Erections and Sperm counts are both on the decline, but are they linked?

Two trends that have been identified but have yet to be linked is the increasing number of reported cases of erectile dysfunction in young men and the plummeting sperm count of men in North America, Europe, Australia, and New Zealand.

Yet, the connection should seem to be apparent. The area of interest, men’s genitalia, is identical and the organs involved serve scant more biological purpose than to fulfill man’s part in the procreative process. It makes sense that what is affecting men’s ability to get erections may overlap with what is causing their counts to plummet. The question then is whether the increase in young men’s problems with erectile dysfunction and the decrease in men’s sperm count in these developed countries are related.

I suspect they are.

The Facts

An Italian study published in 2013 by Capogrosso, et al., (J Sex Med. 2013 Jul;10(7):1833-41) noted that of 439 men with erectile dysfunction, 114 (26%) were under 40 (mean age 32). Worse, nearly half of them had severe ED. What is fascinating is that what distinguished these men from older individuals were lifestyle issues known to affect erections: smoking, illicit drug use, and alcohol consumption. The young men were less likely to have other illnesses, to have leaner body masses, and to have higher testosterone levels than their older counterparts. How they lived impacted how they functioned.

Indeed, in a Swiss study (J Adolesc Health.2012 Jul;51(1):25-31), approximately 30% of young men experienced erectile Dysfunction (ED). They noted that “ED was directly linked with medication without a prescription, length of sexual life, and physical health.” They concluded, “Multiple health-compromising factors are associated with these dysfunctions (ED and PE–Premature Ejaculation). These should act as red flags for health professionals to encourage them to take any opportunity to talk about sexuality with their young male patients.”

So what’s the deal

It is possible that the increase in the number of young men is simply related to the availability of a well advertised solution for ED. However, I doubt that is the case. If a properly functioning penis is important to any group it would be young men. It is unlikely the lack of an advertised solution would be a deterrent to seeking a solution.

So, the rise is likely real.

The decrease in the sperm count was first identified in 1992 (BMJ 1992;305(6854):609-613) in The Carlsen Study. The results showed a definite trend of lower sperm counts over a 50 year period, as well as lower sperm concentration. The data was accumulated by reviewing 61 papers published between 1938 and 1991. The initial data was considered a bit weak because it had a bulk of patients coming from just one study, approximately 30%.

However, a new study published in July 2017 found that sperm counts were indeed dropping. The paper included the results of 185 studies performed between 1973 and 2011 and included over 49,000 men. A 52.4% decline in sperm concentration and a 59.3% drop in sperm count were identified. (Human Reproductive Update, 2017;23(6):646-659)

Both trends are real and it is hard for me to imagine that they are unrelated. It is noteworthy that the sperm count and sperm concentration declines have occurred in industrialized Western countries (North America, Europe, and Australia) but not in Asia, Africa, or South America.

Reasons for change in sperm count

The changes in sperm counts will almost certainly be attributable to an array of influences. Environmental factors like pesticides, or plastics, or fire retardants, or paints must all be considered. However, as with young men who experience ED, some major culprits will be found in lifestyle choices. Before bemoaning global warming, the contributing factors that doesn’t require an international treaty and 30 years to remedy should be addressed.

Consider all the factors that can lead to erectile dysfunction and can lower sperm counts. There are over 200 medications that can contribute to ED and the list of drugs that affect sperm count is long, as well. Sperm quality can be affected by more than anabolic steroids and chemotherapeutic drugs. Medications used to treat ulcers (e.g. Cimetidine), antibiotics, antifungal agents, and a growing list of pharmaceuticals can affect sperm production and cause ED.

Drugs like cocaine and marijuana have a similar impact. Their connection with erectile dysfunction is well known; however, few people realize that consuming pot can lower not only sperm counts and alter sperm morphology (if used within a 3 month window) (Human Reproduction 2014;29(8):1629-1636) but can lower testosterone levels as well. In one study, 1,200 men, ages 18 to 28, were studied to see if pot smoking affected their semen. The study found that “regular marijuana smoking more than once a week was associated with a 28% lower sperm concentration and a 29% lower total sperm count.” (American Journal of Epidemiology 2015;182(6):473-481)

Smoking is another particularly notorious contributor to these dual issues. In fact, according to one study, “smoking and the use of recreational drugs are the most significant risk factors for organic ED in patients younger than 40 years.” (J Androl, 2009;30(5):520-524)
Obesity can result in both ED and a lower sperm count. Similarly, so can a lack of exercise, smoking, stress, poor sleep habits, and a poor diet. Chronic illnesses like kidney disease (World J Nephrol, 2014;3(4):220-229) and liver disease (Clin Mol Hepatol, 2015;21(4):352-357) can result in ED and decreased sperm counts. The list can seem endless.

The main point is that until all the unknown factors that are affecting young men’s ability to have erections and maintain their fertility are known, we should be focusing our attention on the factors we know will optimize their sexual health.