Likelihood of Sperm Production with Your Hormone Profile
You are most likely to have oligospermia (reduced sperm count) rather than azoospermia (complete absence of sperm), though the iatrogenic hyperthyroidism at the time of testing may have temporarily worsened your semen parameters. 1, 2
Understanding Your Hormone Profile
Your FSH of 10.5 IU/L is only mildly elevated above the 7.6 IU/L threshold that typically distinguishes normal from impaired spermatogenesis, and this level is far below the severely elevated FSH (>20-30 IU/L) seen in complete testicular failure. 1, 3
The combination of mildly elevated FSH (10.5), normal LH (7.7), and adequate total testosterone (50 nmol/L, which is approximately 1440 ng/dL—well above normal) is the classic hormonal pattern of oligospermia, not azoospermia. 1
Key points about your hormone levels:
- Normal LH argues strongly against primary testicular failure, as men with complete testicular dysfunction typically have markedly elevated LH alongside elevated FSH 1, 4
- Your high-normal to elevated testosterone (50 nmol/L) makes complete testicular failure extremely unlikely, as primary testicular failure presents with low testosterone 1, 4
- Your elevated SHBG (80 nmol/L) may reduce bioavailable testosterone, which could contribute to some degree of impaired spermatogenesis even with high total testosterone 1
Impact of Iatrogenic Hyperthyroidism
The hyperthyroidism (TSH <0.01) at the time of testing likely worsened your semen parameters temporarily and may have artificially elevated your FSH. 2, 5
Hyperthyroidism causes specific reproductive changes:
- Higher rates of asthenozoospermia (poor motility), oligozoospermia (low count), and teratozoospermia (abnormal morphology) compared to euthyroid men 2
- Elevated SHBG and reduced free/bioavailable testosterone despite normal or high total testosterone 2, 6
- These changes are reversible with treatment of the thyroid disorder—correction of hyperthyroidism improves semen quality 5
Most Likely Scenario
Based on the hormonal pattern and the presence of untreated hyperthyroidism, you most likely have oligospermia that may improve significantly once thyroid function normalizes. 1, 2, 5
The probability breakdown:
- Oligospermia: Most likely (mildly elevated FSH with normal LH and adequate testosterone is the classic pattern) 1, 4
- Normospermia: Possible (FSH levels alone cannot definitively predict fertility status, and up to 50% of men with non-obstructive azoospermia and elevated FSH still have retrievable sperm, so the reverse is also true—some men with mildly elevated FSH have normal counts) 1, 3
- Azoospermia: Unlikely (would typically require FSH >15-20 IU/L with low testosterone and elevated LH, or complete obstruction) 1, 3, 4
Essential Next Steps
Perform at least two semen analyses separated by 2-3 months AFTER achieving euthyroid status, as single analyses during hyperthyroidism are misleading due to the temporary negative effects on spermatogenesis. 3, 2, 5
If semen analysis confirms severe oligospermia (<5 million/mL) or azoospermia after thyroid correction:
- Obtain karyotype analysis and Y-chromosome microdeletion testing (AZFa, AZFb, AZFc regions), as genetic abnormalities can occur even with this hormonal profile 3, 4
- Recheck FSH, LH, testosterone, and SHBG after 3-6 months of euthyroid status to determine your true baseline hormonal profile 1
Critical Pitfalls to Avoid
Never start exogenous testosterone therapy if you desire fertility—it will completely suppress spermatogenesis through negative feedback on the hypothalamus and pituitary, potentially causing azoospermia that can take months to years to recover. 7, 8
Do not assume FSH predicts everything—men with maturation arrest can have normal FSH despite severe spermatogenic dysfunction, and conversely, some men with elevated FSH have normal or near-normal sperm counts. 1, 3
Correct the hyperthyroidism first before making any definitive conclusions about fertility status, as thyroid dysfunction significantly affects semen parameters in a reversible manner. 2, 5