Low Sperm Count in Males: Symptoms, Causes & Treatment

One in six couples attempting to conceive a baby experience difficulties with fertility – and, in roughly half of those cases, the issues lie with the man’s sperm count/quality alone.

The clinical term for low sperm count is “oligospermia.”

Let’s explore how your hormones are likely related to low sperm count, what other factors can cause oligospermia, and how (hormone replacement therapy) HRT can help you treat it.

What is oligospermia in males?

Oligospermia means that a man’s semen contains less than optimal amounts of sperm, which are typically highly concentrated in the semen in healthy men. It’s common in men who struggle to impregnate a partner. According to the Cleveland Clinic, about 10% of all men who attempt to start a family struggle with infertility.

Oligospermia is frequently associated with irregularities in sperm morphology and sperm motility (size and shape). The good news for men is that the condition is highly treatable in most cases, depending on the root cause.

If you’ve experienced ejaculation and/or erection issues, if you’ve noticed pain or swelling in the testicle or groin area, or if you have a medical history that includes prostate/testicle health issues, it’s worth getting checked out to diagnose any potential issues with sperm count and quality and, if necessary, to receive proper treatment to restore healthy sperm counts.

What are the signs and symptoms of low sperm count?

The signs and symptoms of low sperm count in men include:

• Sexual dysfunction (often manifesting in men as erectile dysfunction, otherwise known as ED)
• Pain and/or swelling in the testicular area
• Loss of body and/or facial hair (a typical sign of hormone imbalance)

Only a doctor, using clinical tools, can diagnose low sperm count. So if you suspect you might have the condition, please consult a licensed endocrinologist (hormone doctor) for expert guidance.

What causes low sperm count?

Low sperm count may result from one of many factors, or a combination thereof. Sometimes, the cause is immediately obvious and easily identifiable. Other times, arriving at a diagnosis requires more extensive investigation.

The most frequent culprits for low sperm count in the modern world are:

• Medications. According to the Mayo Clinic, “long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal and antibiotic medications, some ulcer medications, and other medications can impair sperm production and decrease male fertility.” Talk to your doctor about any pharmaceuticals you are currently prescribed to learn how they might be negatively impacting your fertility.
• Lifestyle. Everyday practices and habits can exert a huge effect on your sperm count. The most impactful habits that hurt sperm count include unchecked stress, smoking, limited exercise, poor diet (high in processed foods and poor in essential nutrients), depression and other mental health conditions, and excessive alcohol/drug use.
• Diseases. Various infections, tumors, autoimmune conditions in which the body attacks healthy sperm, and hormone imbalances can trigger low sperm count.

How are your hormones connected to sperm count?

Because of how the human endocrine (hormone) system functions, numerous hormones work in tandem to promote normal sperm production and support healthy sperm levels. It’s best to conceptualize the process involved in sperm production as a hormonal cascade – one hormone triggers another and so on, which acts as an overall balanced system.

These are called hormonal feedback loops. At the top of the hormonal cascade is gonadotropin-releasing hormone, or GnRH, which triggers the release of luteinizing hormone and follicle-stimulating hormone.

Luteinizing hormone (LH), in turn, is responsible primarily for boosting testosterone production in the testes. Follicle-stimulating hormone (FSH) stimulates sperm production.

The testes receive these hormonal inputs and, under normal circumstances, produce enough sperm to maintain fertility.

The master hormone, though, the king of the male reproductive system, is testosterone. Testosterone is the main male sex hormone, produced mostly in the testes. Chronically low testosterone levels lead to a medical condition called hypogonadism.

In one study of the correlation between testosterone levels and fertility, researchers discovered a strong association between low T and poor sperm motility and morphology – motility and morphology, again, being the way the sperm moves and its size and shape, respectively.

How is oligospermia diagnosed?

Men with optimal sperm production produce semen that contains 15 million to greater than 200 million sperm per milliliter of semen. (The threshold was previously 20 million/mL until the World Health Organization revised the parameters.)

If you have less than 15 million sperm per milliliter, or if you produce below the threshold of 39 million sperm per ejaculation, then you may be diagnosed with oligospermia.

Men who produce no sperm at all are diagnosed with a related but separate condition called azoospermia.

Because there are multiple identified underlying factors that can affect sperm production, doctors use several diagnostic tools to determine whether a patient has oligospermia. These include:

• Hormone testing. As we will explore coming up, the hormones (especially testosterone) are intimately involved in the formation of sperm. Many patients with hormone deficiencies experience oligospermia as a secondary condition.
• Post-ejaculation urinalysis. When men suffer from retrograde ejaculation, their sperm is actually deposited in the bladder during climax rather than out through the penis. Urinalysis can detect sperm in the urine, which indicates this issue.
• Genetic tests. Alterations to the Y chromosome may contribute to low sperm counts. Genetic tests can rule this possibility in or out.
• Scrotal ultrasound. If the cause of low sperm count is a structural issue, a scrotal ultrasound can detect issues with the testicles and surrounding tissues.
• Anti-sperm antibody tests. Autoimmunity means that your body attacks its own healthy biological tissues and cells, which can affect the sperm. Antibody tests are useful for detecting these adverse immune reactions.
• Transrectal ultrasound. A small wand is inserted into the rectum for the purpose of identifying any blockages in the ejaculatory ducts and seminal vesicles around the prostate that might prevent healthy ejaculation.
• Specialized sperm function tests. These tests check for sperm function once they have left the body, to determine whether there is an issue with egg penetration and fertilization.

How is low sperm count treated?

Just as doctors have numerous diagnostic tools to determine low sperm count, they also have several treatment options afforded by modern medicine. The most common and effective oligospermia treatments include:

• Surgery. If the reason for low sperm count is a structural issue such as obstructed vas deferens, many times these can be treated with surgery. The drawback of this solution is that it is extremely expensive, invasive, and riskier than other treatment options.
• Treating infections. Pathological infection in the reproductive tracts can be effectively treated with antibiotics/antivirals.
• Assisted reproductive technology (ART). If you’ve been attempting to conceive a child with your wife and have not yet succeeded due to an issue with your sperm, ART may be used to extract and insert your sperm into the female genital tract.
• Hormone replacement therapy (HRT). If a hormone deficiency is at the root of your low sperm count, the only long-term solution to effectively restore healthy sperm levels is HRT. Relative to many other oligospermia treatments, HRT is affordable and safe with a high success rate.

How can HRT help you to treat low sperm count?

Testosterone replacement therapy (TRT) has been associated with low sperm count, but the clinical data shows that with the right complementary therapies, the potential risk of TRT’s effects on fertility can be drastically reduced. In fact, TRT can augment fertility when it’s done right.

Because low sperm count is very often caused or worsened by a hormone imbalance, restoring hormonal equilibrium and managing it is a highly effective long-term solution to oligospermia. Human growth hormone (HGH) replacement therapy has been shown to improve fertility in men when other interventions fail:

“hGH therapy significantly increased sperm concentration and total motile spermatozoa in five out of ten infertile patients who didn’t show any modification in seminal parameters to other previous treatment.”

Other hormones used in the treatment of oligospermia include: hCG, hMG, and antiestrogens (Clomiphene and Tamoxifen).
The balance between estrogen and testosterone is critical for men because an overabundance of estrogen can significantly impair testosterone’s benefits.

Aromatase inhibitors are also frequently beneficial for patients, especially men with excess body fat, because it blocks the enzyme that “converts the circulating testosterone into estrogen within fat cells. Markedly obese men may have an excessive endogenous conversion of testosterone into estrogen.”

The bottom line on sperm count and hormone health

HGH replacement therapy, TRT, and other hormonal therapies are powerful, proven tools to restore optimal sperm counts in men and reverse oligospermia.

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