TESE, Micro-TESE, and Low Testosterone

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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.

The Problem of Low Testosterone/Low T

Studies have shown that after a TESE, or even Micro-TESE, there can be a significant drop in testosterone levels to the point where many patients will be considered hypogonadal. Some studies have shown this drop in testosterone to be temporary¹, while others have noted reduced testosterone levels for two years or more, including Dr. Turek, who pioneered the FNA mapping or testicular mapping procedure. Dr. Turek estimates that testosterone is lowered by upwards of 16% for two years or potentially even longer, equivalent to 10 to 12 years of natural aging.²

Why Does Low Testosterone Matter?

Many men think of the testosterone hormone as what makes them virile. To some degree, this is true, as testosterone is, at least in part, responsible for developing male traits. However, both males and females have testosterone, which regulates far more than just how “manly” you may be. Men with low testosterone often experience fatigue, loss of sexual desire, loss of muscle mass, and other lifestyle changes that can be very disruptive.

What Can Be Done?

If the drop in testosterone is, indeed, transitory, and patients have access to a male fertility specialist like Dr. Kapadia, some of these potential concerns can be addressed and resolved with thoughtful testosterone replacement therapy. However, synthetic testosterone comes with side effects, and ultimately, we prefer to promote a natural increase in testosterone instead. This can be, in part, achieved by improving exercise and diet habits, while also sleeping more and prioritizing quality sleep.

The effects of low T after a TESE or Micro-TESE procedure can also be mitigated by employing a urologic surgeon specializing in a straightforward procedure known as testicular mapping. Testicular mapping is a tried and true yet underutilized option that uses tiny needles to search for sperm in predefined mapped areas of the testes. According to research published by Dr. Kapadia and colleagues, over 55% of men were found to have sperm in their testes using testicular mapping, and those men can continue to have a Micro-TESE, with the knowledge that sperm can likely be retrieved. Without testicular mapping, the remaining 45% of patients would likely have undergone an invasive procedure without positive results.

As you can see, testicular mapping is useful for finding sperm in the testes. As such, Dr. Kapadia believes wholeheartedly that it is the future of sperm detection. To that end, he is one of only a handful of surgeons around the United States that perform these mapping procedures. We see patients from all over the Southeast United States and look forward to welcoming you to our office for more information on this and other male fertility questions.

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  1. Eliveld J, van Wely M, Meißner A, Repping S, van der Veen F, van Pelt AMM. The risk of TESE-induced hypogonadism: a systematic review and meta-analysis. Hum Reprod Update. 2018 Jul 1;24(4):442-454. doi: 10.1093/humupd/dmy015. PMID: 29726895; PMCID: PMC6016714.
  2. https://www.theturekclinic.com/blog/a-new-problem-popular-male-fertility-procedure-can-lower-testosterone-levels/
  3. Kapadia AA, Walsh TJ. Testicular Mapping: A Roadmap to Sperm Retrieval in Nonobstructive Azoospermia? Urol Clin North Am. 2020 May;47(2):157-164. doi: 10.1016/j.ucl.2019.12.013. PMID: 32272987.