High FSH Levels in Celiac Disease and Sperm Count
High FSH levels in individuals with celiac disease can be associated with low sperm count and other sperm abnormalities, particularly affecting sperm chromatin integrity and DNA fragmentation. 1
Relationship Between FSH and Sperm Parameters
- FSH is a key hormone in the regulation of spermatogenesis, with elevated levels often indicating testicular dysfunction
- According to the American Urological Association, high FSH levels with low testosterone strongly suggest impaired testicular function 2
- FSH levels >4.5 IU/L have been associated with abnormal semen analysis in terms of morphology and sperm concentration 3
- Men with FSH levels >7.5 IU/L have a five- to thirteen-fold higher risk of abnormal semen quality compared to men with FSH levels <2.8 IU/L 3
Celiac Disease Impact on Male Fertility
- Celiac disease affects sperm chromatin maturation and DNA fragmentation, even when basic semen parameters may appear normal 1
- Research shows that men with celiac disease have:
- Significantly higher sperm chromatin maturation issues (persistence histones and protamine deficiency)
- Higher sperm DNA damage
- Lower percentage of sperm viability compared to fertile individuals 1
- Earlier studies have demonstrated marked abnormalities in sperm morphology and motility in men with celiac disease 4
Hormonal Patterns in Celiac Disease
- Men with untreated celiac disease may exhibit a pattern of hormonal abnormalities indicative of androgen resistance:
- Increased plasma testosterone
- Reduced dihydrotestosterone (testosterone's potent peripheral metabolite)
- Raised serum luteinizing hormone 5
- This pattern of hormonal disturbance appears relatively specific to celiac disease and tends to normalize as intestinal mucosa heals with gluten withdrawal 5
Evaluation of Male Infertility
- According to the AUA/ASRM guidelines, semen analysis is the cornerstone of male fertility evaluation 6
- Normal sperm concentration is defined as ≥16 million/mL (WHO reference limits) 6
- Oligospermia refers to sperm concentrations below this threshold
- Severely oligospermic is typically defined as sperm concentrations ≤5 million/mL 2
Management Considerations
- Gluten withdrawal appears to improve some aspects of sperm quality in men with celiac disease, particularly sperm morphology 4
- Hormonal evaluation should include:
- Total testosterone levels
- FSH and LH levels
- Consider prolactin measurement if decreased libido or erectile dysfunction is present 2
- Genetic testing should be considered if sperm concentration is <5 million/mL 2
Important Caveats
- Not all men with elevated FSH will have complete absence of sperm; some may still have retrievable sperm via surgical methods 2
- The relationship between FSH levels and sperm parameters is not always linear, and individual variations exist
- The traditional "normal" range for FSH (often cited as up to 18 IU/L) may be too broad; values >4.5 IU/L have been associated with abnormal semen parameters 3
- While celiac disease can affect sperm quality, not all men with celiac disease will experience infertility
For men with celiac disease experiencing fertility issues, strict adherence to a gluten-free diet is essential, along with comprehensive hormonal evaluation and semen analysis to guide appropriate management strategies.