Often, testosterone therapy is given to men with high FSH levels, since high FSH can lead to low testosterone; this can help increase fertility in these men.
Primary hypogonadism is associated with low levels of testosterone and high-normal to high levels of LH and FSH. Secondary hypogonadism is associated with low levels of testosterone and normal to low levels of LH and FSH.
FSH stimulates sperm production. LH is responsible for the production of testosterone.
In men, LH stimulates testosterone production from the interstitial cells of the testes (Leydig cells). FSH stimulates testicular growth and enhances the production of an androgen-binding protein by the Sertoli cells, which are a component of the testicular tubule necessary for sustaining the maturing sperm cell.
If you are a man, high FSH levels may mean: Your testicles have been damaged due to chemotherapy, radiation, infection, or alcohol abuse. You have Klinefelter syndrome, a genetic disorder affects sexual development in males. It often causes infertility.
Often, testosterone therapy is given to men with high FSH levels, since high FSH can lead to low testosterone; this can help increase fertility in these men. In other cases, treating the underlying cause of the abnormal FSH levels will correct the problem.
There are no medications that can directly lower FSH. The only way to decrease FSH is to improve sperm production (through treatments such as correction of a varicocele, treatment of hypogonadism, etc.).
In the male FSH is required for the determination of Sertoli cell number, and for induction and maintenance of normal sperm production. The crucial role of FSH in male gonadal function has been clearly illustrated by the discovery of a patient with an activating mutation of the FSH receptor.
Decreased secretion of FSH and LH results in lack of stimulation of spermatogenesis and decreased testicular secretion of testosterone. Administration of FSH alone has little effect.
In patients with hypogonadotropic hypogonadism, male infertility is due to the lack of stimulation of spermatogenesis by the gonadotropins FSH and luteinizing hormone (LH).
Because oestrogen controls how much FSH we produce (remember that negative feedback loop), when we have less oestrogen, our FSH levels may go up. High FSH levels can therefore indicate that our ovaries aren't functioning properly, be an indicator of low ovarian reserve or an indicator of the onset of menopause.
While each fertility clinic uses a different assay to measure FSH, most centers say that anything above 15 is considered “abnormal.” On average, patients in the 10-to-15 range have a 50% lower success rate of bringing home a baby than others in their age group with FSH levels of 9.5 or below.
Symptoms that highly suggest low testosterone in adults assigned male at birth include: Reduced sex drive. Erectile dysfunction. Loss of armpit and pubic hair.
FSH causes ovarian follicles to enlarge and produce estrogen. Over time, fewer and fewer follicles remain to be stimulated and thus estrogen levels decline as a woman ages. This decline in estrogen leads to an increase in FSH as there is not enough estrogen being produced to "turn off" the brain's production of FSH.
LH controls the production of testosterone (T) by Leydig cells, the endocrine cells located in the interstitium of the testis (Figure 1A). T is essential for male virilization and, in combination with FSH, it triggers and maintains spermatogenesis.
Estrogen alone can suppress testosterone, but for some estrogen alone may not be enough to suppress testosterone sufficiently. production and its effects, as well as potentially having its own small estrogenic effect.
Sometimes, elevated follicle-stimulating hormone (FSH) levels are measured to confirm menopause. When a woman's FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause.
Dosing of FSH for male infertility
The typical starting dose of FSH is 75 IU SQ three times per week, and this dosage is adequate in most men. In some circumstances, FSH dosages can be increased to 150 IU or even 225 IU SQ three times per week, although this can get very expensive.
The FSH level is actually fairly easy to lower medically (with estrogen, the birth control pill, Lupron, etc.), but the underlying problem (diminished ovarian reserve) that causes the elevated FSH cannot necessarily be “fixed.”
Information is out there about different lifestyle changes that may lower the level, but little research has been done on the subject. Some of these changes include herbal supplements, DHEA, decreasing stress, exercising, acupuncture, weight loss or dietary changes.
Psychological stress primarily lowers serum total testosterone level with secondary rise in serum LH and FSH levels altering seminal quality. Stress management is warranted for male infertility cases.
Depending on how high your FSH is, your doctor may order a retest to see if your level was temporarily elevated or if the high result persists over time. Since FSH can fluctuate from cycle to cycle, a single high result is less likely to be concerning as it may be in the normal range in a subsequent month.
Estradiol (Climara Transdermal, Estrace, Estraderm Transdermal, Gynodiol) Restores estrogen levels to concentrations that induce negative feedback at gonadotrophic regulatory centers, which, in turn, reduces FSH release from pituitary.