Condition & Treatments
/ Hormone problems
Hormone problems: one of the most treatable causes of male infertility
Sperm production is controlled by hormones from the brain (FSH and LH), which tell the testes to make sperm and testosterone. When these signals are low, or other hormones such as prolactin are out of balance, sperm production falls. Many hormone problems can be corrected with medication.
I N S H O R T
Low FSH and LH (hypogonadotropic hypogonadism) is rare but very treatable, often restoring sperm production.
High prolactin, often from a small benign pituitary growth, is usually controlled with tablets.
Low testosterone should never be treated with testosterone alone if you want children, as it switches sperm production off.
Common hormone problems
Low FSH and LH (hypogonadotropic hypogonadism).
The brain doesn't send enough signal. Causes include Kallmann syndrome, pituitary problems, past steroid use and severe weight loss or stress.
High prolactin (hyperprolactinaemia).
Lowers testosterone and libido, often from a small benign pituitary growth (prolactinoma).
Low testosterone (hypogonadism).
Can come from the testes or the brain, and is common with excess weight and diabetes.
High oestradiol.
Often linked to excess weight, it can suppress the brain's signals.
Thyroid problems.
Both under- and over-active thyroid can affect sperm.
Tests
Hormone profile:
FSH, LH, testosterone, oestradiol, prolactin and thyroid function, ideally in the morning.
Semen analysis
Pituitary MRI,
if prolactin is high or signals are unexpectedly low.
Scrotal ultrasound,
to check the testes.
Treatment options
hCG and FSH injections, which replace the brain's signals and can start sperm production in men with low FSH and LH.
Tablets that restore the signals, such as clomiphene, or tablets that lower oestradiol, in selected men.
Tablets to lower prolactin, such as cabergoline
Treating thyroid or weight problems, which often helps hormones recover.
Why this matters to your care
Hormone problems are often missed, or treated with testosterone, which makes fertility worse. Prof Raheem tailors hormone treatment to restore sperm production while keeping you well. He has also advised on the European filing of enclomiphene, a treatment that raises testosterone while protecting fertility.