Hormone Biomarkers: Follicle-Stimulating Hormone (FSH) in Men

Optimal Takeaways

Follicle-stimulating hormone is produced in the pituitary gland and directly affects ovaries, testes, and reproduction. In males, FSH regulates sperm count and quality, and decreased levels will have a negative effect on fertility.

Lower levels may be associated with dysfunction of the pituitary or hypothalamus and should be investigated. Higher levels of FSH in men are associated with caloric deficit, pituitary adenoma, and unresponsive testes. Elevated levels may interfere with artificial reproductive techniques and increase the risk of castration-resistant prostate cancer.

Standard Range: 1.40 – 12.00 mIU/mL                             

The ODX Range: 1.60 – 8.00 mIU/mL  

Low male FSH is associated with hypothalamic or anterior pituitary dysfunction (Orlowski 2021).

High male FSH in males is associated with pituitary adenoma, unresponsive gonads, primary impairment of spermatogenesis, and caloric deficit (Orlowski 2021). Elevated levels may be associated with decreased success in retrieving sperm for reproductive therapy.

Overview

Follicle-stimulating hormone is a glycoprotein produced by the anterior pituitary. It affects the ovaries and testes and influences sexual development and reproduction in males and females. In males, FSH regulates spermatogenesis and works with testosterone to maintain sperm count and function. An insufficiency of FSH can negatively affect the number and quality of sperm (Orlowski 2021).

In one prospective study of azoospermic men, those with a higher mean elevated FSH of 28.03 mIU/mL failed sperm retrieval. In contrast, those with a mean FSH of 7.94 mIU/mL underwent successful retrieval. Researchers note that elevated FSH can damage the seminiferous tubules' epithelium and suggest a 19.4 mIU/mL cut-off to predict the likelihood of sperm retrieval for artificial reproductive purposes (Chen 2010). Research suggests that FSH therapy may be effective for infertility in men with an FSH of 8 mIU/mL or below despite FSH being within the conventional range (Santi 2020).

Higher FSH levels may increase the risk of castration-resistant prostate cancer (CRPC) in men undergoing androgen deprivation therapy (ADT). A retrospective study of 323 men with advanced prostate cancer undergoing ADT found that those with FSH above 4.8 mIU/mL had the fastest conversion to CRPC. In contrast, those with FSH of 4.8 mIU/mL or below had the longest time to CRPC development (Hoare 2015).

References

Chen, Shyh-Chyan et al. “Appropriate cut-off value for follicle-stimulating hormone in azoospermia to predict spermatogenesis.” Reproductive biology and endocrinology : RB&E vol. 8 108. 8 Sep. 2010, doi:10.1186/1477-7827-8-108

Hoare, Dylan et al. “Serum follicle-stimulating hormone levels predict time to development of castration-resistant prostate cancer.” Canadian Urological Association journal = Journal de l'Association des urologues du Canada vol. 9,3-4 (2015): 122-7. doi:10.5489/cuaj.2545

Orlowski, Michelle. and Manbeer S. Sarao. “Physiology, Follicle Stimulating Hormone.” StatPearls, StatPearls Publishing, 9 May 2021.

Santi, Daniele et al. “Follicle-stimulating Hormone (FSH) Action on Spermatogenesis: A Focus on Physiological and Therapeutic Roles.” Journal of clinical medicine vol. 9,4 1014. 3 Apr. 2020, doi:10.3390/jcm9041014