Can low progesterone levels in men be treated?

Treatment of Low Progesterone in Men

Low progesterone levels in men are not routinely treated, as progesterone plays a minimal clinical role in male physiology and there are no established guidelines or FDA-approved therapies for this indication. The available evidence focuses overwhelmingly on testosterone management in men, not progesterone replacement.

Why Progesterone Treatment Is Not Standard in Men

Physiological Context

• Men naturally produce progesterone in small amounts from the adrenal cortex and testes, with serum levels similar to women during the follicular phase 1
• Progesterone in men influences spermatogenesis, sperm capacitation, and testosterone biosynthesis in Leydig cells, but these effects are mediated through complex non-genomic pathways 1
• No age-dependent changes in serum progesterone have been demonstrated in men, unlike testosterone 1

Lack of Clinical Guidelines

The most recent and comprehensive male reproductive health guidelines (2021 AUA/ASRM and 2025 EAU) make no mention of progesterone deficiency or replacement therapy in men 2. These guidelines extensively address:

• Testosterone deficiency and replacement 2
• Gonadotropin therapy for hypogonadotropic hypogonadism 2
• Selective estrogen receptor modulators (SERMs) and aromatase inhibitors for fertility 2

None of these authoritative sources recommend progesterone measurement or treatment in men.

When to Consider Hormonal Intervention in Men

Focus on Testosterone, Not Progesterone

If a man presents with symptoms potentially attributed to "low progesterone," the appropriate workup targets testosterone deficiency 2:

Diagnostic Algorithm:

• Measure morning (8-10 AM) total testosterone on two separate occasions 2
• If low, measure free testosterone by equilibrium dialysis and sex hormone-binding globulin 2
• Measure LH and FSH to distinguish primary from secondary hypogonadism 2
• If secondary hypogonadism (low LH/FSH with low testosterone), measure prolactin and consider pituitary imaging 2

Treatment Options for Confirmed Hypogonadism:

• For men NOT seeking fertility: Testosterone replacement therapy (transdermal gel, patches, or intramuscular injections) 2
• For men seeking fertility: Avoid testosterone monotherapy; instead use gonadotropins (hCG with or without FSH), SERMs (clomiphene), or aromatase inhibitors 2

Critical Pitfall

Testosterone monotherapy should never be prescribed to men interested in current or future fertility, as it suppresses gonadotropin secretion and can cause azoospermia 2. This is a clinical principle with strong consensus.

Theoretical Progesterone Effects in Men

While research suggests progesterone may influence male physiology 1, 3, including:

• Central nervous system effects (neurosteroid activity)
• Potential benefits in benign prostatic hypertrophy and prostate cancer 3
• Possible neuroprotective effects 4, 3

These remain experimental observations without clinical translation. No controlled trials support progesterone supplementation in men for any indication 1, 3.

Practical Recommendation

If a man has documented "low progesterone," do not treat the progesterone level itself. Instead:

1. Evaluate for clinically relevant hormone deficiencies (testosterone, thyroid, cortisol) using established diagnostic criteria 2
2. Assess for symptoms of hypogonadism: decreased libido, erectile dysfunction, reduced muscle mass, fatigue, infertility 2
3. If hypogonadism is confirmed, treat according to fertility goals using testosterone replacement or fertility-preserving alternatives 2
4. Refer to endocrinology or male reproductive specialist for complex cases, particularly hypogonadotropic hypogonadism 2

There is no evidence-based indication to measure or treat isolated low progesterone in men in routine clinical practice.