Andrology

Nutraceuticals & General Lifestyle Advice

Leading a healthy lifestyle, not smoking, and trying to maximize your overall health and improve your body composition likely has a significant impact on your reproductive health. Since spermatogenesis is the highest throughput system in the human body, any significant disruption or insult to your body is often reflected in your reproductive system. Interestingly, vigorous exercise is thought to improve sperm counts, likely through improved hormone profiles and decreased obesity. Further, there is no data that briefs, riding a bike, protein supplements, creatine, or moderate alcohol intake (one drink a day or less) impact your reproductive health.

Drugs/Testosterone

Certain prescription and recreational drugs (marijuana and cocaine) can negatively impact your reproductive health. The most common prescription drug that causes a problem for men of childbearing age is use of exogenous testosterone (testosterone through outside sources, rather than that produced in the body). While we have repeatedly discussed using medication to increase testosterone, actually giving a man exogenous testosterone will shut off his sperm production.

An analogy helps to understand this. If we think of the male endocrine (or hormone) system as a thermostat that regulates testosterone, we can think of exogenous testosterone as a space heater. If you place a space heater in a room and heat it up, the thermostat in the room will shut off as it perceives the room as already being warm, and thus, does not need to heat the room. In our case, exogenous testosterone is the space heater and the thermostat is the male endocrine system. Giving a man exogenous testosterone shuts down the male endocrine axis and stops sperm production (usually not permanently). Alternatively, we may use other medications such as clomid that cause the thermostat to go into overdrive by acting like placing an ice pack on the temperature sensor of the thermostat. Doing this tricks the thermostat into thinking it is cold in the room by altering the feedback it is getting and artificially increasing the temperature. The main point here is to not, under any circumstances, take testosterone if you are trying to have children.

Nutraceuticals

Nutraceuticals are broadly defined as any non-FDA regulated substance. Basically, these are any of the products known as health or dietary supplements. All of these substances are not required to undergo rigorous testing for any of their reported uses as they consist of natural substances not synthesized chemicals. This means that their quality is not tightly controlled and that there are, unfortunately, many false claims for what they can do. Very few, if any of them, have robust studies backing them up. The good news is that most will not hurt your reproductive potential, and some may help, we just do not have all the data to back up these claims (with just a few exceptions). However, we are in general believers in alternative and complementary medicine as adjuncts to medical care and feel they can have a valuable role in treating patients.

The one nutraceutical, which we routinely recommend, is Coenzyme Q10 or CoQ10. We suggest that patients take 200 mg of this twice daily as four out of five studies have now shown a significant benefit of this drug in helping the sperm quality of men. CoQ10 works by acting as a cofactor in mitochondria, which are the power plants of all cells. CoQ10 is thought to lessen the damage caused by oxidative stress experienced by sperm (it is an anti-oxidant) and to help sperm move more efficiently.

Oncofertility

Oncofertility is a recently coined term to describe fertility preservation in men and women newly diagnosed with cancer. We will happily make any scheduling changes necessary to see newly diagnosed men with cancer who wish to bank sperm prior to undergoing chemotherapy or radiation treatments which could impact their reproductive health. Should men be azoospermic (no sperm in ejaculate), we are happy to provide surgical sperm extraction should this be desired by the patient. Patients must understand that future use of any of these samples may require in-vitro fertilization.

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