Fertility -- Men

This marker sits in Sense -- signals being produced, detected and acted on.

The primary male androgen; should be drawn in the morning (levels are highest then and fall through the day) and, ideally, confirmed on a second morning sample before acting on a low result.

Typical range: Conventional: total testosterone roughly 300-1000 ng/dL (lab/assay-dependent), free testosterone roughly 5-21 ng/dL (or calculated from total T + SHBG + albumin). The main urology guideline (AUA) sets a working diagnostic threshold around <300 ng/dL *with symptoms* for treatment consideration -- it does not endorse a higher "optimal" target. Functional-medicine opinion often favors the upper half of the range (600-900 ng/dL); this is not an established consensus target.

Food first: Healthy body weight (obesity lowers testosterone both through increased peripheral aromatization to estradiol and through lower SHBG), resistance exercise, adequate sleep, and avoiding chronic caloric restriction or overtraining are more consistently evidence-backed than any single supplement.

When to see someone: This is a sourcing problem more than a nutrient problem. Most commercial "testosterone booster" blends -- tribulus, fenugreek, D-aspartic acid -- do not hold up in trials, and the FDA has documented cases of such products containing **undisclosed anabolic steroids or prescription hormones**. That is a manufacturing and verification failure, and it is precisely why a product needs a traceable manufacturing record and published efficacy behind it before it is worth taking. Separately, a genuinely low result is worth a workup including LH and FSH, since those distinguish a testicular cause from a pituitary one -- and that changes what actually helps.

Pituitary gonadotropins; LH stimulates testicular Leydig cells to produce testosterone, FSH stimulates Sertoli cells and drives spermatogenesis. Together with testosterone, they distinguish primary (testicular) from secondary (pituitary/hypothalamic) hypogonadism.

Typical range: Conventional: LH roughly 1.5-9.3 mIU/mL, FSH roughly 1.5-12.4 mIU/mL (both assay-dependent). A high FSH with low testosterone points to primary testicular failure; low/normal LH and FSH with low testosterone points to a pituitary/hypothalamic cause.

Food first: Adequate total energy intake for high-training-volume men; beyond that, there's no dietary way to move LH/FSH in a man with a normal axis.

When to see someone: An elevated FSH with low testosterone needs medical workup for primary testicular failure -- not a nutrition-first approach.

In men, estradiol is produced mainly via aromatization of testosterone in adipose tissue; elevated levels (common with excess body fat) can suppress the hypothalamic-pituitary-gonadal axis and lower sperm counts, while very low estradiol (e.g., from aromatase-inhibitor misuse) impairs bone health and libido.

Typical range: Conventional: roughly 10-40 pg/mL (assay-dependent; sensitive/mass-spec assays may report differently than standard immunoassays).

Food first: Weight loss if overweight is the most evidence-backed lever; limiting excessive alcohol intake also helps (alcohol impairs hepatic estrogen clearance).

When to see someone: Aromatase-inhibiting drugs and supplements taken to push oestradiol down can over-suppress it, and the cost lands on bone density and libido. There is a floor here as well as a ceiling.

This marker sits in Sense -- signals being produced, detected and acted on.

A liver-made protein that binds testosterone and estradiol, controlling how much circulates free and biologically active.

Typical range: Conventional: roughly 10-57 nmol/L in men (lab/assay-dependent).

Food first: Weight management (higher body fat is associated with lower SHBG in men), adequate but not excessive protein intake.

When to see someone: Treat boron/DIM supplement marketing claims skeptically -- plausible biochemistry, weak outcome evidence.

A pituitary hormone; in men, meaningful elevation suppresses testosterone and libido and, if markedly high, suggests a prolactinoma or medication effect.

Typical range: Conventional: roughly 4-15.2 ng/mL (assay-dependent).

Food first: General stress management and adequate sleep; no reliable dietary lever exists for a truly elevated level.

When to see someone: A significantly elevated prolactin in a man needs medical workup, including pituitary imaging if very high -- this is not a nutrition-first situation.

How many sperm are present and in what volume of ejaculate -- the most basic quantitative fertility screen.

Typical range: WHO 6th edition (2021) lower reference limits (5th percentile of a fertile reference population): semen volume >=1.4 mL, sperm concentration >=16 million/mL, total sperm number >=39 million per ejaculate. (cite: World Health Organization, WHO Laboratory Manual for the Examination and Processing of Human Semen, 6th edition, 2021)

Food first: An overall antioxidant-rich diet, healthy body weight, limiting alcohol/smoking/cannabis (all associated with lower counts), and avoiding chronic scrotal heat exposure (frequent hot tubs/saunas, laptop directly on lap) -- the heat-exposure evidence is weaker than the others but biologically plausible and low-cost to address.

When to see someone: A single semen analysis is noisy -- sperm production takes roughly 72-90 days, so a recent fever, illness, or heat exposure can transiently tank a result. Always repeat an abnormal semen analysis before drawing conclusions, and get a urology/reproductive-endocrinology referral for severely abnormal results rather than relying on supplements alone.

The percentage of sperm that are moving (total motility) and moving in a purposeful, forward direction (progressive motility) -- the parameter most consistently linked to natural conception ability.

Typical range: WHO 6th edition (2021) lower reference limits: total motility >=42%, progressive motility >=30%.

Food first: Fatty fish 2-3x/week or an algae-based EPA/DHA supplement for the general omega-3 signal; otherwise the same overall pattern as the Concentration section.

When to see someone: Same repeat-testing caveat as above -- don't over-interpret a single abnormal motility result.

The percentage of normally shaped sperm by strict (Kruger) criteria. Of the three classic semen parameters, morphology correlates the least reliably with actual conception ability on its own.

Typical range: WHO 6th edition (2021) lower reference limit: >=4% normal forms by strict criteria.

Food first: Same general antioxidant-supportive dietary pattern as the Concentration section; nothing morphology-specific beyond that.

When to see someone: Don't over-interpret an isolated low morphology percentage as "the cause" of infertility -- it needs to be weighed alongside count, motility, and the female partner's workup.

The percentage of sperm with damaged or fragmented DNA (measured via SCSA, TUNEL, or Comet assay -- results are **not** interchangeable across these methods). Elevated fragmentation is associated with lower IVF/ICSI success and higher miscarriage risk even when standard semen parameters look normal.

Typical range: Assay-dependent; commonly cited SCSA-based bands are <15% (good), 15-30% (fair/moderate), >30% (poor), though there is no single validated clinical cutoff that applies across all assay types, and ASRM has not endorsed universal testing for this reason.

Food first: Reducing broad oxidative-stress exposures -- smoking cessation, limiting heat/toxin exposure, treating a varicocele if present, moderating alcohol -- has more consistent mechanistic logic behind it than reaching for any single supplement to lower DNA fragmentation.

When to see someone: High-dose combined antioxidant supplementation is not automatically risk-free. In other contexts (e.g., cancer-prevention trials), high-dose antioxidant supplementation has paradoxically worsened outcomes -- the "antioxidant paradox" -- and there's no evidence that piling on multiple antioxidants at high doses helps a nutrient-replete man. Favor modest, targeted doses of specific nutrients over mega-dosing a combination product.