Understanding Blood Test Results: Normal FSH levels in men

Responsible for kicking off a long chain of events that spurs sperm production, Follicle Stimulating Hormone (FSH) is the best hormonal indicator of the testicle’s ability to produce sperm and a primary hormone to be measured in the evaluation of male fertility.

FSH levels in men

Responsible for kicking off a long chain of events that spurs sperm production, Follicle Stimulating Hormone (FSH) is the best hormonal indicator of the testicle’s ability to produce sperm and a primary hormone to be measured in the evaluation of male fertility.

What is Follicle Stimulating Hormone?

FSH is the hormone responsible for the maturation of eggs in women. If you’ve been researching fertility for a while, your wife may have had an FSH test to ensure that her eggs were “good.”  You may have also leaned that synthesized FSH is often given as an injectable medication to regulate ovulation and the maturation of eggs. During IVF, it is used to hyper-stimulate ovaries to produce multiple eggs for retrieval.

FSH is equally important in men. It plays a critical role in sperm production. There is a complicated hormonal feedback system between the brain and the balls that enables the testicles to accomplish their two primary jobs of producing sperm and testosterone. The process starts in the brain where the hypothalamus (the part of your brain that regulates things like hunger, sleep and body temperature) releases a hormone called Gonadotropin-releasing Hormone (GnRH). GnRH flows down to the pituitary gland and stimulates the release of LH and FSH. FSH gets into the blood stream which takes it to the testicle. Once in the testicle, FSH stimulates germ cells to divide, which is the first step in spermatogenesis. FSH is also absorbed by testicular sertoli cells enabling them to “nurse” baby sperm and help them to develop properly. Normal sperm production requires a minimum level of FSH, LH and Testosterone.

Getting Tested

To measure FSH levels, men need to get a blood test done. Typically, to fully evaluate male fertility, doctors will order a blood test to measure a panel of hormones which usually includes FSH and Testosterone. They may also add Luteinizing Hormone, Estrodial and Prolactin which will provide additional information and insight into your hormonal health.

In a normal day, hormone levels cycle from high to low. Testosterone naturally peaks first thing in the morning (partially responsible for morning wood) For this reason, doctors prefer to measure hormones between 8-10am to get a snap shot of your hormone profile when Testosterone level is likely to be highest.

When preparing for a FSH test there are a few things to make sure your doctor is aware of:

  • Current medications
  • Current or past use of testosterone supplements, anabolic steroids, clomid or other performance enhancers (If you are using something at the gym and aren’t quite sure what it is, you should bring it with you to the appointment.)
  • Recent use of marijuana as it my decrease a number of hormones levels, including FSH

Normal FSH range for adult men: 2-7 mIU/mL

Reference ranges reported for FSH vary greatly from lab to lab. Some have ranges as large as 1-20mIU/mL. These reference ranges are not typically considering “normal” to be a “fertile” range, rather the ranges that can be observed in a large population of men. Normal FSH values for fertility are typically reported between 1-11.1mIU/mL, several recent studies suggest a tighter range of 2-7mIU/mL as more indicative of predicting normal sperm production in men.

Many studies have shown that FSH levels are closely linked to sperm production and can provide a good, non-invasive window into how well the testicles are working. A large study of over 2,000 men showed an average FSH value of 4.2 mIU/mL with a range of 1.8 – 6.8 for men with a normal semen analysis. Other studies comparing fertile and infertile men showed that fertile men typically had FSH levels from 2-5 mIU/mL. Men with low sperm counts often had FSH values that were slightly elevated, ranging from the 5-8.5 uIU/mL. FSH levels above 8 typically correlate with additional reductions in sperm count. Men with azoospermia will often have FSH values above 10 uIU/mL which can go as high as 40 or 50uIU/mL.  Sometimes azoospermia can be caused by a blockage that prevents sperm from exiting the body rather than a failure by the testicle to produce sperm to begin with. In these cases, azoospermic men will often have normal FSH numbers and are good candidates for corrective surgeries or sperm extractions.

What causes high FSH in Men?

Typically, if FSH is high then some sort of damage is causing the testicle to not function as well and the pituitary gland is trying to compensate by going into overdrive and flooding the balls with extra FSH to support spermatogenesis. In cases like this, FSH levels are often off the charts high sometimes double or triple the normal values. Common causes for this include:

What causes low FSH in Men?

The most common reason for FSH deficiency in men is the use of external androgens (testosterone, anabolic steroids or other performance enhancers). External androgens trick the brain into thinking the body is producing naturally high levels of testosterone which shuts down production of follicle stimulating hormone and consequently sperm production. This is most exaggerated in men who have used steroids for long periods of time.

The second most common cause of low FSH levels is a health issue that directly impacts the function of the pituitary gland itself. Most common causes of pituitary malfunction include:

  • Genetic conditions such as Kallman’s Syndrome or Prader-Willi Syndrome
  • Pituitary tumors (cancerous and benign)
  • Hyperprolactinemia
  • Head trauma
  • Various Medications
  • Auto-immune disorders

References

Chen SC1, Hsieh JT, Yu HJ, Chang HC. Appropriate cut-off value for follicle-stimulating hormone in azoospermia to predict spermatogenesis. Reprod Biol Endocrinol. 2010 Sep 8;8:108. doi: 10.1186/1477-7827-8-108.

Andersson AM1, Petersen JH, Jørgensen N, Jensen TK, Skakkebaek NE. Serum inhibin B and follicle-stimulating hormone levels as tools in the evaluation of infertile men: significance of adequate reference values from proven fertile men.J Clin Endocrinol Metab. 2004 Jun;89(6):2873-9.

Grunewald S1, Glander HJ, Paasch U, Kratzsch J. Age-dependent inhibin B concentration in relation to FSH and semen sample qualities: a study in 2448 men. Reproduction. 2013 Mar 1;145(3):237-44. doi: 10.1530/REP-12-0415. Print 2013 Mar 1.

Dandona P1, Rosenberg MT. A practical guide to male hypogonadism in the primary care setting. Int J Clin Pract. 2010 May;64(6):682-96. doi: 10.1111/j.1742-1241.2010.02355.x.

Bhasin S. Approach to the infertile man. J Clin Endocrinol Metab. 2007 Jun;92(6):1995-2004.

Lima N1, Cavaliere H, Knobel M, Halpern A, Medeiros-Neto G. Decreased androgen levels in massively obese men may be associated with impaired function of the gonadostat. Int J Obes Relat Metab Disord. 2000 Nov;24(11):1433-7.

Christina Carnegie, MB, BS, FFPM Diagnosis of Hypogonadism: Clinical Assessments and Laboratory Tests Rev Urol. 2004; 6(Suppl 6): S3–S8.

AACE Guidelines for the diagnosis and treatment of hypogonadism in adult men, updated 2002

Irvin Hirsch, Male Hypogonadism, Merck Manuals Dec 2014


Sara SDx

Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.
Sara SDx

Author: Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.

46 thoughts on “Understanding Blood Test Results: Normal FSH levels in men”

  1. Hi. My FSH is 24.50 IU/L, LH is 8.8 IU/L and testosterone is 237 ng/dL. I have zero spermatozoares. I am 33 years, 96 kg and i have normail life that meen i have not any physical problem. Whats is the problem? Thax

  2. Hello
    I am a 31 year old male.
    My FSH is 21, testosterone is 13.
    Did semen test and got zero count with azoospermia diagnostic.
    Testicular exam revealed no abnormalities except a bit of Varicose on the left testicule 3.5mm.
    Dr. is saying low chance of success but try sperm collection through a biopsy.
    Any insight would be greatly appreciate.
    Hanna

    1. Hi hanna,
      The doc is likely right on this. Usually, high FSH + zero sperm = some sort of testicular damage that can be permanent. This can come from genetics, illness, injury, infection, steroid use and a few other causes. Did you ever have anything happen that could harm the testicle? Have you been tested for Y deletions?

      Sometimes there is sperm still inside the testicle but not enough to make it all the way out of the body. During a biopsy they can look at the tissue and see how healthy it is and if there are any sperm. If they find sperm, they can save if for use during IVF.

      There are several options for you to consider for building a family. You may want to talk to the doctor about this …if you haven’t done genetic test, that might be useful information.

      Does that help clarify? Do you have other questions?

    1. Generally the high FSH level is in response to some sort of damage to testicle tissue. It is not bad for you to have elevated levels of FSH, it won’t hurt you. It’s just a natural reaction of the body to try to help the testicle work harder. You can try to discuss more with your doctor.

    1. That’s generally a next step. Often you can think about doing a sperm extraction at the time of biopsy. You should discuss options with doctor to put together a full plan to minimize invasive procedures.

  3. Hi,

    My husband had lost a testicle at birth. It was dead so they removed it. We went through and IVF ICSI cycle and he had a very low sperm count. We had two beautiful boys but wanted to go through another cycle. His last 3 counts have come back at 0. He has a grade 3 varicocele and also had a large inguinal hernia repair on his left side which is the side of his only testicle. Our urologist wants to fix the varicocele and perform TESE at the same time. Do you think we have any hope of finding sperm? We aren’t sure why he was producing a small amount and no longer is.

    Thank you!

    1. Sounds like there is a reasonable chance of finding sperm. overall, sounds like a good plan. It sounds like you are working with a good doc.

      Has he been tested for deletions? All other hormones normal and FSH high is a little bit of a head scratcher. That sometimes signals a decline in testicle’s ability to make sperm.

      Could be the varicocele getting worse (they can get worse over time) could be the repair clipped something and testicle is performing as it was but nothing coming out.

      1. We are really confident with the dr we found. He said he thinks we have a 70% chance of finding sperm. He’s worried that because the varicocele and inguinal hernia repair are all on the same side of the one testicle that both could be hurting his ability to ejcualte sperm. He was never tested for deletions and our dr didn’t even mention testing for that. He suggested doing the varicocele repair then waiting 6 months if we were comfortable doing TESE. We figured we might as well just do it all at once to see if that gives us more answers.

        1. Ya, I think that’s a reasonable plan. If there’s a lot of sperm in the testicle — there’s your answer. Glad you found a good doc. Let me know if other questions come up 🙂

          1. Sara,

            We did the TESE and found no sperm. Waiting to hear anything from pathology. Dr still thinks we have a shot in 3 months after the varicocele of finding some sperm. He said he had 8 large veins that were fixed. Do you believe that is true? We are worried that the high FSH level means there is no chance at all. Thanks for the advice!

          2. Posted on your other thread, but repeating here in case you don’t see it there:

            If the doc still thinks there’s a shot of finding sperm, its at least worth getting tested in 3 or 6 months. I would test semen, T and FSH. It would give you a sense of if the varicocele was causing the damage or if it was from birth issue. Generally, if they were in doing a TESE they would get an impression of how healthy the tissue was.

            None the less, hard to tell with these things. You may as a couple want to start discussing how you feel about various back up options. Sometimes that is an emotional process that takes time to work through. You may find yourselves on different pages and it is important to hear each other’s perspectives and commit to something that you both can feel good about.

            I’ll be keeping my fingers crossed that the varicocele repair helps improve things…. if you’d like a list of alternative back up options I’m happy to get you started with things I know about.

            XO. Sending big hugs to you both. I know this stuff is hard. You are doing a great job getting educated and advocating for yourselves.

  4. My FSH is 10.8
    Testosterone 12.3
    Free Testosterone 317 pmol/L
    TSH 2.45
    SHBG 23
    ALB 39
    We both are 32years old have been try regularly for last 1 year now.
    GP has suggested me to try for few more months but has told me that he can refer me for semen test if I want. Should we keep trying for baby or should I go for semen analysis?

    1. I would recommend it. Hard to tell what’s going on with sperm without semen analysis.
      If semen analysis looks normal, then keep trying. If not, then you have something that you can work on. There isn’t a downside.

  5. My FSH is 1.5 ….and sperm count is. 40 millions …..active sperms 70%and normal shape is 60,%but. I have. 3 grade varicosele on left. And grade one. On. Right one ..but since I have. This. Probvlem …I had a probvlem of. Erection and. Premature ejaculation …why is. That. …I am 30 yes. .. unmarried.

    1. Did they measure testosterone level?
      Varicocele can impact testosterone production, cause problems with sperm and sexual function. Does the varicocele cause pain?

  6. My name is Saeed. My age is 38 Years Old
    My Sperms Count result is nil. 0
    ________________________________________________
    My Serum PROLOCATIN is………………9.47 ng/ml
    SERUM FSH is……………………………….33.9 mIU/ml
    SERUM TESTORNE are: ………………..319.4 ng/dl

    Please tell me, is it recoverable

    1. something is up. Do you have a urologist or endocrinologist that you could consult with? There are a lot of possible reasons for hormones in these ranges and you should get a full exam by a doctor who is trained in male reproduction to figure out your next steps.

      1. Respected Mis Sara, I am going to get complete medical examination from urologist this week. I will get back to you with results. Thank you so much for your replay and such great work. hats off………

      2. Can I request you to please send me your email ID, where I can send the reports in attachments. I went to the doctor and with level of 33.9 FSH, said that there is no option to recover in such cases.

        1. Unfortunately, this high level of FSH with a low sperm count usually means there is damage to the testicular tissue and there isn’t much that doctors can do to recover. Sometimes they can confirm with additional tests or biopsies but these things can be pretty expensive. Did you discuss any additional testing with your doctor?

  7. My prolactin was 11.92 ng/ml
    My follicle stimulating hormone 2,11 mlU/ml
    Free testosterone with E.L.I.S.A (technology) 20.71 pg/ml ref. range 4.25-30.37
    Testosterone C.L.I.A (technology) 453.6 ng/dl 241-827
    Did semen analysis and testicle tests already. We are based in the Middle East and been trying for over a year.

  8. My fsh is 22. We are having issues with conceiving. Testosterone is 8. What should we do?

    1. Did you get a semen analyis done? What are the units on the FSH and testosterone. Do you have symptoms of low T? Have you experienced any problems with your testicles? Have you visited a urologist?

  9. My fsh level is.96 and testosterone level is 6.8 and I don’t have facial hair at the age of 23.5years

    1. You should get a full evaluation by an endocrinologist or a urologist to better understand what’s going on.
      Often, high FSH, low Testosterone means there is some damage that has happened to the testicle.

  10. Hi My FSH level is 18.05 and as per report testicle is smaller too, hOw can I reduce it so it will come normal?

    1. Sorry for the delay responding. I’ve been traveling for the past month.
      Are you currently talking to a urologist?
      Did anything to damage the testicle?
      Are you trying to conceive? What prompted the test?

  11. If not. Then can it be increased by good diet n excercise. My Testosterone hormone is in normal range. Plz advice

      1. I wad not comfortable at hospital to give semen. I finished my office and went to hospital. I gave my blood sample evening at 7:00 pm on tuesday. My testosterone was 2.85 and ref range was 2.49 to 8.00. My fsh was 3.51 miu/ml. One important point is that my testosterone report came on same day but fsh report came almost after 36 hrs. It means that hospital chek my sample for fsh on thursday. Does time period decrease the harmonal levels. I want to know thar These hormone can be increased by taking good diet and exercise. My work is desk work. From morning to evening i do sitting work. From last 3 month i m daily taking almond walnut and fruits. Please guide me properly. We r trying for child from last 8 months.

  12. Anything that lowers LH and FSH levels, such as a pituitary tumor, can result in low or no sperm production and low testosterone levels. Chronic illness, poor overall health, obesity, and drug abuse may also decrease sperm production and fertility.

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