In order for sperm to be produced normally, the male hormone cycle must be functioning normally. When a male is being assessed for potential infertility, one of the mandatory tests given is therefore a hormone test.
The levels of the reproductive hormones LH, FSH, and testosterone, and as they relate to one another, can sometimes provide insight into the reasons behind the low/missing sperm. However, abnormal male hormone levels are usually not the only factor in a couple’s struggle with infertility. Unfortunately, replacing a hormone discovered to be deficient does not usually fix the problem, though it does help the physician decide on the relevant next steps.
Different combinations of abnormal and normal hormone levels lead to different potential diagnoses.
Elevated LH and FSH with low testosterone:
This combination of test results can indicate testicular failure, also known as hypergonadotropic Hypogonadism. These cases are usually not treatable as the tissues which produce the sperm are damaged.
Normal levels of LH, FSH, and testosterone:
These results usually signify the presence of a physical barrier, ie obstructive azoospermia or retrograde ejaculation. This would mean that sperm is indeed being produced, as all required hormones are present and functional, but is blocked from reaching the ejaculate. In such a case, the precise nature of the obstruction would be explored and is sometimes treatable.
Low testosterone, LH, and FSH:
When all three hormones are lower than expected, it indicates that there is a problem with their release, one which can likely be traced back to the pituitary gland or hypothalamus which are supposed to release them. In these cases, known as hypogonadotropic hypogonadism, hormone replacement therapy can restore fertility to some extent.
Normal testosterone and LH with elevated FSH:
This result usually indicates a problem in the germline cells of the testes which normally form the sperm. This is a result of more commonly seen following chemotherapy treatment.
Elevated testosterone and LH with normal FSH:
These hormone indications could show some amount of hormone resistance, meaning that the tissues which normally respond to the hormone signals do not.
