lowering testosterone levels. Losing weight can bring your testosterone levels back up. Smoking: Smoking also increases your risk of male infertility. Being underweight: Abnormally low weight, malnutrition, and excessive exercise can lead to low testosterone levels and decreased fertility. Klinefelter syndrome (KS) (XXY): This is a genetic disorder where instead of having one X and one Y chromosome, the man has an additional X chromosome. It is a common cause of male infertility. Kallmann syndrome: This is a genetic condition where puberty either fails to begin or doesn’t complete. Pituitary disorders: This includes problems with how the pituitary functions. It may be the result of a pituitary tumor or brain tumor. Or, treatment of a brain tumor with radiation can cause long-term damage the pituitary. Undescended testicles: This usually resolves during early childhood. If not, though, it must be corrected. Otherwise, it can cause hormonal problems later in life. Abnormally high levels of iron: This is also known as hemochromatosis. Testicular injury: If just one testicular is injured, testosterone production may be normal. Cancer treatment: Chemotherapy and radiation therapy can temporarily cause low testosterone and impair sperm production. However, sometimes the damage is permanent. One study found that 30 percent of men experienced low testosterone levels after treatment. HIV/AIDs: the virus can interfere with how the testes, pituitary, and hypothalamus function. This, in turn, can lead to low testosterone levels. Major illness or surgery: This will usually reverse itself after recovery time. Some infections, like mumps, can cause long-term hormonal problems. Medical or recreational drug use: For example, marijuana can cause lower testosterone levels. Extremely high levels of stress: High levels of the stress hormone cortisol have been associated with lower levels of testosterone.
It may be possible in these cases to have testosterone levels return to normal levels after treatment or lifestyle change. This is not always an option, unfortunately. In these cases, your doctor may recommend one, some, or all of the following:
Testosterone supplementation: Your doctor may prescribe injectable testosterone. This in turn will hopefully boost sperm production. Testosterone supplementation may also be prescribed to improve your well-being and general health, even if it won’t solve the fertility problem. Clomid: While most frequently associated with female infertility, Clomid can also be used in men to boost testosterone levels. IVF treatment: IVF may be used together with or instead of hormonal supplementation. If there are female fertility factors involved, your doctor may also recommend trying IVF first. IVF with ICSI: With IVF-ICSI, an individual sperm directly injected into an egg. Testicular sperm extraction (TESE): If low sperm count or no sperm count is a problem, your doctor may suggest testicular sperm extraction (TESE). This involves retrieving sperm directly from the testes via a biopsy. Sperm donor: In some cases, your doctor may recommend using a sperm donor.
Possible signs and symptoms of high testosterone include:
Total testosterone level is above 950 ng/dLFree testosterone level is above 30 ng/dL
Acne Aggression Early puberty, in young men Excessive “hairiness” High blood pressure High libido High red blood cell count Increased risk-taking behaviors Infertility and decreased sperm count
Abnormally high testosterone levels can be caused by:
Tumors: Adrenal and testicular tumors may cause abnormally high testosterone. Anabolic steroid abuse: Sometimes used by athletes and bodybuilders to build more muscle mass or increase athletic performance. Some athletes take Clomid illegally to boost performance. Testosterone supplementation: Sometimes prescribed by a physician, and sometimes purchased illegally without a prescription. Testosterone gel: Coming into contact with someone who is using testosterone gel can be an issues. The gel can accidentally be rubbed off onto someone else, raising their testosterone levels unintentionally.
If it’s due to anabolic steroid use or testosterone supplementation, backing off the supplements or steroids should resolve the problem. This should be done under a doctor’s supervision. It’s surprising to many men that high testosterone can cause infertility. Some men take testosterone supplements thinking it will improve their fertility. Or, they take it hoping to improve their stamina, strength, and energy levels. Unfortunately, testosterone supplementation in men who don’t medically need it can cause infertility.
Abnormal hair growth Acne A deepening voice Anovulation An enlarged clitoris Increased muscle mass Irregular periods Male pattern balding
Possible causes of high testosterone levels in women include:
PCOS: Polycystic ovarian syndrome is a common cause of infertility in women. PCOS is also associated with obesity and insulin resistance. Congenital adrenal hyperplasia (CAH): This is a genetic condition that impairs your adrenal glands from producing essential hormones. It can cause infertility in both men and women. Some women will be diagnosed as children. Other times, it can occur later in life. This is known as late-onset or mild congenital adrenal hyperplasia (CAH). Adrenal or ovarian cancers: extremely high testosterone levels greater than 200 ng/dL may be seen in cases of cancer. Anabolic steroid use: Male athletes aren’t the only ones to abuse steroids to improve performance. Women who abuse steroids may have abnormally high levels of testosterone.
What about low testosterone in women? Women with low testosterone levels may experience:
Cognitive difficulties Depression Fatigue Low libido
Low testosterone in women is usually seen during menopause though it can occur at any age. Testosterone levels decrease along with estrogen and other reproductive hormones. Low testosterone is not usually a problem in women trying to conceive. Another possibility is the anti-androgen drug spironolactone (brand name Aldactone.) Spironolactone is not safe to take when pregnant, so it isn’t appropriate for those trying to conceive. Options for women hoping to have a baby include:
Weight loss and exercise: Losing excess weight and regular exercise, especially in women with PCOS, can help lower testosterone levels and may even restart ovulation. Metformin: Treating insulin resistance with the diabetes drug metformin may help reduce PCOS symptoms and even restart ovulation. Fertility drugs: You will likely need both lifestyle changes and fertility drugs to conceive. Clomid and letrozole are the first line fertility treatments for women with PCOS. Cosmetic treatments: For women trying to conceive, cosmetic treatments like waxing or plucking are possible solutions for unwanted hair growth.
