Is it likely that I am still producing sperm with elevated FSH, low total testosterone, and normal LH and SHBG levels?

Likelihood of Sperm Production with Your Hormone Profile

Yes, you are very likely still producing sperm, though probably at reduced levels compared to optimal spermatogenesis. Your FSH of 10.7 IU/L is moderately elevated but falls well below the threshold that would indicate complete testicular failure, and your normal LH (7.7) with adequate total testosterone (40 nmol/L, approximately 1154 ng/dL) suggests preserved Leydig cell function, which typically correlates with at least some ongoing sperm production 1, 2.

Understanding Your Hormone Pattern

Your FSH level indicates mild testicular dysfunction but not complete spermatogenic failure:

• FSH >7.6 IU/L is associated with some degree of impaired spermatogenesis, but your level of 10.7 IU/L is only moderately elevated 1, 2
• FSH levels are negatively correlated with spermatogonia numbers—higher FSH reflects your pituitary's compensatory attempt to stimulate sperm production in response to reduced testicular efficiency 1, 2
• Critically, up to 50% of men with non-obstructive azoospermia (complete absence of sperm) and elevated FSH still have retrievable sperm, so your moderately elevated FSH does not preclude sperm production 1, 2

Your testosterone and LH levels are reassuring:

• Normal to high testosterone (40 nmol/L) with normal LH (7.7) indicates your Leydig cells are functioning adequately 3
• The presence of normal testosterone in men with FSH levels of 10-12 IU/L suggests preserved Leydig cell function, which typically correlates with at least some preserved spermatogenesis 3
• Both FSH and testosterone are required for optimal spermatogenesis—you have adequate testosterone, which is essential 4, 5

Your elevated SHBG (95) may affect interpretation:

• High SHBG binds testosterone, potentially reducing free (bioavailable) testosterone despite normal total testosterone 6
• This could contribute to your FSH elevation as the pituitary attempts to compensate 3

Essential Next Steps to Confirm Sperm Production

You must obtain a comprehensive semen analysis to determine actual sperm production:

• At least two semen analyses, collected 2-3 months apart after 2-7 days of abstinence, are required to assess sperm concentration, motility, and morphology 2, 3
• FSH levels alone cannot definitively predict fertility status—semen analysis is the only way to confirm whether you're producing sperm and in what quantity 1, 2
• Normal sperm parameters are: concentration >16 million/mL, total count >39 million per ejaculate, with normal motility and morphology 2

If semen analysis shows severe oligospermia (<5 million/mL) or azoospermia:

• Proceed with karyotype analysis and Y-chromosome microdeletion testing, as genetic abnormalities (Klinefelter syndrome, Y-chromosome microdeletions) are established causes when FSH is elevated with poor semen parameters 1, 3
• Physical examination focusing on testicular volume and consistency would provide additional diagnostic information—normal-sized testes with FSH of 10.7 suggest better prognosis than atrophic testes 2, 3

Addressing Reversible Factors

Before assuming permanent testicular dysfunction, address metabolic factors:

• High SHBG can be elevated in metabolic stress, obesity, or thyroid dysfunction—these conditions can artificially elevate FSH and should be evaluated 3
• Weight optimization and metabolic improvement can normalize gonadotropin levels in some cases 3
• Check thyroid function (TSH, free T4) as thyroid disorders commonly affect reproductive hormones 3
• Repeat hormonal testing after addressing any metabolic stressors, as FSH levels in the 9-12 IU/L range often normalize to 7-9 IU/L once reversible factors resolve 3

Critical Management Pitfalls to Avoid

Never use testosterone supplementation if fertility is a concern:

• Exogenous testosterone suppresses both LH and FSH through negative feedback on the hypothalamus and pituitary 6
• At large doses of exogenous androgens, spermatogenesis may be suppressed through feedback inhibition of pituitary FSH, potentially causing azoospermia 6
• This would worsen or eliminate your sperm production 1, 2, 3, 6

Do not assume "normal" based on laboratory reference ranges:

• Many laboratory reference ranges for FSH extend to 18 IU/L, but research shows that FSH >4.5 IU/L is associated with abnormal semen parameters in terms of morphology and sperm concentration 7
• Your FSH of 10.7 IU/L warrants investigation regardless of what the lab report calls "normal" 2, 3

Treatment Considerations If Needed

If semen analysis confirms reduced sperm production:

• For idiopathic infertility with your FSH level, FSH analogue treatment may improve sperm concentration, pregnancy rate, and live birth rate 2, 3
• Selective estrogen receptor modulators (SERMs) or aromatase inhibitors may be considered, though benefits are limited compared to assisted reproductive technology 1, 3
• Assisted reproductive technology (IVF/ICSI) offers superior pregnancy rates compared to empiric hormonal therapy 3

The bottom line: Your hormone profile suggests reduced but not absent spermatogenesis—only a semen analysis can confirm whether you're producing sperm and guide further management.