Assessment of Your Hormone Profile
Your hormone levels suggest mild testicular dysfunction but do NOT indicate imminent testicular failure, and you are likely still fertile. 1
Understanding Your Specific Numbers
Your FSH of 10.5 IU/L is moderately elevated above the typical threshold of 7.6 IU/L that suggests some degree of testicular dysfunction, but this level falls well below the severely elevated range (>35 IU/L) that would indicate primary testicular failure 1. Your total testosterone of 40 nmol/L (approximately 1154 ng/dL) is actually in the high-normal to elevated range, and your LH of 7.7 IU/L is within normal limits 1.
The combination of mildly elevated FSH with normal-to-high testosterone and normal LH does NOT represent the classic pattern of testicular failure, which would show low testosterone with markedly elevated both FSH and LH 1.
Why You're Likely Still Fertile
FSH levels alone cannot definitively predict fertility status - up to 50% of men with non-obstructive azoospermia and elevated FSH still have retrievable sperm, and your FSH is only mildly elevated 1
Your elevated SHBG (90) may be artificially lowering your free testosterone, but your total testosterone remains robust, suggesting preserved Leydig cell function 1
Men with FSH levels in the 10-12 IU/L range can maintain normal fertility, as FSH shows natural variation among healthy men 2
The negative correlation between FSH and spermatogenesis is not absolute - men with maturation arrest can have normal FSH despite dysfunction, and conversely, mildly elevated FSH doesn't preclude normal sperm production 1, 3
Critical Next Steps You Must Take
Obtain a complete semen analysis immediately - this is the only way to definitively assess your actual fertility status, as hormone levels provide indirect information only 1, 2. The analysis should include:
- Sperm concentration (normal >16 million/mL) 2
- Total sperm count (normal >39 million per ejaculate) 2
- Motility and morphology assessment 2
- At least two separate analyses 2-3 months apart, as single analyses can be misleading due to natural variability 1
Evaluate for reversible causes of FSH elevation:
- Check thyroid function (TSH, free T4) - thyroid disorders commonly disrupt the hypothalamic-pituitary-gonadal axis and can elevate FSH while affecting spermatogenesis 1, 4
- Assess metabolic status - obesity (BMI >25) and metabolic stress can affect gonadotropin levels 1
- Check prolactin - hyperprolactinemia can elevate FSH 1
- Review environmental exposures - toxins like lead, cadmium, and occupational exposures (oil/gas extraction) may contribute 1
What Your SHBG of 90 Means
Your elevated SHBG is binding more of your testosterone, potentially reducing your bioavailable (free) testosterone despite the high total level 1. This can occur with:
- Thyroid dysfunction (hyperthyroidism increases SHBG) 4
- Metabolic factors
- Certain medications
Calculate your free testosterone using total testosterone, SHBG, and albumin to determine your actual bioavailable hormone level 1.
Important Caveats and Pitfalls
Never start testosterone supplementation if you desire fertility - exogenous testosterone suppresses FSH and LH through negative feedback, causing further impairment of spermatogenesis and potentially causing azoospermia 1, 3, 2
FSH can fluctuate due to pulsatile gonadotropin secretion, so repeat measurement after addressing any reversible factors (thyroid, metabolic optimization) in 3-6 months 1
Weight normalization and metabolic optimization may improve hormonal parameters in some cases 1
If Semen Analysis Shows Problems
Should your semen analysis reveal oligospermia (<15 million/mL) or azoospermia:
Genetic testing is indicated - karyotype analysis and Y-chromosome microdeletion testing (AZFa, AZFb, AZFc regions) if sperm concentration <5-10 million/mL 1, 3
Consider assisted reproductive technology (ART/IVF-ICSI) - this offers superior pregnancy rates compared to empiric hormonal therapy 1
FSH analogues have limited benefits that are outweighed by ART advantages 1, 3
Avoid supplements and antioxidants - these have questionable clinical utility in treating male infertility 3, 2
Bottom Line
Your hormone profile suggests mild testicular dysfunction, not impending failure. The preserved testosterone with only moderately elevated FSH indicates your testes are still functioning. Obtain semen analysis and evaluate for reversible causes (especially thyroid and metabolic factors) before concluding anything definitive about your fertility status 1, 2.