Male Health

It’s hard to believe that my last post was in 2015, almost 5 years before the COVID-19 pandemic hit in force. I started this blog to answer questions that my patients were asking me, and I answered quite a lot here. When it began, it was 2010, a scant 6 years after the debut of Facebook, 4 years after Twitter, and only 3 years after the first iPhone. Much has happened since then.

In my last post, I wrote that you could follow me on Twitter. That was before Twitter sold itself, renamed itself X, and removed nearly all content moderation. I no longer go there.

I’ve kept the engine in this blog running smoothly so that you can search for topics, explore the archives, and use the word cloud. The information is still good and timely.

We’re entering a golden age of male reproductive medicine with new diagnostic tools and the promise of medicines specifically designed to treat male infertility. From time to time I’ll post the big advances here. But for now, enjoy and explore the site.

Follow me on Twitter. Seriously.

It’s been a little over five years. I wrote my first post on this blog, The Mysteries of Funny Looking Sperm, April 18, 2010. At the time, this blog was very much an experiment, and I had no idea how it would work. In my daily life, I see a lot of men with difficulties having children or other male health problems, and they don’t tell you anything about that when you take “sex ed” in high school. Lots of men share the same problems, and I would say the same things to different men throughout the day. So I thought that I would put my end of those conversations in a general way on a blog, so that men around the world with questions about male reproductive health might find some answers.

My first few blog posts came from those common conversations. I see a lot of men with male endocrine problems, so I wrote a few posts on how the endocrine system works in a man and how it can be fixed if needed. I wrote about concerns like, can a man’s underwear cause problems with his sperm? At first, I shut off comments after two weeks, but I quickly realized that many people found my posts not by reading the blog start to finish, but through a search for a specific concern. That makes a lot of sense: I do that, too. People would be coming at a post weeks, months, or even years after I wrote it. My third post on April 28th, 2010, How Clomid Works in Men, is still my most visited one with 874 comments as of today.

After a while, people started asking great questions in the comments. Sometimes I could answer them in a couple of lines in the comments section, but some required longer answers. I added posts for a few of these great questions. Understandably, although I tried to make it very prominent in the FAQ, people would still ask me medical questions about themselves and their loved ones. It’s really frustrating, but I can’t answer them. I don’t have the basic information through the web that all doctors need to make a diagnosis and treat a patient, which includes a physical examination. I need to see people in person to be their doctor.

As the blog evolved, I began posting about news events, important scientific studies, and general items of interest in male health. But most people still come across the blog by searching for a specific problem or question, and that’s the way it mainly seems to work. So for those who read a post from years past and have a question, I’ll often recommend reading the comments and other posts on the blog, as the answers are usually there.

But if you’re interested in male health, and you want a more up-to-date stream of information, then follow me on Twitter. I post pretty frequently there, often with links to important news articles about male health and the other parts of my job in science, engineering, and education. You’ll even see my human side from time to time. I’ll of course still write here on this blog when the need for more words arises.

See you in the Twitterverse!

Wiki (not sure if that’s his real name) wrote in a comment, “is low Testosterone unusual for young athletic men (under 25) , what will be your minimum level (red line) for Testosterone of men under 25, as i found the minimum level varies according to each lab … mostly skewed based on the middle aged men they usually test.”

Great question! A while ago, many used “age-indexed” testosterone, meaning that lower levels were considered normal in older men. Most in the field have abandoned that approach as it’s like saying, we know that diabetes is more common as people age, so we’ll just use higher blood sugars as normal when they get older. That would be an approach ignorant of the basis of the disease. To make matters worse, to create the age-indexed thresholds of normal testosterone, each lab essentially was required to do that themselves. So you had a lot of labs with different numbers, and that made interpreting those lab results really difficult.

Your question gets to another point, though, which is what is a normal testosterone for an individual man? Testosterone doesn’t work by itself; a whole machine inside the cell uses it. It’s like gas in a car: you can have the same gas, but a Ferrari will drive differently than a Volvo. (No offense to Volvo owners intended.) So one man’s testosterone of 350 ng/dL may be perfectly fine, but for another, that may be low.

That’s why guys need to do evaluation and treatment with their doctors. (If you are trying to figure out a good doctor who knows about hormones in men, check out that part of the FAQ.) A doctor can evaluate the whole man and see other signs of low testosterone, and tailor treatment with different medications (many of which are described elsewhere in this blog.)

Thanks, Wiki, for the great question!

As I’ve written before in this blog, clomiphene is an effective if off-label treatment for men with low testosterone who want to preserve their fertility. If used directly, testosterone itself actually decreases the making of testosterone and sperm in a man’s testis. Clomiphene increases testosterone production in the testis by increasing the pituitary hormones that tell the testis to make testosterone.

In the March issue of Fertility and Sterility, a journal that I co-edit with Dr. Antonio Pellicer, Drs. Kim and co-authors review the published medical literature on treating low testosterone with clomiphene and other drugs besides testosterone. They conclude that clomiphene is a safe and effective treatment for men with low testosterone and note that less than one year of treatment with testosterone is usually reversible if a man wants his fertility to return. Unfortunately, we don’t know all that much about longer treatments with testosterone, and many men who have been on testosterone for several years do not have sperm return even with other forms of treatment.

Drs Kim and co-authors give us a nice review that supports the use of clomiphene for men with low testosterone who want to preserve their fertility.

I’ve always been frustrated by the default WordPress search engine. All too often when I entered search terms to test it, I got Mal the error duck. Somewhat charming at first, Mal quickly became pretty frustrating. I could only imagine how frustrating it must have been for the readers of this blog to get the information they want. I spent a few hours researching better search tools and finally decided to install Relevanssi. I’ve tweaked it and tested it, and it seems to work pretty well. Let me know what you think!