Male hormone tests for couples trying to conceive

A male hormone test measures the hormones that drive sperm production, mainly testosterone, FSH and LH, and often prolactin. It is not usually the first male fertility test (that is a semen analysis), but it is the natural second step when a semen result is low, when a man has symptoms of low testosterone, or when a couple wants the male side checked as thoroughly as the female side.

Fertility conversations tend to focus on the woman's hormones. The man has a hormonal system too, running on the same signals from the same part of the brain, and it is just as testable.

How male hormones control sperm production

The chain starts in the brain. The pituitary gland releases two hormones, FSH and LH, into the bloodstream. In men, FSH acts on the cells in the testes that support developing sperm, while LH tells other cells in the testes to make testosterone. Testosterone, in turn, is needed in high local concentrations inside the testes for sperm to mature.

If you have read about the female cycle, these names will be familiar. FSH and LH are the same hormones that drive egg development and ovulation in women. The difference is that in men they run at a steady level rather than rising and falling across a monthly cycle, which makes timing the test far simpler.

What a male hormone test measures

• Testosterone. The main male sex hormone. Labs usually report total testosterone, and some also calculate free testosterone (the portion not bound to proteins in the blood). Low testosterone can affect sperm production, libido, energy and mood, and it can be a sign that the signals from the pituitary, or the testes themselves, are not working as expected.
• FSH. In men, FSH is a useful indicator of how the sperm-producing tissue is functioning. A high FSH with a low sperm count suggests the testes are struggling to respond, so the pituitary is pushing harder. A low FSH alongside low testosterone points the other way, to the signal itself being weak.
• LH. Read together with testosterone. High LH with low testosterone suggests the testes are not responding to the signal; low LH with low testosterone suggests the signal is not being sent.
• Prolactin. A hormone better known for its role in breastfeeding, but present in men too. Raised prolactin can suppress LH and testosterone and is one of the treatable causes a doctor will want to rule out.
• SHBG (sex hormone binding globulin). Sometimes included, because it changes how much testosterone is actually available to tissues. It is more useful in men who carry extra weight or have other metabolic factors.

Some panels add oestradiol, because men make a small amount of oestrogen from testosterone, and thyroid function, because thyroid problems can affect fertility in either partner. The glossary covers each of these markers in plain terms.

When a male hormone test is worth doing

• A low or borderline semen analysis. Hormones help a doctor work out why the count or motility is low, and whether it is likely to respond to treatment.
• Symptoms of low testosterone. Low libido, difficulty with erections, persistent tiredness, loss of muscle or reduced body hair. These overlap with many other causes, so a blood test helps sort them out.
• A history that raises questions. Undescended testes as a child, testicular injury or surgery, chemotherapy, anabolic steroid use (which strongly suppresses the body's own testosterone and sperm production), or a known pituitary condition.
• A couple wanting both sides assessed together. When the female partner is doing a fertility panel, testing the male partner's hormones at the same time gives the doctor the full picture in one sitting rather than two.

How to prepare for the blood draw

Testosterone follows a daily rhythm and is highest in the morning, so the standard advice is to have blood collected between about 8am and 10am. Levels are also lowered by acute illness, poor sleep and heavy exercise in the previous day or so, and a single low reading is usually confirmed with a second morning sample before anyone acts on it.

Fasting is not strictly required, but eating lowers testosterone for a few hours, so the Endocrine Society of Australia suggests a fasting morning sample where practical. Fasting also covers glucose or lipids if your doctor has requested those. If you take any supplements marketed for testosterone, or any anabolic steroids, tell the doctor, because they change the result dramatically.

Reading the result as a couple

The value of male hormone testing is in the pattern, not any single figure. A doctor looks at testosterone alongside FSH and LH to work out where in the chain a problem sits, and reads all of it alongside the semen analysis. A man with normal hormones and a low sperm count is a different situation from a man with low testosterone and high LH, and each has a different set of next steps.

Reference ranges for male hormones are set for adult men and vary between labs and analysers, so a result just outside the printed range is not automatically a problem. What matters is the combination and the clinical context, which is why a KnowLuna doctor can be added to walk through it, or your own doctor reads it if you brought their request.

Pathways and what it costs

The KnowLuna male hormone panel is $129 with your own doctor's request, or you can add a KnowLuna doctor for $59 to request the test and explain the result by video. Collection at an accredited centre is included. Many couples order it alongside the semen analysis and the female hormone panel so that one consult covers both partners.

Common questions

General information only, not medical advice. If your symptoms are severe or sudden, see a doctor promptly.