Male fertility problems: symptoms, sperm health, and hormone testing

Hormones, recovery, sleep, nutrition, lifestyle, and overall health can all play a role in sperm production and reproductive health. Yet many men only start thinking about fertility after months of trying to conceive.

The reality is that male fertility problems (or hurdles) are common, and they do not always cause obvious symptoms. In fact, male factor infertility contributes to around 40–50% of infertility cases, either alone or alongside female fertility factors.¹

Whether you are trying to conceive now, planning for the future, or simply taking a more proactive approach to your health, understanding sperm health and hormone balance may provide useful insight.

In this guide, we cover:

• What are the signs of male fertility problems?
• What affects sperm health?
• Can low testosterone affect fertility?
• Lifestyle, recovery, and male fertility
• Nutritional deficiencies and sperm health
• Can medications affect male fertility?
• Male fertility testing explained
• When should men consider fertility testing?
• Understanding male fertility health

What are the signs of male fertility problems?
 

Male fertility problems do not always cause symptoms.

For many couples, difficulty conceiving may be the first sign something is affecting sperm health or hormone balance.

Some men may also experience:

• Reduced libido 
• Erectile dysfunction 
• Low energy levels 
• Reduced muscle mass 
• Testicular pain or swelling 
• Reduced facial or body hair 
• Gynecomastia (enlarged breast tissue) 

Because reproductive hormones influence much more than fertility alone, symptoms such as fatigue, poor recovery, reduced performance, low mood, or changes in body composition may sometimes overlap with fertility concerns.

What affects sperm health?
 

Sperm health can be affected by a number of things, and is assessed by examing several markers. 
 

Sperm health is usually assessed through:

• Sperm count 
• Motility (movement) 
• Morphology (shape) 
• DNA integrity 

Research suggests sperm quality may be affected by:

• Hormone imbalances 
• Smoking 
• Excess alcohol intake 
• Poor sleep 
• Chronic stress 
• Obesity 
• Recreational drugs 
• Anabolic steroid use 
• Excessive heat exposure 
• Certain medications 
• Nutritional deficiencies 

Sperm production is closely linked to overall health and recovery, which is why male fertility is increasingly being discussed as part of wider metabolic and hormonal health rather than as a standalone issue.

If you would like practical guidance on this topic, read our article on how to improve male fertility and sperm quality.

Can low testosterone affect fertility?

Testosterone plays many important roles within the body. 

These include:

• Libido 
• Energy levels 
• Muscle mass 
• Recovery 
• Sperm production 

Low testosterone or imbalances in hormones such as FSH, LH, prolactin, and thyroid hormones may sometimes affect fertility.

However, fertility and testosterone are more complex than many people realise.

For example, anabolic steroids and testosterone replacement therapy (TRT) may actually suppress sperm production by disrupting hormone signalling between the brain and testicles.²

If you’re on TRT or thinking about starting, it’s best to discuss your fertility plans with your TRT providing doctor. Dr Doug Savage at Leger explains more about protecting fertility while on TRT in this expert article.

Hormone blood tests can help assess:

• Testosterone 
• Free testosterone 
• FSH 
• LH 
• Prolactin 
• Thyroid hormones 

If symptoms such as low energy, poor recovery, reduced libido, or fertility concerns are on your radar, our Male Hormone Blood Test and Advanced Male Fertility Blood Test may help provide useful insight.

Lifestyle, recovery, and male fertility
 

Male fertility is not just about reproduction. It can also reflect wider overall health.

Research suggests poor sleep, chronic stress, obesity, smoking, excess alcohol intake, and low physical activity may all negatively affect sperm quality and hormone balance.³

Taking proper time for recovery also matters more than many men realise.

Poor sleep and chronic stress may affect:

• Testosterone levels 
• Recovery capacity 
• Libido 
• Metabolic health 
• Sperm production 

Heat exposure around the testicles may also play a role in sperm health. Frequent hot tubs, saunas, tight cycling shorts, or prolonged laptop use when placed on the lap are often discussed in relation to sperm production, although evidence varies.

This does not mean every small lifestyle habit dramatically affects fertility overnight, despite what social media may suggest. Fertility is usually influenced by a combination of factors over time.

Nutritional deficiencies and sperm health
 

Research suggests certain nutrients may support sperm development, antioxidant protection, and hormone production.

Low levels of some vitamins and minerals have been associated with reduced sperm quality in some studies.⁴

Nutrients commonly linked to male fertility include:

• Zinc 
• Vitamin D 
• Selenium 
• Folate (vitamin B9) 
• Vitamin B12 
• Omega-3 fatty acids 
• Coenzyme Q10 

That said, fertility supplements are not magic pills. And as with all supplements, they can only be beneficial if you’re addressing a deficiency. If your vitamin D levels are within the healthy range, then adding more isn’t going to create magic sperm. 

Taking large amounts of supplements will not necessarily improve fertility if deficiencies are not present, and broader lifestyle factors often have a larger overall impact.

Our Nutrition Collection includes blood tests that provide reliable insights into your nutritional status, so you can make changes based on real data. 

For men wanting a more proactive overview of hormone, nutritional, and metabolic health, tests such as our Ultimate Performance Blood Test or Advanced Well Man Blood Test may help identify areas worth improving.

 

Can medications affect male fertility?
 

Some medications may affect sperm production, libido, or reproductive hormone balance.

Examples sometimes linked to male fertility concerns include:

• Anabolic steroids 
• Testosterone replacement therapy 
• Certain antidepressants 
• Some chemotherapy drugs 
• Certain blood pressure medications 

This does not mean prescribed medication should be stopped without medical advice.

If fertility is a concern, speaking to a healthcare professional may help clarify whether medication, hormone health, or lifestyle factors could be contributing factors.

Male fertility testing explained
 

Male fertility testing can help identify possible factors, giving you a clearer picture of what may be influencing your chances of conception.

Male fertility investigations may include:

• Semen analysis 
• Hormone blood testing 
• Testosterone testing 
• Thyroid testing 
• Ultrasound scans 
• Medical history review 

Hormone blood tests may help assess:

• Testosterone 
• FSH 
• LH 
• Prolactin 
• Thyroid hormones 

Testing cannot guarantee fertility outcomes, but it may provide useful insight into sperm production, reproductive hormones, and overall fertility health.

If you are unsure where to start, our fertility test buying guide explains the different fertility blood tests available for men and women.

When should men consider fertility testing?
 

There are many reasons men choose to explore fertility testing, from wanting reassurance to understanding whether there may be factors affecting reproductive health.

You may want to consider fertility testing if you:

• Have been trying to conceive for 12 months 
• Have symptoms of low testosterone 
• Have concerns about sperm quality 
• Have erectile dysfunction or reduced libido 
• Have a history of anabolic steroid use 
• Have testicular pain or swelling 
• Want a proactive understanding of hormone health and fertility 

Understanding male fertility health
 

Fertility is rarely influenced by one thing alone.

Hormones, sleep, recovery, nutrition, lifestyle, sperm health, and overall wellbeing may all play a role in male reproductive health.

If you are concerned about fertility, hormone testing and semen analysis may help provide useful insight into sperm health, testosterone levels, and possible next steps.

 

 

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References 

1. Agarwal, A., Baskaran, S., Parekh, N., Cho, C.L., Henkel, R., Vij, S., Arafa, M., Panner Selvam, M.K. and Shah, R. (2021) ‘Male infertility’, The Lancet, 397(10271), pp. 319–333. doi: 10.1016/S0140-6736(20)32667-2.
2. Patel, A.S., Leong, J.Y., Ramos, L. and Ramasamy, R. (2019) ‘Anabolic steroids and male infertility’, The World Journal of Men’s Health, 37(1), pp. 1–7. doi: 10.5534/wjmh.180002.
3. Sharma, R., Biedenharn, K.R., Fedor, J.M. and Agarwal, A. (2013) ‘Lifestyle factors and reproductive health: taking control of your fertility’, Reproductive Biology and Endocrinology, 11, article 66. doi: 10.1186/1477-7827-11-66.
4. Salas-Huetos, A., Bulló, M. and Salas-Salvadó, J. (2017) ‘Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies’, Human Reproduction Update, 23(4), pp. 371–389. doi: 10.1093/humupd/dmx006.
5. Eisenberg, M.L. and Lipshultz, L.I. (2011) ‘Varicocele-induced infertility’, Urologic Clinics of North America, 38(2), pp. 211–218. doi: 10.1016/j.ucl.2011.03.003.