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TESE, Micro-TESE, and Low Testosterone

Posted on by Akash Kapadia, MD in ,

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TESEs were first performed in the early 1990s and provided men with a fertility option even if semen analysis showed no sperm – known as azoospermia. This ushered in an era of male fertility options that allowed urologists to retrieve sperm in about 30% of men, ultimately resulting in about 25% of men being able to become fathers. With 1% or so of all American men not having usable sperm in their semen, this was a major step forward.

Around the same time, we began to understand the landscape of male versus female infertility, and we now know that about a third of all infertility issues can be attributed to the male patient, a third to the female patient, and a third to both. So, finding a way to improve male fertility has addressed a key concern of couples struggling to conceive.

The TESE and even micro-TESE is an invasive procedure used for sperm extraction from the testes. Both require cutting into the testicle, at which point the urologic surgeon tests areas of the testicle for sperm. If sperm are found, they are extracted for later insemination.

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What to Know About Testicular Mapping

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While there’s plenty we don’t know, we have learned a lot about male fertility and reproduction over the past few decades. One of the most exciting areas of research and advancement has been in the management of male fertility concerns. Nonobstructive azoospermia was at one time considered difficult or impossible to treat, yet now, many men with no detectable sperm in their semen have become fathers. Today, there are several sperm extraction techniques available to these men, but most are invasive. As such, there has been a need for minimally invasive diagnostics to see whether sperm can be found in the testes.

This is where testicular mapping or FNA mapping comes into play. Testicular mapping is a highly effective, mildly invasive diagnostic procedure in which the testicles are mapped using fine needle aspiration. During the procedure, testicular tissue samples are removed and then analyzed to see if sperm is present. This has been a game-changer for patients that once only had the more invasive micro-TESE as their only option. The following information on testicular mapping should be of interest to men suffering from Azoospermia.

  • We expect to find sperm in about 50% of men with azoospermia
  • Over 30% of men are eventually able to become fathers as a result
  • It’s a Less-Invasive, similarly effective diagnostic option versus a Micro-TESE
  • It doesn’t reduce testosterone levels appreciably
  • Only a few physicians perform it around the US

Why a Second Procedure?

Knowing that testicular mapping is purely a diagnostic procedure, why wouldn’t we just use a micro-TESE that allows for both diagnosis and treatment? The answer is simple. About 50% of men with nonobstructive azoospermia do not have viable sperm in the testes. Both testicular mapping and micro-TESE are very good at identifying patients with viable sperm, but the micro-TESE does so in a much more invasive manner. That means that about 50% of our patients will have an unnecessarily invasive procedure that inhibits their lives and lifestyles and may even cause longer-term low testosterone.

Will It Hurt?

One of the best qualities of testicular mapping is how minimally invasive it is and how little the procedure hurts. To be sure, there will be some discomfort after the procedure as the anesthetic wears off. However, anesthesia is administered during the procedure, and patients do not feel appreciable discomfort. On the other hand, a micro-TESE can cause significant discomfort during the recovery period.

Is Micro-TESE a Bad Procedure?

While the above discusses the downsides of a micro-TESE versus testicular mapping, understand that these limitations are only in the diagnostic realm, and that is why Dr. Kapadia is one of the few urologic surgeons around the country to offer testicular mapping. However, as a sperm extraction procedure (something that testicular mapping cannot do), micro-TESE is the gold standard. If we know there is viable sperm in the testes, a micro-TESE is the most effective way to extract it and help our patients become fathers.

In short, working with Dr. Kapadia to optimize a diagnostic and sperm extraction plan can save time and discomfort in appropriate patients. Dr. Kapadia sees azoospermia patients from all over the southeast United States, and we look forward to scheduling a consultation with you to learn more about the diagnostic options that you may have.

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Can Tongkat Ali Boost My Testosterone? A Urologist’s Perspective

Posted on by Akash Kapadia, MD in , ,

Disclaimer: We want to address Tongkat Ali due to its recent and sudden rise in popularity, however, it is important to note that these studies are poorly designed and lack high-quality data. We can’t be sure of the benefits of Tongkat Ali until they are shown in well-designed clinical trials. Patients should consult with a physician regarding safety before starting any supplement regimen.

man dumping Tongkat Ali supplement from bottle into hand

Tongkat Ali or Longjack, an herb found in Southeast Asia and commonly used as part of traditional holistic medicine there, has risen in popularity due to claims about its effectiveness in increasing testosterone, reducing stress, and potentially even boosting male fertility. Various podcasters, including Joe Rogan and Professor of Neurobiology at Stanford University Andrew Huberman, have discussed this herb in depth. They posit that taking Tongkat Ali boosts antioxidant levels in the body to fight free radicals while normalizing certain hormones like testosterone and Cortisol. Do these claims hold water? Let’s dive in.

Before we evaluate each of these claims, it is important to note that the FDA does not oversee supplements. Therefore, you must do your due diligence about which supplements to buy, as their purity and concentrations can vary. Safety should be your primary concern. Continue reading “Can Tongkat Ali Boost My Testosterone? A Urologist’s Perspective” →