Semen Analysis and Hormonal Treatment Concerns

Semen analysis and questions related to hormonal medications?

Question 1: Hello Doctor, yesterday (April 26) I had a semen analysis, and the results are as follows: Liquefaction time: 50 minutes; Appearance: gray; pH: 8; Volume: 2.5 ml; Aggregation type: Grade 2; Concentration: 98 x 10^6 sperm/ml; Total sperm count: 245 x 10^6 sperm/ejaculate; Sperm motility: 82%; Total motility at 60 minutes: 83%; Progressive motility at 60 minutes: 75%; Morphology: 14%; White blood cells: 2 x 10^6/ml; Red blood cells: 0.
The liquefaction time is slightly longer (but in the past, I observed it usually liquefies in about ten minutes).
The white blood cell count should be less than 1, and mine is 2.
I would like to know if it is necessary to see a doctor.
Question 2: My libido is quite low; watching videos or physical contact with others does not excite me.
I just feel normal, like it’s just a body and contact, with no emotional response.
I experience morning erections 2-3 times a week, with varying firmness.
I previously visited a urology clinic and purchased Cialis, but it was not very effective.
Even a dose of 5 mg caused severe headaches and a feeling of being feverish, like having a heavy cold, and I am generally sensitive to bodily reactions.
Emotionally, I feel "overcast," lacking the lightness I used to feel, and I have negative emotions such as helplessness, depression, and anger.
Currently, I have graduated and have no academic pressure; my part-time job is just administrative work, so there is no work stress.
However, I have shallow sleep and easily suffer from insomnia.
In recent years, I have suspected anxiety and autonomic nervous system dysregulation.
My current symptoms include: 1.
Low libido, 2.
Fatigue, 3.
Poor mood, 4.
Insomnia, 5.
Delayed ejaculation (taking a long time with no sensation, and even becoming softer), 6.
Inability to complete intercourse (insufficient firmness), 7.
The penis begins to soften within 10-30 seconds of lacking stimulation, and I cannot maintain an erection without sexual arousal.
However, if I keep my hand on it continuously, I can ejaculate.
In real sexual intercourse, there will inevitably be moments of pause, but hugging, kissing, and touching do not evoke or maintain my sexual desire.
Additionally, I have had testosterone tested twice (blood drawn before 10 AM); the first result was 627 ng/dL, which the doctor considered somewhat low, so a second test was done (including luteal phase and brain tests), resulting in 745 ng/dL, which the doctor said was normal.
However, I hope to ideally reach 1100-1200 ng/dL.
Question 3: This is a matter of personal preference.
I would like to ask if it is possible for an average person to receive human chorionic gonadotropin (hCG) injections, or if a doctor’s diagnosis is required to confirm necessity before self-paying for the injections? I ask this because I hope to increase the size of my testicles, which are currently about 20 ml (but is 2.5 ml of ejaculate from 20 ml testicles too little?).
I hope to exceed 30 ml (30 ml) to achieve a greater volume of ejaculation, purely as a preference.
I also understand that this, like testosterone injections, may affect libido (enhancing it).
However, I am unsure if there are safety concerns for the average person receiving hCG injections.
Will administering this hormone (for 3 months to 1 year) increase the risk of testicular cancer? I hope to promote healthy and safe testicular development without the formation of lumps.
These are my three questions; thank you, Doctor, and I wish you health and happiness.

Mr. Lin, 20~29 year old female. Ask Date: 2023/04/27

Dr. Fu Shizhang reply Urology

In summary, it is recommended that online consultations with a urologist cannot replace an in-person consultation and physical examination by a physician.
If there is a medical condition, it is still advised to seek care at a medical facility.

Reply Date: 2023/04/27

More Info

Understanding semen analysis and hormonal treatment concerns is a multifaceted issue that encompasses various aspects of male reproductive health, hormonal balance, and psychological well-being. Based on your inquiries, let's break down the concerns and provide a comprehensive overview.

Question 1: Semen Analysis Results
Your semen analysis shows several parameters that warrant attention. The liquefaction time of 50 minutes is longer than the typical range (usually around 15-30 minutes), which could indicate a potential issue with seminal fluid consistency. The presence of leukocytes (2 million/ml) is slightly elevated, as normal levels should ideally be below 1 million/ml. This could suggest an inflammatory response or infection, which may require further evaluation by a healthcare professional.

Given these results, it is advisable to consult a urologist or a fertility specialist. They can provide a more in-depth analysis of your semen quality and determine if any underlying conditions need to be addressed. Additionally, they can help interpret the significance of the elevated leukocyte count and longer liquefaction time in the context of your overall reproductive health.

Question 2: Low Libido and Associated Symptoms
Your description of low libido, fatigue, mood disturbances, and sleep issues suggests a complex interplay of physical and psychological factors. Low testosterone levels can contribute to decreased sexual desire and erectile dysfunction, but your recent testosterone tests indicate levels within the normal range, albeit on the lower end. It's important to note that testosterone levels can fluctuate and may not fully explain your symptoms.

The side effects you experienced with medications like sildenafil (commonly known as Viagra) are not uncommon, especially in individuals who are sensitive to medications. The headaches and feelings of malaise you described could be side effects of the medication rather than a direct result of your underlying condition.

Given your symptoms of anxiety, depression, and sleep disturbances, it may be beneficial to explore a holistic approach that includes psychological support, lifestyle modifications, and possibly medication adjustments. Cognitive-behavioral therapy (CBT) or counseling could help address the emotional aspects of your condition, while lifestyle changes such as regular exercise, a balanced diet, and good sleep hygiene may improve your overall well-being.

Question 3: Use of hCG and Safety Concerns
Human chorionic gonadotropin (hCG) is a hormone that can stimulate the testes to produce testosterone and may promote testicular growth. However, it is crucial to approach the use of hCG under medical supervision. Self-administering hormones without a proper diagnosis and monitoring can lead to significant health risks, including hormonal imbalances and potential long-term effects on fertility and testicular health.

There is no conclusive evidence that hCG increases the risk of testicular cancer, but any hormonal treatment should be approached cautiously. Regular monitoring by a healthcare provider is essential to ensure safety and efficacy. If you are considering hCG for testicular enlargement or testosterone enhancement, it is imperative to discuss this with a qualified healthcare professional who can evaluate your specific situation and provide guidance based on your health status and goals.

Conclusion
In summary, your concerns regarding semen analysis, low libido, and the use of hCG highlight the importance of a comprehensive approach to male reproductive health. Consulting with specialists in urology and endocrinology can provide you with tailored advice and treatment options. Additionally, addressing psychological factors through therapy or counseling can significantly enhance your quality of life. Always prioritize safety and seek professional guidance before starting any hormonal treatments.

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