What are the implications of my normal testosterone level (36.2 nmol/L), normal sperm count (60 million/mL), slightly below average testicular volume (10 mL bilaterally), and high normal Follicle-Stimulating Hormone (FSH) level (10.2 IU/L) on my fertility?

Your Fertility Status: Reassuring Parameters with Mild Testicular Compensation

Your hormone and fertility parameters indicate normal fertility potential with mild testicular compensation—your sperm count is excellent, testosterone is robust, and while your FSH is in the upper-normal range suggesting your pituitary is working slightly harder to maintain spermatogenesis, this does not preclude normal fertility or sperm production. 1

Understanding Your Specific Numbers

Sperm Count: Excellent

• Your sperm concentration of 60 million/mL significantly exceeds the WHO lower reference limit of 16 million/mL 1
• This places you well within the normal fertile range, with total motile sperm count likely exceeding the 10 million threshold associated with good natural conception rates 1
• Men with sperm counts at your level have >90% chance of achieving pregnancy within 2-3 years of trying if the female partner is under 30 1

Testosterone: Normal to High-Normal

• Your testosterone of 36.2 nmol/L (approximately 1044 ng/dL) is in the high-normal to elevated range 1
• This level makes primary testicular failure extremely unlikely 1
• Normal testosterone with your FSH pattern suggests Leydig cells are functioning adequately, which typically correlates with preserved spermatogenesis 2

FSH 10.2 IU/L: Upper-Normal with Clinical Significance

• FSH >7.6 IU/L indicates the pituitary is compensating for some degree of testicular resistance, but this does not mean absent or severely impaired sperm production 1, 3
• Your FSH of 10.2 IU/L falls in the "borderline-elevated" range (9-12 IU/L) that warrants investigation but is not severely elevated 2
• FSH levels are negatively correlated with spermatogonia numbers—higher FSH reflects the pituitary working harder to maintain spermatogenesis 1
• Critical distinction: Men with FSH 10-12 IU/L typically have oligospermia (reduced counts), not azoospermia (zero sperm), and your actual sperm count of 60 million/mL confirms normal production despite the elevated FSH 1, 4

Testicular Volume 10 mL Bilaterally: Borderline-Small

• Testicular volumes <12 mL are generally considered small or atrophic and associated with impaired spermatogenesis risk 5
• However, testicular volume of 10 mL typically correlates with oligospermia rather than azoospermia, and your documented normal sperm count confirms adequate testicular function 1, 5
• Mean testicular size strongly correlates with total sperm count and sperm concentration, but individual variation exists 5, 6

What This Pattern Means: Compensated Testicular Function

Your hormone profile represents "compensated primary testicular function"—your testes have reduced reserve, so your pituitary produces more FSH to maintain normal sperm production, and this compensation is currently successful. 4

• Three documented cases in the literature describe men with elevated FSH (similar to yours) who maintained normal sperm counts and proven fertility, representing compensated testicular disease 4
• 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 you already have documented normal sperm production 1
• Some men maintain normal fertility despite FSH levels in the 10-12 IU/L range, though this represents biological variation rather than the norm 2

Essential Next Steps to Characterize Your Status

Immediate Diagnostic Workup

1. Measure complete hormonal panel: LH, prolactin, and SHBG to calculate free testosterone 1, 2

   • LH will help distinguish whether this is primary testicular dysfunction (elevated LH) versus secondary causes (normal/low LH) 1
   • SHBG is important because high SHBG can reduce bioavailable testosterone even with normal total testosterone 1

2. Repeat semen analysis in 2-3 months to confirm stability 1, 2

   • Single analyses can be misleading due to natural variability 1
   • Declining sperm parameters would warrant more aggressive evaluation 1

3. Physical examination by urologist or male fertility specialist 7, 1

   • Assess for varicocele (palpable on standing examination), which can cause progressive testicular damage and is treatable 1
   • Evaluate testicular consistency and vas deferens/epididymal abnormalities 1
   • Check for size discrepancy >2 mL between testes, which warrants ultrasound 5

Addressing Potentially Reversible Factors

Before making definitive conclusions, address metabolic and lifestyle factors that can artificially elevate FSH: 2

• Check thyroid function (TSH, free T4) 1, 2

  • Thyroid dysfunction disrupts the hypothalamic-pituitary-gonadal axis and can elevate FSH 1
  • Correction of thyroid disorders can normalize FSH levels 1

• Optimize body weight if BMI >25 2

  • Obesity and metabolic syndrome impair the HPG axis 2
  • Weight loss through low-calorie diets can reverse obesity-associated hormonal dysfunction 2

• Repeat FSH testing after 3-6 months of metabolic optimization 2

  • FSH levels in the 9-12 IU/L range often normalize to 7-9 IU/L once acute illness, obesity, or other reversible factors resolve 2

Critical Actions to Protect Your Fertility

Absolute Contraindications

NEVER use exogenous testosterone or anabolic steroids if you desire current or future fertility 1, 2

• Testosterone completely suppresses FSH and LH through negative feedback on the hypothalamus and pituitary 1
• This causes azoospermia (zero sperm) that can take months to years to recover 1, 2
• Even with your current normal sperm count, testosterone would eliminate sperm production 1

Fertility Preservation Considerations

Given your borderline testicular volume and elevated FSH, consider sperm cryopreservation if follow-up testing shows declining parameters 1

• Men with elevated FSH and small testicular volumes are at risk for progressive spermatogenic failure 1
• Once azoospermia develops, even microsurgical testicular sperm extraction (micro-TESE) only achieves 40-50% sperm retrieval rates 1
• Banking 2-3 ejaculates provides insurance against technical failures or need for multiple treatment attempts 1

Lifestyle Optimization

• Smoking cessation, maintaining healthy body weight (BMI <25), and minimizing heat exposure to testes 1
• Avoid gonadotoxic medications, chemotherapy, or radiation therapy without fertility preservation 1
• Optimize Type 1 diabetes control if applicable, as metabolic stress affects the HPG axis 1

When to Seek Fertility Assistance

Natural Conception Timeline

• With your current parameters (sperm count 60 million/mL, normal testosterone), you have excellent natural conception potential 1
• If female partner is under 30 with no known fertility factors, expectant management for 6-12 months is appropriate 1
• Consider fertility evaluation after 12 months of timed intercourse without conception 1

Red Flags Requiring Urgent Urology Referral

• Rapid testicular atrophy or development of palpable testicular mass 1
• Decline in sperm concentration to <5 million/mL on repeat testing 1
• Development of severe oligospermia or azoospermia 1

Treatment Options If Parameters Decline

If Sperm Count Remains Normal

• Continue monitoring with repeat semen analysis every 6-12 months 1
• Address reversible factors (thyroid, weight, varicocele if present) 1, 2
• No hormonal treatment indicated if sperm production remains adequate 2

If Sperm Count Declines to Oligospermia Range

• FSH analogue treatment may improve sperm concentration, pregnancy rate, and live birth rate in idiopathic infertility with FSH <12 IU/L 2
• Selective estrogen receptor modulators (SERMs) or aromatase inhibitors have limited benefits compared to assisted reproductive technology 1, 2
• IVF/ICSI offers superior pregnancy rates and should be discussed early, especially given female partner age considerations 1, 2

If Progression to Azoospermia

• Microsurgical testicular sperm extraction (micro-TESE) offers 40-50% sperm retrieval rates even with elevated FSH 1, 2
• Genetic testing (karyotype and Y-chromosome microdeletion) mandatory before TESE 1

Important Caveats

• Your documented normal sperm count of 60 million/mL is the most reassuring finding—it proves your testes are currently producing sperm normally despite the borderline parameters 1
• FSH of 10.2 IU/L with normal sperm count represents the "compensated" pattern described in the literature, where fertility is maintained at the expense of elevated FSH 4
• Testicular volume of 10 mL is borderline-small but not severely atrophic (<12 mL threshold), and your normal sperm count confirms adequate function 1, 5
• The combination of normal testosterone (36.2 nmol/L) and normal sperm count (60 million/mL) makes primary testicular failure extremely unlikely 1