With an elevated Follicle-Stimulating Hormone (FSH) level of 10.4, normal Luteinizing Hormone (LH) and total testosterone levels, and Sex Hormone-Binding Globulin (SHBG) level, am I likely to have a low sperm count or azoospermia?

Interpretation of Your Hormone Profile and Sperm Count Likelihood

With an FSH of 10.4 IU/L, normal LH of 7.7 IU/L, adequate total testosterone of 35 nmol/L, and elevated SHBG of 92 nmol/L, you most likely have oligospermia (low sperm count) rather than azoospermia (complete absence of sperm). 1

Understanding Your FSH Level

Your FSH of 10.4 IU/L falls into the "borderline elevated" range that indicates some degree of testicular dysfunction, but this does NOT mean complete testicular failure: 1

• FSH >7.6 IU/L is associated with impaired spermatogenesis, but men in the 10-12 IU/L range typically maintain some sperm production rather than complete azoospermia 1, 2
• FSH levels are negatively correlated with spermatogonia numbers - higher FSH reflects the pituitary compensating for reduced testicular function 1, 3
• Research shows 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, but this indicates reduced counts, not necessarily zero 4

Why Oligospermia is More Likely Than Azoospermia

Several factors in your hormone profile argue against complete testicular failure:

• Your LH is normal at 7.7 IU/L - this argues against primary testicular failure, which would typically show both FSH and LH markedly elevated 1
• Your testosterone is adequate at 35 nmol/L - the presence of normal/high testosterone with only mildly elevated FSH suggests Leydig cells are functioning adequately, which typically correlates with at least some preserved spermatogenesis 1
• This hormone pattern (mildly elevated FSH with normal LH and adequate testosterone) is the classic presentation of oligospermia, not azoospermia 2

The SHBG Factor

Your elevated SHBG of 92 nmol/L deserves attention:

• High SHBG reduces bioavailable testosterone, which could contribute to impaired spermatogenesis even though your total testosterone appears adequate 2
• SHBG elevation can be caused by hyperthyroidism, liver disease, or certain medications - these reversible causes should be evaluated 2
• However, intratesticular testosterone (which drives spermatogenesis) is maintained by LH stimulation and is independent of SHBG levels - since your LH is normal, this provides some reassurance 2

Critical Next Steps You Must Take

Do NOT make any treatment decisions until you obtain:

1. At least two semen analyses separated by 2-3 months (after 2-7 days abstinence) - this is the only way to know your actual sperm count 1, 3
2. Thyroid function tests (TSH, free T4) - thyroid dysfunction commonly affects reproductive hormones and is reversible 1
3. Prolactin level - to exclude hyperprolactinemia which can disrupt gonadotropin secretion 1
4. Calculate free testosterone using your total testosterone and SHBG to determine bioavailable testosterone 2

If Semen Analysis Shows Severe Oligospermia or Azoospermia

Genetic testing becomes mandatory: 1, 2, 3

• Karyotype analysis to exclude Klinefelter syndrome and other chromosomal abnormalities
• Y-chromosome microdeletion testing (AZFa, AZFb, AZFc regions) if sperm concentration is <5 million/mL

Treatment Considerations Based on Likely Oligospermia

If you desire fertility, absolutely avoid these critical mistakes:

• NEVER take exogenous testosterone - it will completely suppress spermatogenesis through negative feedback, potentially causing azoospermia that takes months to years to recover 1, 2, 3
• Address reversible factors first - optimize weight if BMI >25, correct thyroid dysfunction if present, and address metabolic stressors 1

Potential treatment options if oligospermia is confirmed:

• FSH analogue treatment may improve sperm concentration in idiopathic infertility, though benefits are modest and FSH is not FDA-approved for this indication 1, 3
• Selective estrogen receptor modulators (SERMs) or aromatase inhibitors have been used off-label with limited benefits 1, 3
• Assisted reproductive technology (IVF/ICSI) offers superior pregnancy rates compared to empiric hormonal therapy and should be discussed early 1, 2

Important Caveats About FSH Prediction

FSH levels alone cannot definitively predict fertility status: 1, 2, 3

• Up to 50% of men with non-obstructive azoospermia and elevated FSH still have retrievable sperm with testicular sperm extraction 1, 2
• Some men with maturation arrest can have normal FSH despite severe spermatogenic dysfunction 1, 3
• Only semen analysis can determine your actual reproductive function - hormone levels provide clues but not definitive answers 3

Most Likely Scenario

Based on your specific hormone profile (FSH 10.4, normal LH 7.7, adequate testosterone 35 nmol/L), the most probable outcome is oligospermia with sperm concentration in the 1-15 million/mL range, rather than complete azoospermia. 2 However, this remains a prediction until confirmed by semen analysis.