Will Testosterone Therapy Lower My Sperm Count? Donna Lee and Dustin Fontenot, PA-C Answer a Listener Question

Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in medical and urology care and the best urology humor out there.

In this segment,  Donna Lee and NAU Urology Specialists' Dustin Fontenot, PA-C answer a listener's question about fertility and testosterone treatment. While many assume that testosterone therapy would increase sperm production, the opposite is usually the case--the body's feedback mechanisms tend to inhibit sperm production in response to surges in testosterone. What does that means for men in their child-bearing years? Anyone beginning testosterone therapy needs baseline labs, and semen analysis should be part of that baseline if you ever plan on conceiving. There is a relationship between low testoerone (which leads people to seek hormone treatment) and low sperm count already, so taking testosterone could reduce an already low sperm count to almost zero. If you are actively seeking to get pregnant, there are ways to boost your natural sperm and testosterone production with adjunctive medications. There are also medications like Clomiphene which boost testosterone in fertility-sparing ways. While stopping testosterone treatment is often enough to bring sperm counts back up, there is always the back-up option to freeze sperm before beginning treatment. Importantly, whether you're hoping to conceive tomorrow or ten years from now, the best thing you can do is talk to your doctor about how your hormone treatment might affect your fertility and what plans you can make to preserve it.

This episode was previously aired on 1.23.21. Don’t forget to like, subscribe, and share us with a friend! As always, be well!

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Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Transcript

Welcome back to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.

Donna Lee: Welcome to the Armor Men's Health Hour. This is Donna Lee . You can reach out to us during the week at (512) 238-0762. You can send your questions to armormenshealth@gmail.com. Like I keep saying, we are an award-winning podcast. And you can also listen to our podcasts wherever you catch them for free. Today, we have Dustin Fontenot with us. Welcome back, Dustin.

Dustin Fontenot: Hi. Thanks for having us.

Donna Lee: Dustin is one of our amazing PAs. And last time I said to him, when we did a podcast, I said, "What do you want to talk about?" And he said, "Kittens." And I was like, "Sweet. Let's talk about kittens!" So we talked about my 22 pound p*ssy and that I have a really big cat. So today I thought we'd talk, he said, I texted you, "What do you want to talk about?" And you said...

Dustin Fontenot: Puppies!

Donna Lee: So of course I have something to talk about. I have too many Wiener dogs, so we can talk about my wieners.

Dustin Fontenot: OK.

Donna Lee: We have three teenage boys. We have too many Wiener dogs, and oftentimes there's, the little Wiener dogs are sitting on their laps. My son, his name is Sterling--he's going to kill me for this--but sometimes I walk in the room and he's petting the Wiener dog. And he'll tell me, "Mom, please leave me alone. I'm stroking my wiener." So there's never an end.

Dustin Fontenot: That's very awkward.

Donna Lee: It is a little awkward, but there's no end to wiener jokes in our house. And apparently cat jokes.

Dustin Fontenot: Yeah. They never get old.

Donna Lee: You have a big cat too.

Dustin Fontenot: Yeah, I do.

Donna Lee: And you got Katie...wait? Anyway, Dustin and I were going to talk to him about some real things today. Dustin, this has been kind of weighing on me. We have a lot of patients on BioTE, and that is the testosterone that you put on your backside. It's a little teeny, tiny little pellet.

Dustin Fontenot: Yes.

Donna Lee: How big is this pellet?

Dustin Fontenot: I usually tell patients it's like the size of a cooked grain of rice.

Donna Lee: Really? It's that small?

Dustin Fontenot: Yeah.

Donna Lee: Oh, well I've only been in the clinic for four years. You'd think I would know that. I had been thinking myself about doing it, but I get my testosterone injections every two weeks. So really quickly, tell us about, tell the guys out there listening what's the benefit to getting pellets versus coming in once a week or doing self-injections if they don't want to do that anymore?

Dustin Fontenot: Yeah. So the pellets sort of make the whole process really easy. They last for about six months. The big benefit is convenience, right? So instead of having to do a weekly injection or applying a cream every day, we can put the pellets in and it's kind of set it and forget it. We put them in and you don't have to worry about it for six months. The process takes all of about 10 minutes. We numb up an area in the back of your hip, a little numbing medication, make a little small incision and put the pellets in. There's no stitches or anything like that.

Donna Lee: It's that small?

Dustin Fontenot: We just put...that small. We'll put a band-aid on it, a little dressing, ice pack, and you're good to go.

Donna Lee: And so you don't feel it like when you sit down cause it's up higher on the upper side of your butt/hip?

Dustin Fontenot: That's, right? Yeah. So it's more, it's up higher, closer to your hips so that you don't actually sit on them.

Donna Lee: Gotcha. So it's a , it's a regular stream, if you will, of testosterone. It's a flow of testosterone so that you're not getting the surges, like when you get injections?

Dustin Fontenot: Right. So it's continuously released. So, whereas, you know, with the injections, you'll get sort of a high and low throughout your cycle. This allows it to have a much more steady state, which is a lot more physiologically closer to what our natural testosterone production is.

Donna Lee: Okay. Gotcha. Okay. And then, so for men, it's every six months on average?

Dustin Fontenot: Yep. And women, every three on average.

Donna Lee: And then, so all you really have to do is get blood work done before you get the next implant, if you will?

Dustin Fontenot: Correct.

Donna Lee: Okay. And that's just testosterone, getting your testosterone checked, with the labs.

Dustin Fontenot: Mhmm. And some other hormones, and we're just making sure that the dosing and things like that is correct. And the interval that your on.

Donna Lee: Perfect. Well, that sounds like a winner for our KLBJ guys out there who, who don't want to deal with the injections. Cause we sure get a lot of people in every week.

Dustin Fontenot: Yeah. It's a great option.

Donna Lee: Right. So we have a listener question I thought that would be great for you. Again, send your questions to armormenshealth@gmail.com. This particular question from a patient/listener said, "How do we know if testosterone therapy affects fertility? I'm in my mid thirties?"

Dustin Fontenot: Yeah. That's a great question. And it's a topic that comes up a lot actually with our patients in that sort of age group that are either trying to have children currently or in the near future. And so traditional testosterone therapy , with the use of exogenous testosterone or, you know, either the injections or the pellets like we were talking about, can certainly reduce current sperm counts. So it will actually lower--in some guys, not all , there's plenty of men that get pregnant all day long while they're on testosterone treatment. But...

Donna Lee: That's counterintuitive to me. You'd think, I always thought if patients were on testosterone, they have more sperm. It's not really the case.

Dustin Fontenot: Yeah. It , it has to do with a feedback mechanism in the body that kind of turns down the production of sperm. So it's a, it's a real, it's a real concern, and it's one that we talk about with every patient that comes in, you know, discussing treatment if they're still in kind of that baby-making phase. So there's ways to mitigate it. And , and we can do baseline semen analysis to kind of see where your counts are, and then periodically do semen analysis during the treatment to make sure that your counts don't drop off. There's adjunctive medications that we can use as well to help maintain that sort of natural sperm production and some of your own natural testosterone production as well. And then we have other treatment options that are not testosterone, but can help your body produce more testosterone in a fertility-sparing way.

Donna Lee: Like what? Supplements?

Dustin Fontenot: No , um, it's a medication called Clomiphene.

Donna Lee: Oh, gotcha.

Dustin Fontenot: Yeah. So it's a pill form that kind of tricks the body into making more of its own natural testosterone. But doing so, it doesn't affect the fertility. In fact, it can actually increase sperm counts.

Donna Lee: Are there any big side effects to that?

Dustin Fontenot: Not really. You know, anecdotally, the guys will tell, usually most guys don't feel as well on that medication as they do taking, you know , traditional testosterone. And whether or not that's a kind of placebo thing where they just, you know, they feel better if they're getting actual testosterone versus a medication to try to enhance their own, not their own body's testosterone.

Donna Lee: I know I like getting testosterone.

Dustin Fontenot: Most do.

Donna Lee: I have told you, I have those amazing dreams after, after my injection every other week. But so, tell me more about the fertility patients ? So the guy's in his 30 mid thirties, forties...that is a valid concern. We've never, I never really thought about that.

Dustin Fontenot: Yeah. And so, you know, it all kind of comes down to sort of what their immediate timeframe is, right? So like, are they actively trying to conceive versus you know, we have some younger guys that may not even be married, and they're like, "Well, hopefully I'll have children one day." But you know, so...

Donna Lee: On the 5/10 year plan.

Dustin Fontenot: So the approach is a little bit different. But you know, another kind of option that we can have is we'll have patients actually go in bank sperm. So you go to a sperm bank and you can freeze your sperm. And that acts as sort of like your insurance policy. It's kind of like, you know, worst case scenario when you do try to conceive, if we're unable to get counts back up, you know you have that frozen sperm that you can thaw out and use. In most cases, even guys that are on testosterone therapy for a period of time, we can get their sperm counts back or back up to normal levels just by taking them off the testosterone. And then with a couple of other medications we can use to help get those numbers back up.

Donna Lee: Gotcha . So it's sort of reversible.

Dustin Fontenot: Yeah. Most of the time it is. But again, having that, that frozen sperm kinda as a backup is never a bad idea.

Donna Lee: So interesting. Freeze some sperm. Is there a place in Austin that they have the bank?

Dustin Fontenot: Yeah.

Donna Lee: Well I guess it'd be in every city, but...

Dustin Fontenot: Every big city.

Donna Lee: I never thought about that. What else can you tell us about men who are concerned about fertility and starting testosterone?

Dustin Fontenot: Well, they definitely need to have a conversation with whatever provider they're seeing about it. The wrong thing is just to go in blind. We always recommend as well as a baseline semen analysis before they even get started, because it could be the case as to where your sperm counts were already low before you even thought about testosterone treatment. And so, you know, putting you on it could definitely drop you down to either zero or not enough to get pregnant. So having that baseline information is important. And many times , there is a relationship between low testosterone and low sperm counts, too. So, you know, if you don't do that, and then five years later, you want to get pregnant and your counts are low...well, we didn't really ever know what it was five years ago before he even started treatment. You know, so having that information right off the bat, I think is really important.

Donna Lee: Okay. That's fascinating. I never thought about that. You can get your sperm and counted at the office and I'm always fascinated about the magazines we have in the office.

Dustin Fontenot: Yeah. Yeah. So we , they actually did a study. They, they measured how long it took guys to ejaculate in the office producing a semen sample. And so they used kind of just traditional pornography and then on one side of the hallway. And then on the other side of the hallway, they did like the really bad fetish stuff. Like, like the ones you got to reach, like way back on the counter for.

Donna Lee: The ones you get arrested for.

Dustin Fontenot: Yeah. Taboo. And so, so then they found that the ones, the fetish stuff, the guys were able to produce their sample way quicker.

Donna Lee: Stop. Stop talking. For real?

Dustin Fontenot: For real.

Donna Lee: Y'all are gross!

Dustin Fontenot: So that is the reason why we have such a...

Donna Lee: We have a fetish section in our clinic. But yeah. You're just coming in with your cell phone. I'm sure you can make it happen.

Dustin Fontenot: Yeah. I mean, this is kind of before the whole cell phone days and things like that. So.

Donna Lee: Right. Interesting. Well, if you've learned anything today, I've learned that all of you guys are dirty, and just kind of weird. Well, if you want more information or want to see Dustin as a patient, you can call us at (512) 238-0762. If you're super curious, you can come check out our fetish magazine lists in the office that we should update. Our website's armormenshealth at, I'm sorry, armormenshealth.com. You can send us your questions to armormenshealth@gmail.com. And you can also check out our podcasts wherever you listen to podcasts. You can Google Dustin Fontenot, PA, extraordinaire. Thank you, Dustin.

Dustin Fontenot: You're welcome .

Dr. Mistry wants to hear from you email questions to armormenshealth@gmail.com. We'll be right back with the Armor Men's Health Hour.