A lower live birth rate for couples with a male partner with low TT is a compelling finding that merits further study. To our knowledge, this is the first study evaluating the association of testosterone to reproductive outcomes. Unfortunately, studies relating these outcomes to the male partner’s endocrine status are lacking. No association was seen with sperm concentration or motility, but sperm morphology was decreased in the men with low TT. Many experts advocate that all infertile males should have endocrine testing (5–6). This inverse relationship between testosterone and BMI is well established (1), yet complex. Similarly, conception and clinical pregnancy rates were lower in women partnered with a male with low TT; however, these differences did not reach statistical significance (Table 2). The Journal of Psychosexual Health found evidence to support L-arginine as a beneficial treatment for erectile dysfunction. It also raises levels of testosterone, which increases libido and builds up muscle mass and strength. Erectile dysfunction, premature ejaculations and poor sexual performance are a pretty touchy subject for men. Research shows that combining dietary changes, exercise, stress management, and targeted supplements can increase sperm count by 50% to 100% within this timeframe. Maca root (Peruvian ginseng) has been shown to improve libido and sperm vitality, apparently working independently of hormone levels, making it a safe addition for most men. While moderate soy consumption is likely harmless for most men, those actively trying to increase sperm count may want to limit soy-based foods temporarily. Men who are considering TRT or who are already undergoing therapy should have open and honest conversations with their healthcare providers about their expectations. While some men may notice changes quickly, for others, it can take several weeks or even months to see the full effects of the therapy. Some men may see significant changes, while others may only notice minor improvements. It can include factors like sexual desire, arousal, and the emotional connection with a partner. Sexual satisfaction is a broad term that includes not just orgasm but also the overall enjoyment of sexual activity. This section will explain how TRT can influence these aspects, what changes men might experience, and how to balance expectations with realistic outcomes. If fertility is a concern, it’s essential to discuss this with your doctor before starting TRT. Managing stress and mental health conditions is important for maximizing the benefits of TRT. These mental health conditions can interfere with the effectiveness of TRT. Stress, anxiety, and depression can all reduce sexual desire and performance. Cardiovascular conditions can affect blood flow, which is crucial for achieving and maintaining an erection and for ejaculation. Diabetes can damage nerves, including those involved in ejaculation, making it harder for TRT to have a positive impact. Return after cancer treatment is less predictable. The chance depends on the cause and on whether sperm-forming cells are still present. In selected cases, a biopsy or sperm retrieval procedure checks whether sperm exist inside the testes and can also collect sperm for IVF. When azoospermia is confirmed, clinicians may order karyotype testing or Y-chromosome microdeletion testing. Low LH and FSH with low testosterone can point to a brain-signal issue. In a study of 402 men evaluated for infertility, 98.8% had at least one addressable habit (smoking, alcohol, heat exposure, obesity, or poor diet). Milk product intake was linked to better sperm concentration and motility. If you smoke and your volume is low, quitting is the most direct thing you can do. Values at or above these thresholds are considered within the range seen in fertile men, but they are not guarantees of fertility. Low testosterone (hypogonadism) can impair the glands that produce seminal fluid. This threshold comes from the World Health Organization's analysis of fertile men and represents the fifth percentile, meaning 95% of men with proven fertility produce at least this much. The result is reported alongside other parameters like sperm concentration, motility, and morphology. Physical activity is one of the most effective ways to boost male fertility. Research shows that sperm counts in Western countries have dropped by nearly 60% since the 1970s, and the decline appears to be accelerating. Managing stress through exercise or natural supplements like ashwagandha can help improve fertility. Testosterone supplements can reduce sperm count and are not recommended for men who are trying to conceive. Blood tests often include FSH, LH, and testosterone. If the first sample shows no sperm, labs may spin the sample (centrifuge) to check for rare sperm cells. The goal is to separate "no sperm made" from "sperm made but blocked." That split shapes the next step. Many men don’t realize testosterone therapy can act like birth control. The testes work best a bit cooler than core body temperature. Varicocele can also be linked with poor semen parameters in some men. This can happen with pituitary disorders, some tumors, past head injury, and some treatments that affect hormone glands.