Why Semen Analysis Fails to Inform—and Testosterone Fails to Help—Male Fertility
Is the Semen Analysis Worth It?
This is basically the question Italian investigators recently asked in a Review/Opinion article in Endocrinology,¹ and the answer was, maybe not!
Here are some of the more interesting conclusions:
(i) Making semen analyses over the years—based on WHO recommendations—more and more complicated, did not improve the ability to interpret results and to better understand “what is going on in the testes.”
(ii) In association with IVF, the male partner is (within reasonable parameters), still, merely considered as a relatively unimportant “sperm provider.”
(iii) Consequently, there is a general believe that there really is no need for better semen analysis tools (we plead guilty!).
(iv) Some recent investigations have suggested that sexual arousal may produce better semen samples than masturbation, the usual way specimens are produced.
(v) Semen analyses have been shown to differ significantly between laboratories. (vi) Some newly developed tests may have additive diagnostic value (we are not sure of that at all!).
And (vii) the authors recommend “move away” from the centrality of the semen analysis in evaluating men.
What this review really informed us about is that the CHR’s current understanding of a semen analysis is basically correct; As long as a semen sample is within “reasonable” parameters in count, motility, and morphology, further detail is irrelevant, as long as ICSI is available.
Reference
Furini et al., Endocrine 2025.90:1067-1078
The Pendulum Continues Swinging When It Comes to Male Testosterone Supplementation
Who thinks that androgen supplementation is controversial only in women is, of course, mistaken. It, indeed, may be even more controversial in men because the indications are so much more variable. Testosterone supplementation in men trying to impregnate their partners is, of course, contraindicated because it will shut down sperm production in the testes. But otherwise, an FDA panel of experts recently published new recommendations for testosterone supplementation in men, which loosened prior restrictions.¹
Comprised of urologists and health officials (and no fertility specialists), the panel recommended loosening restrictions beyond only low T (hypogonadism)for men, calling for expanded FDA-approved uses beyond disease-induced low T to include age-related declines. In addition, the FDA removed T’s controlled substance status. The change in recommendations was based on prior changes in guidelines from major medical societies and the observation that prior stricter rules led to more unregulated and unsupervised T utilization.¹
As a panel recommendation, these changes are only “advisory,” and the FDA leadership must now make final decisions, though the expectation is that this final decision will follow panel recommendations.
Reference
FDA. December 2025. FDA panel on testosterone replacement therapy for men. https://www.google.com/search?q=FDA+panel+on+testosterone+replacement+therapy+for+men&rlz=1C5CHFA_enUS1083US1083&oq=FDA+panel+on+testosterone+replacement+therapy+for+men&gs_lcrp=EgZjaHJvbWUyBggAEEUYOdIBCjI1NjgxajBqMTWoAgiwAgE&sourceid=chrome&ie=UTF-8