Reproduction is hormonally driven. Healthy male fertility requires a normal functioning pituitary gland and hypothalamus. To regulate reproduction, the hypothalamus signals the secretion of gonadotropin releasing hormone (GnRH). It’s this hormone that’s essential for the simulating the production of the luteinising hormone (LH) needed for testosterone production. GnRH also regulates sperm production through signalling the follicle stimulating hormone (FSH). Maintaining the correct balance between all the reproductive hormones is very important for fertility.
Types of hormonal abnormalities that affect male fertility
A severe deficiency in the production of GnRH is known as hypogonadism. This condition negatively affects sperm production and can cause male infertility. In some cases, the condition can be reversed with appropriate treatments.
There are a wide range of hypogonadism classifications, including primary and secondary forms. Primary hypogonadism is a defect inherent within the gonad. Conversely, secondary hypogonadism (also known as central hypogonadism) originates outside the gonad and is caused by pituitary or hypothalamic defects.
Examples of primary hypogonadism include Noonan syndrome, Turner syndrome, and Klinefelter syndrome. Primary hypogonadism may also develop as a result of hemochromatosis (too much iron), testicular injury, undescended testicles, or the mumps virus. An example of secondary hypogonadism is Kallmann syndrome. Other conditions may also lead to secondary hypogonadism such as HIV/AIDS, certain medications, obesity, inflammatory disease, pituitary disorders, and concurrent illness.
Hypogonadism is an uncommon condition and usually present at birth. It is generally the result of a genetic defect that compromises pituitary gland function. In some cases, hypogonadism develops later in life in response to tumours of the brain of pituitary gland. Radiation treatments may also lead to hypogonadism.
Testosterone replacement therapy (TRT) is the usual treatment for hypogonadism as a result of gonad failure1. This can help to restore sexual function, prevent bone loss, and increase muscle strength. Often men receiving TRT also report an increase in sex drive, energy, and overall sense of well-being. Secondary hypogonadism as a result of pituitary problems may be treated with pituitary hormones. This can help to improve sperm production and treat infertility.
The opposite of hypogonadism, hypergonadism refers to excessive gonad hormone production. It can lead to an abnormally high level of testosterone. This condition can also negatively impact fertility and ultimately decrease sperm production. This condition is rare and usually associated with adolescence and precocious puberty. In adult males hypergonadism may be triggered by anabolic steroid use, autoimmune disease, or tumours. These tumours can be malignant, although they are usually benign.
Surgery may be offered to remove the tumours and restore normal adrenal function. In some cases, part or all of the adrenal gland may need to be removed. If a tumour is found to be cancerous, radiation treatment may be necessary. If no tumours are detected, hormone treatment may be an option. This can be more difficult compared with hypogonadism, as it’s easier to add hormones to the body rather than remove them.
Between 10 and 40% of infertile males have elevated prolactin levels. Also known as the luteotropic hormone, one of the main roles of prolactin is to facilitate lactation in mammals. Mild elevations of prolactin do not negatively affect male fertility. However, elevated prolaction levels can reduce libido, promote erectile dysfunction, and decrease sperm production.
The treatment for hyperprolactinemia will depend on the cause. If the condition is due to a tumour medications such as cabergoline and bromocriptine are often effective2. Surgery to remove a tumour may be used in medications are ineffective3. Often as a last resort, radiation treatment may be necessary. In instances where there is no known cause for hyperprolactinemia hormone replacement therapy with synthetic thyroid hormones can help to balance prolactin levels. There are medications which can also help to restore hormone balance.
Men suffering from low levels of thyroid hormones can experience poor testicular function, low libido, and poor semen quality. Only approximately 1% of infertile men suffer from this condition. It can be caused by too much iodine in a man’s diet.
Generally hypothyroidism is easily treated with hormone replacement therapy. The medication commonly used is thyroxine4.
Congenital adrenal hyperplasia
Abnormally high levels of adrenal androgens can suppress pituitary gland function. This can cause low sperm count, decreased motility, and an increase in immature sperm cells. This is a rare condition, only affecting around 1% of infertile men. This condition may be treated with cortisone replacement therapy using medications such as hydrocortisone or dexamethasone5.
This condition is characterised by total failure of pituitary gland function. This leads to erectile dysfunction, poor sperm quality, decreased libido, lethargy, undersized testicle, and loss of secondary sex characteristics. Supplementation with human chorionic gonadotropin (hCG) and other missing pituitary hormones may help to stimulate testosterone production and improve semen parameters6.
Hormones are not only influenced by specific conditions. Lifestyle can also affect fertility by altering hormones. Stress, nutrient deficiencies, insufficient sleep, tobacco and alcohol use, inactivity; these are some factors that can impact hormone production. Unlike pre-existing hormonal abnormalities, these situations can usually be easily reversed by making positive lifestyle adjustments.
Symptoms of hormonal abnormalities
Hormonal abnormalities can present themselves in different ways. Usually it’s a combination of symptoms such as fatigue, irritability, mood swings, low sex drive, impotency, increased body fat, loss of lean muscle mass, loss of bone mass, decrease in body hair. In the case of hypergonadism, men may have excessive hair growth, high libido, severe mood swing, and acne.
Specialist can perform hormone tests to determine specific imbalances. It’s important to recognise that what’s considered the normal range for hormone levels will vary depending on the specific hormone tested and age of the patient. Blood tests are taken to measure levels of testosterone, cortisol, DHEA, progesterone, oestrogen, and thyroid hormones. Several urine tests at different time intervals may also be requested. Saliva tests can also help to determine hormone profiles. In some cases, a MRI or CT scan may be requested to determine if there are tumours affecting hormone production.
Treatment options and side effects
If a hormone abnormality is identified there may be several treatment options available depending on the specific imbalance. There has been a wide range of medications developed to help restore hormonal balance. Medications may be taken orally, injected, applied as skin patches or mouth patches, or implants. An in-depth doctor consultation will be able to assess your individual situation and advise on the best course of treatment.
Any hormone replacement therapy will present some side effects. These may include fluid retention, acne, frequent urination, and sleep apnea. It’s important to discuss your individual treatment with your doctor and the potential side effects.
In the case of tumours causing hormonal abnormalities certain medications may be available to stop growth and induce shrinkage. In some situations surgery may be an option. If a biopsy confirms that the tumour is cancerous, radiation therapy may be necessary. With any surgical procedure or cancer treatment there are risks which need to be discussed with your doctor. In some cases, it may not be possible to restore fertility.
The length of time it takes to correct hormonal abnormalities will depend on the condition. It can take several weeks to months for the body to respond. As sperm takes three months to fully mature, it may take between six and twelve months before there is a noticeable change in fertility. It’s important to discuss treatment duration with your doctor.
In some cases correcting hormonal abnormalities may not improve male fertility. In situations where radiation treatment is needed to stop cancerous tumours it can adversely affect fertility. However, generally semen parameters can be improved once hormonal abnormalities are addressed. Your doctor will be able to advise you on the success rate of your specific treatment in improving fertility.
The costs treating hormonal abnormalities will vary depending on where you live, the treatment you need, and if you select a private or public healthcare facility. In some situations partial costs may be recovered depending on health insurance and individual circumstance.
Learn more about the cost of hormone treatments in your regionFIND A CLINIC
- “Petak, S. et.al. (2002). American Assoication of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients–2002 update. Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, Volume 8, Issue 6, (pp. 440-56).” ↩
- “Verhelst, J. et.al. (1998). Cabergoline in the Treatment of Hyperprolactinemia: A Study in 455 Patients. The Journal of Clinical Endocrinology & Metabolism. Volume, 84, Issue 7, (pp. 2518-22).” ↩
- “Molitch, M. (1992). Pathologic hyperprolactinemia. Endocrinology and Metobolism Clinics of North America. Volume 21, Issue 4, (pp. 877-901)”. ↩
- “Nystrom, et.al. (2011). Treatment of Hypothyroidism. Thyroid Disease in Adults. Chapter 12 (pp. 119-126).” ↩
- “Phyllis, W. et.al. (2003). Congenital adrenal hyperplasia. The New England Journal of Medicine, Volume, 349, (pp. 117-88).” ↩
- “Liu, P. (2001). Predicting pregnancy and spermatogenesis by survival analysis during gonadotrophin treatment of gonadotrophin-deficient infertile men. Human Reproduction. Volume 17, Issue 3, (pp. 625-33).” ↩