What does a follicle-stimulating hormone (FSH) level of 10.8, near the upper limit of the normal range, indicate for my fertility?

FSH Level of 10.8 and Male Fertility

An FSH level of 10.8 IU/L indicates mild testicular dysfunction with likely reduced sperm production, but this does NOT mean you are infertile—most men with this FSH level still produce sperm, though potentially at lower concentrations than optimal. 1, 2

Understanding Your FSH Level

Your FSH of 10.8 sits in a concerning but not catastrophic range:

• FSH levels are negatively correlated with sperm production—higher FSH generally signals the pituitary is working harder to compensate for reduced testicular function 1, 2
• Men with FSH >7.5 IU/L have a 5-13 fold higher risk of abnormal sperm concentration compared to men with FSH <2.8 IU/L 3
• However, FSH alone cannot definitively predict fertility—up to 50% of men with non-obstructive azoospermia (complete absence of sperm) and even higher FSH levels still have retrievable sperm 1

What This Likely Means for You

Most probable scenario: You have oligospermia (reduced sperm count) rather than azoospermia (no sperm). 1, 2

The pattern suggests:

• Your testes are producing sperm but at suboptimal levels 1
• Your pituitary is compensating by releasing more FSH to stimulate the testes 2
• Natural conception remains possible, though may take longer than average 2

Critical Next Steps

1. Obtain a comprehensive semen analysis (at least 2 samples, 2-3 months apart) 1, 2

• This is the ONLY way to know your actual sperm count
• Single analyses are misleading due to natural variability 1
• Look for: concentration (normal >16 million/mL), total count (normal >39 million), motility, and morphology 2

2. Complete your hormonal evaluation 1, 2

• Measure LH and total testosterone to determine if this represents primary testicular dysfunction 1
• Check prolactin to exclude hyperprolactinemia 1
• Assess thyroid function (TSH, free T4)—thyroid disorders commonly affect reproductive hormones and are reversible 1
• Measure SHBG to calculate free testosterone, as high SHBG can reduce bioavailable testosterone 1

3. Physical examination focusing on testicular size and consistency 2

• Normal-sized testes with FSH of 10.8 suggest better prognosis than atrophic testes 1
• Testicular atrophy would indicate more severe primary testicular failure 1

4. If semen analysis shows severe oligospermia (<5 million/mL), obtain genetic testing 1, 2

• Karyotype analysis to exclude Klinefelter syndrome 1
• Y-chromosome microdeletion testing (AZFa, AZFb, AZFc regions) if count <1 million/mL 1

Potentially Reversible Causes to Address

Before assuming permanent dysfunction, investigate and correct:

• Thyroid disorders—can disrupt the hypothalamic-pituitary-gonadal axis and are fully reversible with treatment 1
• Metabolic stress and obesity (BMI >25)—weight normalization may improve hormonal parameters 1
• Environmental exposures—smoking, poor diet, toxins (lead, cadmium), occupational exposures can temporarily affect FSH 1, 2
• Medications—certain drugs can impair spermatogenesis 1

Recheck FSH, LH, testosterone, and thyroid function after 3-6 months of metabolic optimization. 1

Critical Pitfalls to Avoid

NEVER start testosterone supplementation if you desire fertility—exogenous testosterone completely suppresses FSH and LH through negative feedback, causing azoospermia that can take months to years to recover. 1, 2

Do not rely on FSH alone—men with maturation arrest can have normal FSH despite severe spermatogenic dysfunction, and conversely, some men with elevated FSH maintain adequate sperm production. 1, 2

Avoid panic based on a single FSH value—FSH levels fluctuate due to pulsatile secretion, and measurements should be repeated for confirmation. 1

Treatment Considerations If Needed

If semen analysis confirms oligospermia:

• Assisted reproductive technology (IVF/ICSI) offers the highest pregnancy rates and should be discussed early, particularly considering female partner age 1
• FSH analogue treatment may modestly improve sperm concentration in idiopathic oligospermia, though benefits are limited and FSH is not FDA-approved for this indication 1, 4
• Selective estrogen receptor modulators (SERMs) and aromatase inhibitors have limited benefits outweighed by ART advantages 1
• If non-obstructive azoospermia is confirmed, microsurgical testicular sperm extraction (micro-TESE) offers 40-50% sperm retrieval rates even with elevated FSH 1

Bottom Line

Your FSH of 10.8 suggests reduced but not absent sperm production—the vast majority of men with this level still have sperm in their ejaculate. 1, 2 The key is obtaining actual semen analysis to determine your true fertility status, completing hormonal workup to identify reversible causes, and avoiding testosterone supplementation. Natural conception remains possible, and multiple treatment options exist if needed.