Am I still producing sperm with elevated FSH and iatrogenic hypothyroidism?

Yes, You Are Very Likely Still Producing Sperm

Your FSH of 10.5 IU/L, while mildly elevated, does not preclude sperm production, and the iatrogenic hypothyroidism at the time of testing likely contributed to this elevation—correcting your thyroid function should improve both your FSH level and spermatogenesis. 1, 2, 3

Why Your Thyroid Status Matters Critically Here

• Primary hypothyroidism directly disrupts the hypothalamic-pituitary-gonadal axis and causes reversible hypogonadotropic hypogonadism in men 3
• Thyroid dysfunction negatively affects semen quality, with hypothyroidism having more marked effects than hyperthyroidism 2
• Treatment of thyroid disorders improves semen quality—this is reversible 2
• Men with primary hypothyroidism have subnormal LH responses to GnRH and reduced free testosterone, both of which normalize with thyroid hormone replacement 3

Understanding Your FSH Level of 10.5 IU/L

• FSH >7.6 IU/L suggests some degree of testicular dysfunction, but this threshold is lower than many realize 1, 4
• Your FSH of 10.5 IU/L falls in the "borderline elevated" range (9-12 IU/L), which often normalizes to 7-9 IU/L once reversible factors like thyroid dysfunction resolve 5
• FSH levels are negatively correlated with spermatogonia numbers—higher FSH reflects the pituitary compensating for reduced testicular function 1
• Critical point: FSH levels alone cannot definitively predict fertility status—up to 50% of men with non-obstructive azoospermia and elevated FSH still have retrievable sperm 1, 6

What the Evidence Shows About Sperm Production at Your FSH Level

• Men with FSH 10-12 IU/L typically have some degree of impaired spermatogenesis but not necessarily complete absence of sperm production 5
• Research shows FSH >4.5 IU/L is associated with abnormal semen parameters (morphology and concentration), but this doesn't mean zero sperm 7
• Even men with FSH >45 IU/L have 60% sperm retrieval rates with microdissection TESE, so your level of 10.5 IU/L is far from indicating azoospermia 6
• Some men maintain normal fertility despite FSH in the 10-12 IU/L range 1

Essential Next Steps You Must Take

Complete hormonal panel:

• Measure testosterone, LH, and prolactin alongside repeat FSH to evaluate your entire hypothalamic-pituitary-gonadal axis 4, 5
• Recheck FSH after your thyroid function is optimized—this is critical because your initial value was obtained during iatrogenic hypothyroidism 5, 2

Semen analysis:

• Obtain at least two semen analyses (2-3 months apart, after 2-7 days abstinence) to assess actual sperm production 4, 5
• This is the definitive test—FSH is only a surrogate marker 1, 4

Physical examination:

• Check testicular volume and consistency—testicular atrophy suggests more severe dysfunction 1
• Assess for varicocele, which can be corrected 4

Critical Management Pitfalls to Avoid

• Never take exogenous testosterone if you're concerned about fertility—it will suppress FSH and LH through negative feedback, potentially causing azoospermia 4, 5
• Don't assume your FSH is "normal" just because it's below some laboratory reference ranges (often 1.4-18.1 IU/L)—these ranges don't reflect fertility-specific thresholds 1, 7
• Don't make definitive conclusions about fertility based on a single FSH value obtained during thyroid dysfunction 5, 2

Prognosis and Realistic Expectations

• The presence of iatrogenic hypothyroidism at the time of FSH testing strongly suggests your FSH will improve with thyroid correction 2, 3
• Men with borderline FSH (9-12 IU/L) should undergo repeat testing after addressing metabolic stressors, as levels often normalize 5
• If genetic testing becomes necessary (only if semen analysis shows severe oligospermia <5 million/mL or azoospermia), karyotype and Y-chromosome microdeletion testing would guide prognosis 4, 5