Despite misconceptions linking low testosterone levels specifically to erectile dysfunction, urologist and pelvic surgeon Dr. Rena Malik, M.D., emphasizes that the most common causes of erectile dysfunction are coexisting health conditions that impact blood vessels, such as high blood pressure, heart disease and diabetes. Engaging in regular exercise improves cardiovascular health while also enhancing testosterone levels that contribute to other factors for men’s sexual health, including testicular function and subjective sex drive.

‍Supplements like tongkat ali and maca root can be used to help counteract low libido (which may be a side effect of antidepressants) through their effects on free testosterone and dopamine, respectively. Understanding your personal libido baseline and desired level of sexual activity — which can vary due to age and life circumstances — can serve as a subjective measure of health and well-being.

Male fertility depends on the continual production of healthy sperm, which can be influenced by age, genetics and lifestyle. A major lifestyle factor is chronic or repeated heat damage to the testes: even a small increase in the temperature of the testes can significantly reduce spermatogenesis (the process of making new sperm cells), so tight-fitting clothing and extended time in saunas and hot tubs should be avoided.

Fertility testing can include a semen analysis, which assesses sperm concentration, motility and morphology (shape and structure). Undergoing fertility screenings that include semen analysis every five years can identify potential reproductive health issues and explore treatment options, if needed. You may consider freezing sperm if planning to have children in the future, as paternal age can influence developmental outcomes in offspring, such as an increased incidence of autism with older paternal age (due to DNA fragmentation).

Testosterone is a critical hormone for men beyond just sexual function, affecting muscle mass, energy levels and mental health. Prolactin is another hormone with effects on reproductive and overall hormonal function and can directly influence testosterone levels. Elevated prolactin can inhibit testosterone production, which in turn can impair sperm production and contribute to male sexual dysfunction.

Treatment options for hormonal imbalances include testosterone replacement therapy (TRT) to treat low testosterone or general hormone replacement therapy (HRT) if treating an imbalance in growth hormone, thyroid hormone or even estrogen. These therapies can improve mood and energy levels, sleep quality and physical performance, but also have potential side effects that can impact fertility. 

Exogenous testosterone can dramatically reduce sperm production by suppressing the body’s natural hormone signals that stimulate the testes to produce sperm. These effects can be mitigated by the addition of human chorionic gonadotropin (HCG) or follicle-stimulating hormone (FSH), which can mimic the body’s natural hormone signals.