The most apparent male symptoms of infertility are related to the inability of the female partner to become pregnant. However, other, more subtle symptoms are often overlooked. Because male fertility is just as critical for successful conception as female fertility, these symptoms need to be discussed.
Approximately 12% of all men experience infertility, with about 50% of infertility cases directly or indirectly due to complications with the male partner (1,2).
Leveraging modifiable nutrition and lifestyle factors can help remedy male symptoms of infertility, increasing the chances of conception.
In this blog, we’ll cover the top 5 male symptoms of infertility and how to fix them:
- sexual dysfunctions such as difficulty with ejaculation, erection, or reduced sexual desire
- issues with the testes, such as pain or swelling
- decreased facial and body hair and abnormal breast growth
- recurrent respiratory infections/inability to smell
- metabolic syndrome/blood sugar imbalances (and the role of metformin in congenital disabilities)
Let’s start with the most significant group of symptoms—problems with sexual function.
Symptom #1: Not In the Mood
The first symptom of infertility is actually a group of symptoms called sexual dysfunctions. These include problems with ejaculation, erection, or sexual desire.
Infertility is a sensitive and sometimes emotional subject for almost all couples. But, culturally, discussing the topic of male sexual dysfunction is deeply taboo. Sometimes men are not in the mood sexually, and they’re not in the emotional mood to bring it up.
The uneasiness of reporting sexual dysfunction bleeds into our ability to know how prevalent these issues truly are. They may be much more common than medically documented, yet our cultural norms keep men from speaking with their clinicians.
It’s important to recognize the underreporting of male sexual dysfunction. It creates a devastating cycle of feeling personally abnormal because an accurate baseline of population occurrence doesn’t exist!
For instance, lowered libido may affect up to 68.7% of men (2). But why does this happen?
Psychological factors such as lifestyle stress can play a part. However, physiology also contributes. Research tells us that lowered libido, along with any symptom of sexual dysfunction, is commonly linked to important underlying causes that affect systemic health, not just reproductive health.
Low testosterone levels, imbalances in the nervous system, and toxic overload from environmental pollutants are specifically connected to a lowered sex drive. Additionally, prescription drugs such as anti-hypertensives, cholesterol-lowering medications, antidepressants, and anti-anxiety medications can negatively affect libido. Excessive alcohol or over-the-counter drugs like cimetidine, sold under the brand name Tagamet HB for heartburn relief, can also dampen sexual desire (3).
Dietary components such as inadequate protein or antioxidant-rich foods may also contribute to sexual dysfunction. Many studies have explored the role of protein intake in male infertility, but, specifically, low protein diets can lead to lowered serum testosterone and follicle-stimulating hormone, both critical for a healthy libido.
A lack of daily protein can also negatively affect the weight of the testis and sperm production (4), while consuming colorful foods containing vitamin C, vitamin A, and coenzyme Q10 could boost both male reproductive health and the health of offspring (5).
In one large study from 2017, 15% of the over 4500 male participants experienced a lack of interest in sex, with a strong association between lack of interest and not feeling emotionally connected to their sexual partner. This finding illustrates that a lack of libido doesn’t always coincide with male symptoms of infertility—it can also be related to an emotional or mental state (6).
Erectile dysfunction, or ED, is likely the most researched of all male symptoms of infertility and is arguably the hardest on the psyche. It is also incredibly common.
“The Massachusetts Male Aging Study reported [that] 52% of 40–70 year old men suffer from varying degrees of SD. In addition, epidemiological evidence suggested that impotence has affected 10 million American men” (3).
The underlying reasons for ED are unclear, mainly because penile erection is complex. It combines functions of the central and peripheral nervous systems, endocrine, and cardiovascular system with psychological state.
However, there are risk factors related to erectile dysfunction that, again, as with all male sexual dysfunction, are critical to explore. These factors influence the whole person, not just his sexual ability.
Cardiovascular disease, metabolic disorders such as diabetes, obesity, neurological disease, depression, excessive alcohol consumption, and smoking (which can worsen multiple male symptoms of infertility) can underlie ED.
Amazingly, arterial disease, characterized by blockages in the vessels that carry blood from the heart to the legs, is strongly connected with erectile dysfunction.
In one study of 300 men with documented coronary artery disease, almost half reported erectile dysfunction that occurred approximately three years before more obvious symptoms of cardiovascular disease (7).
This finding alone is a reason to speak with your doctor and ask for a complete cardiovascular examination if ongoing erectile dysfunction is part of your symptom picture.
Symptom #2: Pain or swelling
The tenderness or even light swelling you experience in your testes might be a reason to consult a clinician.
Pain or swelling in the testes is one of the top male symptoms of infertility. And the most frequent cause is a common condition called varicocele.
Varicocele is like a varicose vein, except it occurs in the scrotum, the bag of skin that holds the testes. The underlying cause is usually faulty valves in the veins of the scrotum. As a result, blood pools in these veins rather than being transported back to the heart. Varicoceles are classified as small, medium, or large. And because they are sometimes painless, many men may not even realize they are there.
However, varicocele is the number one reason for abnormal sperm analysis, including low sperm count, inability for sperm to move around properly (sperm motility), and irregular sperm shape and size (sperm morphology) (8).
Issues with sperm can significantly contribute to infertility. So, the progression looks like this: pain or swelling in the testes → likely caused by varicocele → likely leading to abnormal sperm form and function → infertility.
If you’re a man with known infertility, you should ask to be checked for varicocele, as it is found in 35 to 81% of infertility cases. The most effective treatment is varicocelectomy, a microscopic surgery that repairs the veins (9).
Symptom #3: Decreased facial and body hair and abnormal breast growth
Decreases in facial and body hair, or atypical breast growth, formally known as gynecomastia, are signs of hormone imbalances and are classic signs of male infertility.
Males begin developing androgen hair-growth patterns in puberty. This shift is marked by an increase in testosterone and other androgens, such as dihydrotestosterone (DHT) and dehydroepiandrosterone (DHEA), that lead to the characteristic thick, dark hair often found on males’ faces, chests, armpits, and pubic region.
Hormonal imbalances, such as decreased androgens or disruptions in levels of other sex hormones such as estrogen, progesterone, or prolactin, can lead to thinning or abnormal growth patterns in males’ facial and body hair. However, these same hormonal issues can also underlie infertility due to androgens’ roles in sexual function and sperm formation and function (10).
A similar infertility symptom is found in abnormal breast growth. The hallmark hormonal problem underlying gynecomastia is an increase in estrogen relative to androgens. If the ratio of estrogen to androgens becomes skewed, the breast tissue can grow.
Both of these symptoms warrant a complete check-up with a licensed practitioner, as they are evidence of sometimes serious conditions.
Be aware that supplemental testosterone, technically called exogenous testosterone, though effective for relieving male symptoms of infertility such as low libido, erectile dysfunction, or gynecomastia, may actually lead to diminished sperm production.
“…despite the androgenic effects of testosterone on sexual function, libido and mood; its effect on gonadotropins leads to the inhibition of sperm production . This effect may diminish with the cessation of testosterone intake, but the extent of recovery is not clear for chronic users [16,19]” (11).
Symptom #4: Recurrent respiratory infections and inability to smell
You may be wondering how these two symptoms are connected to male infertility. It’s a great question with multiple answers.
Infertility and recurring respiratory tract infections can be linked to a rare genetic disorder called Kartagener’s Syndrome. This disorder is often characterized by chronic respiratory infections, bronchial scarring, and situs inversus, where the internal organs form in a mirror image of typical anatomy, with the liver on the left side of the body and the heart on the right, for example.
The majority of men with this disorder are, of course, aware of the syndrome due to their anatomical arrangement. However, some are unaware, and some cases of Kartagener’s Syndrome are termed “incomplete KS” if the internal organs are in the usual arrangement, making the diagnosis less clear.
Most men with this disorder also have infertility due to the disorder’s effect on sperm function. The sperm “tail” is limited in movement or unable to move, so the sperm cannot fertilize the egg (12).
The inability to smell may also be connected to infertility via another rare genetic disorder called Kallmann Syndrome. This syndrome occurs more often in males than females and is characterized by delayed or absent puberty due to the inability of the hypothalamus to secrete necessary sex hormones. Amazingly, these patients also experience a very limited or no ability to smell (13).
As with Kartagener’s Syndrome, those with Kallmann Syndrome are almost always aware of their diagnosis.
One common factor between the symptoms of recurrent respiratory infection, inability to smell, and infertility can also be nutritional rather than genetic.
Zinc deficiency is widely prevalent, with estimates at approximately 12% of the population of the United States (14).
Zinc is essential for male fertility as it plays roles in sperm motility and egg fertilization, along with protecting against oxidative stress and helping DNA repair (15, 16). And it plays enormous roles in immune and olfactory functions, or our ability to taste and smell (17).
It is hypothetically possible that males with zinc deficiency may notice decreased taste and smell and may also suffer from subfertility or infertility. Cigarette smokers, especially, may fall into this category as smoking is well known to contribute to zinc deficiency.
Symptom #5: Metabolic syndrome
Diabetes and other blood sugar imbalances manifested as metabolic syndrome are well-researched for their harmful effects on sperm quality and general male fertility.
Metabolically-connected issues such as obesity, imbalanced blood lipids, high blood pressure, and insulin resistance have been studied for their specific roles as male symptoms of infertility.
“Adopting a healthy lifestyle appears to be the single most important intervention to prevent the unwanted effects of MetS on men’s health and fertility” (18).
Improving blood sugar balance through antioxidant-rich foods, movement, and stress and toxin reduction are the most potent and safe ways to become metabolically fit and regain fertility.
This is especially true as we have learned more about metformin, the fourth most prescribed drug in the United States as of 2019 and indicated as a first-line drug for those with diabetes. Amazingly, metformin is thought to be the world’s most widely prescribed diabetes medication.
Unfortunately, as revealed by a 2022 study, metformin is more than likely connected to birth defects when taken near the time of sperm development, approximately three months before conception (19).
The study reported that babies of fathers who took metformin in the preconception period had birth defects at a rate of 5.2% compared to the baseline rate of 3.3%. The study went on to report that babies of fathers who took beta-blockers in the preconception period may also have a greater chance of being born with birth defects.
It’s important to note that this study examined possible associations between drugs and congenital disabilities and wasn’t an experimental study showing clear causation. However, the connection between these drugs and congenital disabilities is something to pay close attention to for those wishing to become pregnant.
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