Not so common but one certainly that we all learn about in medical school called Kallmann syndrome which is we call a central defect syndrome. It is when a person has a defect of the midline of essential your body, and in the pituitary gland, they’re not secreting those hormones, especially FSH. They’re not there, and they don’t have the actual material that the tissue to secrete it. So the testicle never gets the stimulus to make testosterone or to make sperm. And in fact, those men are usually diagnosed late in adolescence when they fail to go through puberty.
So again that’s not a deal breaker.
And what about huge and hurt. So testosterone replacement which is becoming a multi-billion dollar industry and the number of men that I see on testosterone replacement, then come to me for fertility issues, keeps escalating over and over, year and year again. And it’s not going to go away. And this is coming from physicians that prescribe the testosterone replacement as actually well as of course the black market for testosterone and the anabolic steroid users.
Essentially what happens is when a man takes testosterone his body is not making, his pituitary gland goes to sleep because it’s getting the signal that is testosterone levels are so high, it doesn’t need to make testosterone anymore. So his production goes down and hands in hand with that because it suppresses that FSH as well sperm producing hormone. His sperm counts go down as well. Often to 0. So that’s a big thing to remember and a big thing to discuss with your doctor, because a lot of these testosterone preparations men look as it supplements and they may not even mention as medication.
So when you’re filling out your intake sheets, and you go to your physician, and it says medications, and you don’t put testosterone therapy. You think that is a supplement. You have to let your doctor know that you’re on some testosterone therapy. It’s going to change the diagnosis; it is going to change the workup, and ultimately it’s going to change your success for the better, because testosterone therapy, infertility is very very reversible.
So for me, I look at all those labs to get an idea of how much that testosterone replacement may be affecting his sperm counts.
What about narcotics?
I can find out by doing the appropriate blood test to see if they are on those medications, I’ll check the FSH levels, I’ll check their other pituitary hormones, and be able to determine if their narcotic use is causing their fertility issues. But essentially it works the same way. There’s nothing wrong with the testicles in this situation, the sperm factor is there, it’s just out to lunch or sitting on the couch disabled from the narcotic use.