Is adequate sperm production likely with elevated FSH and low total testosterone?

Likelihood of Adequate Sperm Production with Your Hormone Profile

Your hormone profile suggests moderately impaired spermatogenesis, but adequate sperm production is still likely present—though possibly at reduced levels—and a semen analysis is essential to confirm actual sperm count. 1, 2

Understanding Your Specific Numbers

Your FSH of 10.5 IU/L falls into a concerning but not catastrophic range:

• FSH >7.6 IU/L indicates some degree of testicular dysfunction, with your level of 10.5 suggesting moderate impairment of spermatogenesis 1, 2
• However, FSH levels show variable correlation with actual sperm retrieval outcomes—men with FSH in your range frequently maintain sperm production, though often at reduced concentrations 1, 3
• Research demonstrates that FSH levels >4.5 IU/L are associated with abnormal sperm concentration and morphology, with risk increasing as FSH rises, but this does not mean complete absence of sperm 4

Your testicular length of 4cm is at the lower end of normal (normal range typically 4-5cm), which combined with elevated FSH suggests some testicular dysfunction but not severe atrophy 1

Critical Context from Your Other Hormones

Your LH of 7.7 IU/L and total testosterone of 40 nmol/L (approximately 1154 ng/dL) provide important context:

• Your testosterone level is actually quite robust, which is favorable for maintaining spermatogenesis 5, 6
• The combination of moderately elevated FSH with normal-to-high testosterone suggests primary testicular dysfunction that is partial rather than complete 1
• Your very high SHBG of 90 (assuming nmol/L) may be binding much of your testosterone, potentially reducing bioavailable testosterone despite high total levels 2

What This Means for Sperm Production

The most likely scenario is oligospermia (reduced sperm count) rather than azoospermia (complete absence):

• FSH levels are negatively correlated with spermatogonia number—higher FSH generally indicates decreased sperm production, but this correlation is not absolute 1, 3
• Men with FSH in the 10-12 IU/L range commonly maintain some level of sperm production 2
• Even among men with non-obstructive azoospermia and elevated FSH, up to 50% have retrievable sperm, suggesting your chances of having at least some sperm are reasonable 1
• Research shows that FSH levels >7.5 IU/L carry 5-13 fold higher risk of abnormal semen parameters compared to FSH <2.8 IU/L, but "abnormal" includes oligospermia, not just azoospermia 4

Essential Next Steps

You must obtain a complete semen analysis to determine your actual sperm count—hormone levels alone cannot definitively predict fertility status 2, 3:

• Perform at least two semen analyses after centrifugation to confirm sperm presence and concentration 1
• If sperm concentration is <5-10 million/mL, genetic testing (karyotype and Y-chromosome microdeletion analysis) is recommended 1, 3
• Consider evaluating free or bioavailable testosterone given your very high SHBG, as this may reveal functional hypogonadism despite high total testosterone 2

Critical Pitfalls to Avoid

Never use exogenous testosterone if you desire fertility—testosterone therapy suppresses FSH and LH through negative feedback, which will further impair or completely eliminate sperm production and can cause azoospermia 7:

• The FDA label explicitly states: "At large doses of exogenous androgens, spermatogenesis may also be suppressed through feedback inhibition of pituitary follicle stimulating hormone (FSH)" 7
• This is one of the most common iatrogenic causes of male infertility in clinical practice 2

Men with maturation arrest can have normal or near-normal FSH despite severe spermatogenic dysfunction, so FSH alone is insufficient for diagnosis 1, 3

Treatment Considerations If Needed

If semen analysis confirms oligospermia or azoospermia:

• Assisted reproductive technology (IVF/ICSI) offers superior pregnancy rates compared to empirical hormonal therapy 2
• FSH analogues, selective estrogen receptor modulators (SERMs), and aromatase inhibitors have limited benefits that are outweighed by ART advantages 2, 3
• If azoospermia is confirmed, microdissection testicular sperm extraction (mTESE) retrieves sperm 1.5 times more often than conventional TESE 1