Archive for the ‘Fertility’ Category

Erectile, Sexual Function Better in Active Men

The more a man exercises, the better his erectile and sexual function, regardless of his race, according to a new study designed to define a minimum exercise threshold for best sexual function.

Many studies have highlighted the relationship between better erectile function and exercise, but black men have been underrepresented in the literature.

“This study is the first to link the benefits of exercise in relation to improved erectile and sexual function in a racially diverse group of patients,” said senior author Adriana Vidal, PhD, of the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute and Department of Surgery in Los Angeles.

This cross-sectional study included nearly 300 participants from a case-control study that assessed risk factors for prostate cancer conducted at the Durham Veterans Affairs Medical Center.

The men, about one-third of them black, self-reported their activity levels.

The researchers then stratified them into 4 exercise groups: sedentary, mildly active, moderately active, and highly active.

The subjects also self-reported their sexual function, including the ability to have erections and orgasms, the quality and frequency of erections, and overall sexual function.

MORE FREQUENT EXERCISE = HIGHER SEXUAL FUNCTION

A multivariate analysis showed that men who reported more frequent exercise, a total of 18 metabolic equivalents (METS) per week, had higher sexual function scores, regardless of race.

MET hours reflect both the total time of exercise and the intensity of exercise.

A score of 18 METS is the equivalent of 2 hours of strenuous exercise, such as running or swimming; 3.5 hours of moderate exercise; or 6 hours of light exercise.

“Higher exercise was associated with a better sexual function score.

Importantly, there was no interaction between black race and exercise, meaning more exercise was linked with better erectile/sexual function regardless of race,” the researchers stated.

In contrast, exercise at lower levels was not statistically or clinically associated with erectile or sexual function in men of any ethnicity.

Additional contributors to low sexual function included diabetes mellitus, older age, past or current smoking, and coronary artery disease.

LESS INTENSE EXERCISE BETTER THAN NONE

Study coauthor Stephen Freedland, MD, Director of the Center for Integrated Research in Cancer and Lifestyle in the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, cautions that exercise should be tailored for each person.

“When it comes to exercise, there is no one-size-fits-all approach,” said Dr Freedland, who also serves as codirector of the Cancer Genetics and Prevention Program.

“However, we are confident that even some degree of exercise, even if less intense, is better than no exercise at all.”

The researchers published their results online in the March 20, 2015 issue of Sexual Medicine.

Modest Alcohol Consumption Lowers Semen Quality

Drinking modest amounts of alcohol may affect the sperm quality of young men, according to a new study.

“Young men should try to avoid habitual alcohol intake of more than 5 units weekly and especially more than 25 units weekly, which may be beneficial not only for their general health but their semen quality as well,” said Tina Kold Jensen, Professor of Research at the Department of Environmental Medicine, University of Southern Denmark, Copenhagen, Denmark.

One unit of alcohol was defined as the equivalent to 1 beer, 1 glass of wine, or 1 shot of alcohol.

“We also found that increasing alcohol consumption the week preceding the visit was associated with changes in reproductive hormones, especially a significant increase in serum free testosterone and reduction in sex hormone binding globulin,” Dr. Jensen said.

HEALTHY YOUNG MEN AND THEIR ALCOHOL

This appears to be the first study among healthy young men with detailed information on alcohol intake.

Dr. Jensen said, “Previous studies have not found adverse effects of low alcohol intake (more than 5 units per week), however, they only assessed average intake.

We assessed daily intake the week preceding the semen delivery.”

She added: “We think we found a strong association because we asked the men about intake last week and then extrapolated to a normal week.

We know that normal sperm take 3 months to mature.

Normal consumption is a better marker than just last week’s consumption.”

STUDY RESULTS

The cross-sectional, population-based study asked 1221 men to fill out a questionnaire on whether the previous week was a “normal” week of alcohol consumption and then studied the 553 who stated that it was.

These men, age 18 to 28 years, all had undergone a medical examination between 2008 and 2012 to assess their fitness for military service, which is compulsory in Denmark.

Sperm concentration, total sperm count, and percentage of spermatozoa with normal morphology were negatively associated with increasing habitual alcohol intake.

This association was observed in men reporting at least 5 units in a typical week but was most pronounced for men with a typical intake of more than 25 units per week.

Men who had a typical weekly intake of more than 40 units had a 33% reduction in sperm concentration compared with men who had an intake of 1 to 5 units per week.

Binge drinking was not independently associated with semen quality.

“We do not know how much of a direct effect on semen quality was due to the adverse effect of alcohol on spermatogenesis, but we adjusted for other lifestyle factors, such as smoking, diet, and exercise,” said Dr. Jensen.

“But it may be a certain lifestyle associated with alcohol intake that is harmful to semen quality.”

The researchers think that even moderate alcohol consumption could be a contributing factor in the low sperm counts reported among young men.

Whether semen quality is restored if alcohol intake is reduced remains to be seen, they stated.

The researchers reported their results in the October 2, 2014 issue of the British Medical Journal Open.

No Added Heart Attack Risk With Testosterone Therapy in Older Men

Testosterone therapy does not increase the risk of heart attack, or myocardial infarction (MI), among older men, according to a comprehensive new study.

“We believe this is a methodologically rigorous study and should be thoughtfully weighed, critiqued, and discussed alongside the other studies of testosterone therapy and cardiovascular outcomes,” said lead author Jacques Baillargeon, PhD, Director, Epidemiology Division and Associate Professor of Preventive Medicine & Community Health at the University of Texas Medical Branch in Galveston.

“Although recent observational studies have reported an increased risk of cardiovascular disease associated with testosterone use, there is a large body of evidence that is consistent with our finding of no increased risk of MI associated with testosterone use,” Dr. Baillargeon said.

He noted that there are cardiovascular risks associated with untreated hypogonadism (a condition in which the body doesn’t produce enough testosterone) and those should be factored into the risk-benefit assessment about testosterone therapy.

INCREASE IN TESTOSTERONE PRESCRIPTIONS

Testosterone prescriptions for older men in the United States have increased more than 3-fold over the past decade.

This trend has been driven by increases in direct-to-consumer marketing; rapid expansion of clinics specializing in the treatment of low testosterone; the development of new drugs and improved delivery mechanisms, particularly dermal gels; and greater diagnostic awareness of hypogonadism, stated Dr. Baillargeon.

The retrospective study used information from 25,000 Medicare beneficiaries aged 66 years and older.

It compared more than 6,300 men treated with testosterone for 8 years with more than 19,000 who were not treated with testosterone.

“We found that use of intramuscular testosterone therapy was not associated with an increased risk of MI,” Dr. Baillargeon said.

In fact, testosterone was associated with a possible protective effect — reduced risk of MI in patients with the highest prognostic risk index.

There were no differences in risk in patients in the lower prognostic risk groups.

HOW TESTOSTERONE AFFECTS THE HEART

There are a number of physiologic pathways whereby testosterone therapy may affect the risk of adverse cardiovascular events.

“Some have reported that testosterone therapy may improve cardiovascular health by way of decreasing fat mass, insulin sensitivity, and lipid profile,” said Dr. Baillargeon.

“Also, testosterone may possess anti-inflammatory and anticoagulant properties.”

He continued, “It is possible that our findings of a protective effect among men in the highest MI prognostic group reflect a process whereby testosterone reduces peripheral vascular resistance, thereby reducing stress on the heart among those who have some degree of coronary artery disease.

It is important to note that there are also postulated mechanisms through which testosterone may increase the risk of cardiovascular disease.

Given the broad range of proposed biologic pathways, it is important to conduct further research on this topic.”

CONCERNS ABOUT TESTOSTERONE THERAPY

Several recent studies have raised concerns about cardiovascular risks associated with testosterone therapy, in particular for older men.

On June 19, the FDA expanded labeling on testosterone products to include a general warning about the risk of blood clots in veins.

The FDA and European Medicines Agency also are further examining the safety of these products.

The researchers reported their results in the July 2, 2014 issue of the Annals of Pharmacotherapy.

Evidence on Testosterone Therapy Does Not Support Cardiac Risk

Does testosterone therapy to treat testosterone deficiency, or “low T,” increase a man’s risk of cardiovascular disease?

No, says a provocative editorial that asserts there are flaws in the cardiovascular risks quoted in recent articles in the scientific literature and mass media.

The public judgment of the overselling of testosterone therapy demands a response, stated the lead author, Martin Miner, MD, Clinical Associate Professor of Family Medicine and Urology, Warren Alpert Medical School of Brown University.

The editorial appeared in the April 8, 2014 issue of Journal of Men’s Health.

NO CREDIBLE EVIDENCE

“As researchers and clinicians with extensive experience with testosterone deficiency and its treatment, we do not find any credible evidence that testosterone prescriptions increase health risks.

We find the assertion that testosterone is prescribed to men ‘who are simply reluctant to accept the fact that they are getting older’ is without foundation, and we object to comments that question the reality of testosterone deficiency, regardless of whether it is called hypogonadism or, as in advertisements, ‘low T,’” Dr. Miner stated.

“In addition, in our opinion, the idea that physicians prescribe testosterone due to pressure from drug companies is irresponsible and not supported by scientific evidence.”

OVER-THE-TOP COMMENTS

Over-the-top comments tend to scare both patients and physicians.

“The FDA announcement that it is investigating the reports of increased cardiovascular risks has only added to the impression that a major study has determined serious problems with testosterone therapy,” he stated.

A case in point is a recent report published in PLoS ONE that investigated the risk of acute nonfatal myocardial infarction (MI), or heart attack, in a retrospective cohort study of a health-claims database.

The authors compared the rates of heart attack within the first 90 days of an initial prescription for testosterone with the rates of heart attack for the 12 prior months in nearly 56,000 men.

They also examined pre- and post-prescription incidence rates for nonfatal heart attack in another large cohort of more than 167,000 men for whom only phosphodiesterase-5 inhibitor (PDE5i) medications (such as Viagra) were prescribed, and after adjusting for potential confounders, compared these results to those of men who received testosterone prescriptions.

The authors concluded that the risk of heart attack following testosterone prescription was “substantially” increased (at least twofold) in older men and younger men with preexisting, diagnosed heart disease.

STUDY IS “TOO FLAWED”

“A close examination reveals that this study is too flawed to provide meaningful information on the cardiovascular risk of testosterone therapy,” stated Dr. Miner.

“First, the overall rate of nonfatal MI in the testosterone-treated group increased in all ages from 3.48 to 4.75 per 1,000 person-years.

This amounts to just greater than 1 additional MI in 1,000 years of exposure to testosterone.

It is misleading to characterize this increase as ‘substantial’ based on relative risk when the absolute risk is so small and clinically meaningless.”

Also, the study duration (90 days) was short, and a true control group would have consisted of men with untreated testosterone deficiency, not those who received PDE5i medications.

The overall risk was low, and the number of events in subgroups was remarkably few, he noted.

More data from larger, longer term studies are needed to assess the potential effects of testosterone therapy on cardiovascular events in men.

Based on the current evidence, he stated, “we can find no foundation for suggesting new restrictions on testosterone therapy in men with cardiac disease.”

Optimal, Not High, Testosterone Levels Help Men Live Longer

Older men with optimal testosterone levels — not too high or too low — tend to live longer, according to a new study.

A man’s testosterone level normally declines with age, and lower testosterone has been associated with increased mortality in aging men.

This has sparked marketing of testosterone replacement therapy targeting middle-aged and older men, including direct-to-consumer advertising and campaigns aimed at physicians.

“Optimal circulating total testosterone is a robust biomarker for survival in aging men,” notes lead author Professor Bu Yeap, MBBS, FRACP, PhD, of the University of Western Australia.

However, older men with midrange levels of testosterone and its metabolite dihydrotestosterone (DHT) had the lowest death rates from any cause, and men with higher DHT levels were at lower risk for dying from ischemic heart disease, the researchers reported in the January 2014 issue of the Journal of Clinical Endocrinology & Metabolism.

Therefore, there was no benefit of having a high-normal testosterone level, he said.

Dr. Yeap and colleagues studied 3690 men aged 70 to 89 years living in Perth, Western Australia, as part of the Health In Men Study.

Levels of testosterone and DHT were measured in blood samples collected between 2001 and 2004 and compared with survival up to December 2010.

There were 974 deaths, including 325 from ischemic heart disease.

Men who died had lower mean baseline testosterone and DHT levels.

After adjustment for other risk factors—including age, overweight, and other confounding factors (education, smoking, body mass index, waist-to-hip ratio, hypertension, dyslipidemia, diabetes, creatinine levels, and prevalent cardiovascular disease and cancer) testosterone and DHT levels were associated with all-cause mortality.

Cumulative mortality was highest in those with the lowest levels of testosterone; the second-highest rate was seen among men with the highest levels of testosterone.

Those with testosterone in the middle range had the lowest incidence of death from any cause.

These results are particularly important because of conflicting results in studies of testosterone replacement therapy.

Some research has suggested lower mortality in men treated with testosterone; other studies have found the opposite.

There is a particular concern about the potential for heart problems after the use of testosterone replacement therapy in older men with comorbidities.

Studies have found a higher risk of adverse cardiovascular events, including death, in men with multiple comorbidities undergoing coronary angiography treated with testosterone, compared with those who did not receive it.

A National Institutes of Health study of testosterone supplementation in older men was terminated early in 2010 when there was an excess of cardiovascular events found among men who took testosterone.

Dr. Yeap said there needs to be more research of the biological basis for the associations between testosterone levels and the risk of dying, including randomized trials of testosterone supplementation.

“Having the right amount of testosterone and DHT may be important for men’s health as they grow older, but we need to conduct clinical trials to determine whether modifying levels of sex hormones would improve health outcomes in older men,” he stated.

Testosterone Tempers Response to Flu Vaccination

Men with high levels of testosterone may have weakened immune systems, which may be the reason why men’s immune systems respond less strongly to vaccinations.

That’s the main result of the first study to show an explicit correlation between testosterone levels, gene expression, and immune responsiveness in humans.

The expression of genes regulating lipid metabolism correlate with differing vaccine responses observed between the sexes, and a number of these genes also have been shown to be immunosuppressive and likely regulated by testosterone, according to lead author David Furman, PhD, Research Associate in the Department of Microbiology and Immunology at Stanford University School of Medicine in Stanford, CA.

“In addition, elevated levels of free testosterone and expression of such gene signatures appear to be highly detrimental for the production of neutralizing antibodies against influenza in men,” he said.

In general, males have less robust immune responses for reasons that are not well-understood.

The researchers published their results ahead of print on December 23, 2013 in the Proceedings of the National Academy of Sciences.

They used a systems analysis to investigate this difference by analyzing the neutralizing antibody response to a trivalent inactivated seasonal influenza vaccine and a large number of immune system components, including serum cytokines and chemokines, blood cell subset frequencies, genome-wide gene expression, and cellular responses to diverse in vitro stimuli in 87 patients of various ages.

The men with elevated serum testosterone levels and associated gene signatures exhibited the lowest antibody responses to the flu vaccine.

The researchers also identified a cluster of genes involved in lipid biosynthesis that had been previously shown to be up-regulated by testosterone, which correlated with poor virus-neutralizing activity in men.

The results demonstrate a strong association between androgens and genes involved in lipid metabolism, suggesting that these could be important drivers of the differences in immune responses, Dr. Furman said.

“We hypothesize that these genes connected with lipid metabolism and immunosuppressive shunt down the response by generating suppressive monocytes and T cells, and could be activated when a critical concentration of testosterone is reached,” he said.

Testosterone’s effect on the immune system may be linked to a man’s evolutionary role, Dr. Furman said.

“Infection with pathogens constituting evolutionary pressure, such as highly pathogenic influenza virus, SARS infection, or dengue fever, often generates an exacerbated and uncontrolled expansion of immune cells and production of inflammatory cytokines, the so-called cytokine storm, which causes tissue damage, endothelial leakage with pulmonary edema, and lung failure.

Therefore, in these cases of evolutionary pressure one can think that mechanisms of immunosuppression (high production of testosterone) might be beneficial, and therefore selected.”

Dr. Furman added, “Our study strongly indicates that testosterone supplementation is detrimental.

However, it might be positive in cases where the immune response is harmful, for example, in autoimmunity or cytokine storms.”

He noted that “sex steroids have a huge effect in immunity.

Primary care physicians should be aware of this when considering vaccination regimes.”

Obese, Overweight Men Have Inferior Semen

Men who are overweight or obese have lower sperm counts and lower ejaculate volumes, according to the results of the first study to make this association in men who were trying to conceive, but who did not have known infertility.

“Our study provides further data showing the link between being overweight and sperm quality,” said lead author Dr. Michael Eisenberg of Stanford University School of Medicine.

“Most prior studies examined infertile men only, while our study examines all men who were trying to conceive.

Moreover, we looked at both body mass index (BMI) as well as waist circumference to determine the relationship with sperm production.”

Dr. Eisenberg and colleagues examined data from the Longitudinal Investigation of Fertility and the Environment Study, a population-based, prospective cohort of more than 500 couples attempting to conceive in Texas and Michigan.

They analyzed data from 468 men, mean age 32, the majority of whom (82%) were overweight or obese.

More than half said they participated in physical activity less than once a week.

Fewer than 10% had a low sperm count.

The researchers reported their results online on December 4, 2013 in the journal Human Reproduction.

When the researchers examined semen parameters, they found that ejaculate volume declined with increasing BMI and waist circumference.

Similarly, the total sperm count showed a linear decline with waist circumference.

A man in the normal BMI range had an ejaculate volume of 3.3 mL, compared with 2.8 mL for men who were severely obese.

Men with the largest waists, more than 40 inches, had about 22% lower total sperm count compared with men who had waist measurements under 37 inches.

The percentage of men with abnormal volume, concentration, and total sperm increased with increasing body size.

There was no significant relationship seen between body size and other fertility factors, including semen concentration, motility, vitality, morphology, or DNA fragmentation index.

“Body size as measured by BMI or waist circumference is negatively associated with semen parameters, with little influence of physical activity,” Dr. Eisenberg noted.

The Heavier Man, The Lower the Sperm Count

The heavier the man, the higher the chances of a low sperm count, he suggested.

“I think bringing attention to another adverse outcome of obesity is important,” Dr. Eisenberg said.

“Men need to know that in addition to health aspects, obesity may also impair reproductive goals.”

It’s still unknown what a reduction in body weight does to the sperm counts of men starting with a low sperm count, Dr. Eisenberg noted.

“We don’t have a good answer at this point,” he said.

“However, we do know that weight loss helps overall health, so at a minimum we can expect a health benefit for an overweight man who loses weight.”

Dr. Eisenberg stated that primary care physicians need to “bring awareness to this relationship.

This may provide another motivation for men to change lifestyle habits, knowing that it can impact fertility.”

In addition, as men discuss plans for starting a family, this study can provide important information as to who may be at risk for impaired fertility, he noted.

How Hormones Play a Role in Mood Swings During Fertility Treatments

Infertile men and women often say they feel sad or tired.

They can’t eat or sleep, they are anxious, irritable, or pessimistic.

These are all symptoms of depression.

Women, more than men, tend to express higher levels of depression about infertility.

Studies show that women tend to experience greater levels of distress than their male partners in terms of anxiety, depression, and hostility as well as more stress and lower self-esteem.

Often it’s the woman who has to bear the brunt of the medical interventions.

She has to show up for regular monitoring and go through the day-to-day struggle of hormone injections, drug side effects, and recurring periods.

Some of the depression is due to the effect of hormones on a woman’s mood during fertility treatments, writes Piave Pitisci Lake, M.D., Member of the American Fertility Association (AFA) Mental Health Advisory Council, in the July issue of the AFA newsletter.

“There is no doubt that women experience mood and anxiety symptoms during hormone therapy for fertility treatment,” writes Dr. Lake, who is a psychiatrist in Mount Pleasant, SC, who has an interest in women’s mental health and infertility issues.

“The causes of these symptoms are multiple, including the psychological issues involved in having to undergo fertility treatment.

In addition, there are specific points during a treatment cycle that are associated with increased anxiety and distress.

The length of time one has been pursuing fertility treatment also affects how vulnerable a woman might be to symptoms of depression and anxiety.

There is now some evidence to suggest that, among women given hormone therapy for fertility treatment, fluctuating levels of hormones, especially declining levels of estrogen, will have a negative effect on mood beyond that attributable to psychological distress.”

So how can a woman handle the emotional issues of fertility treatments?

— Recognize that feelings of depression, anxiety, guilt, isolation, and anger are very common among infertile couples.

— The more you know about your condition, its causes and treatments, the less stress you will feel about it.

— You can manage the effects of stress through techniques such as breathing exercises, journal writing, meditation and relaxation, mindfulness, and making time for yourself.

— You can learn to replace negative thoughts with new, more balanced thoughts.

— You and your partner may respond differently to infertility. Support each other and try to understand your partner’s feelings.

8 Ways to Super-Swimming Sperm

The You Docs — Mehmet Oz, host of “The Dr. Oz Show” and Mike Roizen of the Cleveland Clinic — the authors of several best-selling health books, write about a sperm improvement plan in a recent syndicated column.

“Healthy sperm and a robust sperm count improve your odds that a single sperm will survive its ultra-marathon journey and meet an eligible egg,” they write.

To give your sperm a healthy “makeover” and improve your fertility, take these 8 steps for super-swimmer sperm:

1. Eat less (like none) of the bad fats and more of the good ones.

Eating lots of saturated fat — found in red meats, processed meats, full-fat dairy products and many snack foods and desserts — can reduce sperm counts by 38%, and slow the swimming ability of the remaining 62%.

But getting more omega-3 fatty acids from fish like salmon and wild trout means higher counts.

To get more omega-3s you can also take a supplement of 1,500 mg DHA (the most active omega-3) daily for 10 weeks, then cut back to 1,000 mg a day.

2. Hang out at the farm stand.

Filling up on fruit and veggies protects sperm quality and quantity by revving up your body’s defenses that keep them healthy.

3. Add vitamin D-3 and zinc.

Plenty of vitamin D-3 helps sperm swim better and faster.

Aim for 1,000 IU a day from a D-3 supplement.

Add 12 mg of zinc a day for a healthy sperm count and superior shape.

Great and healthy food sources of zinc include poultry, beans, cashews and no-fat, no-added-sugar yogurt.

4. Get that laptop off your lap and your phone out of your pocket.

Surfing the web or checking email with a Wi-Fi-connected laptop humming in your lap is bad news for sperms’ swimming skills and the precious DNA cargo they carry.

Phones may hamper male fertility, too.

5. Keep cool where it counts.

Sperm production needs temperatures cooler than the rest of your body, which is why hot tubs, a fever and even a desk job can torpedo your count.

Take stand-up breaks at work, let ’em breathe, and make the switch to boxers from briefs.

Tight skivvies can reduce sperm counts by up to 50 percent.

Cyclists, mix up your exercise routine, too.

6. Skip the drinks and smokes.

Smoking slashes your sperm count by 13-17% and triggers genetic abnormalities.

There’s evidence marijuana is also bad news.

More than one beer, glass of wine or cocktail a day also messes with sperm quality.

After two drinks, sperm get mixed up and travel in weird directions.

7. Stay trim for your swimmers.

Adding extra pounds subtracts from your sperm count and ups the number of abnormal sperm in your arsenal.

Why?

Obesity may alter hormone levels and heat up your testicles.

8. Don’t hold back in the bedroom.

Daily fun between the sheets improves sperm quality dramatically.

Compared to several days of abstinence, daily intimacy reduces DNA damage in sperm by about 30%.

Public Enemy #1 for Male Fertility: Anabolic Steroids

Anabolic steroids, such as testosterone and its derivatives, are often taken by athletes to get “pumped.”

But these drugs have a unique side effect — they can shrink a man’s testicles and drastically reduce his fertility.

One of the more serious side effects of these poisonous chemicals is on male reproductive organs, says Marc Goldstein, MD, director of the Center for Male Reproductive Medicine and Microsurgery and surgeon-in-chief of male reproductive medicine and surgery at Weill Cornell Medical Center.

“Because of the high level of circulating testosterone caused by the steroids, the testicles no longer need to manufacture this hormone, so they being to shrink.

This reduces sperm production and may lead to both impotence and sterility,” says Dr. Goldstein.

In a new article posted on the American Fertility Association website, Stanton C. Honig, MD, Associate Clinical Professor of Surgery/Urology and Obstetrics and Gynecology at the University of Connecticut School of Medicine, examines how anabolic steroids affect male fertility.

“The use of anabolic steroids historically has been used by athletes in major sports, such as weight lifting, baseball and football,” writes Dr. Honig, who is also a Staff Urologist at Yale New Haven Hospital and the Hospital of St. Raphael in New Haven, CT.

“Because these so-called ‘role models’ use these drugs, anabolic steroid use or abuse has filtered down and is being used by recreational weight lifters, college, and high school athletes.”

The good news is that in many cases this problem is reversible, Dr. Honig says.

Once performance enhancing drugs (PEDs) such as steroids are stopped, sperm production may start again and sperm will return in the ejaculate, usually in about 3 months.

However, for those who have used steroids for years, this may take up to 2 years.

Once steroids are stopped, medical therapy may help enhance the ability of a man’s body to restart sperm production.

What’s more, PEDs can also cause sexual dysfunction, Dr. Honig notes.

When testosterone levels crash, this may lead to tiredness, loss of energy, and loss of sex drive.

“The most important point here is if you want to have children at some point in your life, DON’T USE ANABOLIC STEROIDS!!!” Dr. Honig admonishes.

And Dr. Goldstein agrees: “If you want to preserve your fertility, do not use anabolic steroids.”

In fact, testosterone has been successfully used as a contraceptive for men, he notes.