When seeing a new infertile couple, semen analysis is one of the first tests we request. For the last few years, I have found an amazing number of male patients with azoospermia (lack of sperm) and abnormal sperm concentration and/or motility due to the effect of treatments with testosterone or anabolic steroid agents.
There is an overwhelming amount of information available to the public that can be difficult to understand. Many men who suffer from stress, chronic fatigue or who want to improve their sexual or athletic functions are looking for an easy and fast fix.
The societal influence
- We are bombarded by “Low T” television and magazine advertisements with the inevitable advice “Ask your Doctor” prior to use. Primary care physicians are often prompted to prescribe the advertised drug and, unfortunately, some physicians give in.
- Many men will try to treat themselves, using whatever remedy they may believe will benefit them most. Whether they receive advice from family or friends, or scout the web for the most recent supplement or trend, they may begin their own treatment without consulting a physician or fulling understanding the impact.
- Athletes interested in enhancing their performance are more likely to succumb to the temptation of using anabolic steroids. According to a recent poll, there are more than 1 million current or former steroid users in the United States. Androgens are often taken in high doses, up to 100 times the dose used in replacement therapy.
The indirect effect is a significant decrease in sperm production
For men who use testosterone, either illicitly or with a prescription given to them by a doctor, the body is fooled in thinking that it is producing enough testosterone, and in turn starts making less of its own. However, the body needs its own testosterone to produce sperm. It cannot use an artificial source of testosterone given by an external source for that production.
Unfortunately, this side effect is not commonly recognized by physicians or even by some urologists. Additional adverse side effects include decreased testicular size, breast enlargement, acne, oily skin, increase in red cell count, aggressiveness and “roid” rage.
It is a simple concept, yet one that needs more awareness from couples in the reproductive age trying to reach conception. Fortunately, stopping the testosterone or the steroids will allow the body to resume sperm production over a period of months. But it may require a significant sacrifice for the men who have, by then, acquired an addiction to the hormone and have to go without “cold turkey.”