Opioid Pain medication Can Lower a Man’s Testosterone

Opioid (pain) medication, including morphine sulfate and oxycodone, commonly used for patients with chronic pain, carries risks of addiction and side effects including nausea, itching, constipation, and low testosterone.  This problem is often not recognized since a patient with persistent pain (of many causes) has many symptoms which may be similar to symptoms of low testosterone.  Opioids are among the most frequently prescribed analgesic drugs but may lead to low testosterone in 20 to 80% of men with decreased attention span, decreased sex drive (libido), fatigue, depressive state, erratic mood.  In addition, muscle loss, bone loss (osteoporosis), low blood count (anemia), erectile dysfunction, delayed ejaculation (semen emission) may occur.  In addition, the risk of cardiovascular disease and diabetes mellitus (increased blood sugar which has many negative effects on the body) are increased.  Chronic opioid use may also adversely affect sperm function (very few studies have addressed this).

The treatment of patients with low testosterone (due to pain medication) is the same as for those with low testosterone of other causes and is managed by a urologist.  Testosterone replacement therapy (TRT) in multiple preparations may have beneficial effects on serum testosterone and qualtity of life.  An alternative to topical or injected testosterone would be the use of human chorionic gonadotropin (hCG injection) or clomiphene citrate (oral pill) which act through a different mechanism to “turn on” the body’s natural testosterone production.

See the following for more detailed information about opioid medication effect on testosterone.  For more information on low testosterone treatment, click here.  Dr. Wosnitzer previously initiated a clinical trial in the New York area recruiting men with chronic pain (treated with narcotic or other pain medication) and diagnosed low testosterone.  Additional information regarding management of chronic pain and low testosterone is available here and by contacting us for a personalized consultation.

Watermelon – Got Lycopene?

Did you know that watermelon, a summertime favorite fruit, is high in the antioxidant called lycopene?

While tomatoes are  most well known to be high in lycopene, lycopene is also found in watermelon and guava.  Lycopene, a carotenoid, has potential anti-prostate cancer properties as well as being pro-fertility (sperm shape) – it has up to twice the antioxidant capacity of β-carotene.  The mean lycopene concentration of watermelon is about 40% higher than for raw tomato, and watermelon ranks 5th among the major contributors of lycopene in the U.S. diet.

Research in the past few decades show that increasing blood levels of lycopene might lower triglyceride and LDL-cholesterol levels, thus lowering cardiovascular disease risk.

Bottom line: Don’t hesitate to have watermelon this summer!


Are your testicles hot?  Probably not the way you might be thinking, and certainly not good for your health!

The Issue:  Varicocele (pronounced varik-o-seal) is an abnormal dilation or englargement of testicular veins.  These veins normally drain blood from the testicles and send it back toward the heart.  Pooling of blood in these enlarged veins causes the testicle to become hotter temperature than normal (think of your car’s engine!) and this affects the cells in the testicle.  Varicoceles become an issue if you are a man with low testosterone, difficulty having children, or testicular pain.

Varicocele is the most frequent cause of infertility in a male, occurring in up to 15% of the general adult male population, and in up to 40% among men with infertility (difficulty having a child when the female partner has no fertility issues).  With increased heat in the scrotum, the testicles and their cells (Sertoli cells play a key role in sperm production and the Leydig cells in testosterone production) start to have major issues and do not perform well.  The significance of acting early to diagnose and treat varicocele is that the testicle function (sperm and testosterone production) decreases more and more over time when a varicocele is present (more).  Therefore, an undiagnosed varicocele can result in abnormalities in a man’s sperm count, sperm shape, sperm movement, or even sperm genetic code (DNA), and decreased testosterone in the blood (more).

Diagnosis: The varicocele may not have been bothersome or noticed by the patient before, but your urologist can often detect these just by examining the scrotum.  There is a grading system (1 = smallest, to 3 = largest) that is used and the varicocele can also be confirmed on ultrasound imaging (no radiation and painless, completed in less than 30 minutes).  A varicocele is considered significant if can be detected on physical exam or if the veins are  >2.7 millimeters on ultrasound imaging).  Once confirmed by exam and or imaging, discuss further with your physician regarding your semen analysis (checks for sperm abnormalities) and blood total testosterone level.

Treatment:  If a patient has sperm abnormalities or low testosterone, or less commonly dull aching pain in the testicle, then varicoceles are most commonly eliminated with a surgery called varicocelectomy.  This surgery takes the dilated veins (again, the blood vessels that drain the testicle) and these are pinched off, and blocked permanently.  This can be done on one or both testicles.  There are other veins that carry the necessary blood away from the testicle so this does not cause any issue.  For more in-depth information about varicocelectomy, see our article.

Varicocelectomy will stop additional testicular damage from the varicocele and in many men lead to improved semen parameters, increased Leydig cell function, and subsequently increased testosterone especially if your testosterone was low before the surgery (more).  During this surgery, it is ideal for the artery (vessel that supplies blood from the heart to the testicle) to be spared, although sometimes the artery is eliminated.  There are multiple ways to perform this surgery, but the outcomes have been shown to be the best (with the fewest varicocele recurrences) when the surgeon uses a microscope (microsurgical subinguinal approach) (more).  Feel free to read more about microsurgical varicocelectomy or ask your urologist who specializes in this procedure.

For more information on microsurgical varicocelectomy treatment, click here. For more information on low testosterone, see our blog posts on hypogonadism.

We are pleased to discuss the varicocele diagnosis and treatment further with you. Please contact CMHR for additional information and to schedule a consultation.  We welcome our patients from Connecticut, New York, New Jersey, Rhode Island, Massachusetts, Pennsylvania, Delaware, Maryland, Washington DC, throughout the United States, and internationally.

Is Sperm Quality Declining?

Background: The global decline of human sperm quality remains a matter of debate.  Although many prior studies were flawed (more), numerous studies from the international literature describe a global decrease in sperm concentration among men.  A recent study from France looked at 26,000 normal men (ages 18 to 70, with infertile female partners) and identified a significant and continuous decrease in sperm concentration and in normal-shaped sperm between 1989 and 2005.

Some studies have shown that mean sperm counts have decreased significantly since the 1940’s.  The current trend for decline in semen parameters parallels increasing levels of obesity worldwide.  However, there is great geographic and ethnic variation.

Recent research from April 2015 again indicates that during the past 30 years, a decline in semen quality was found in semen parameters analyzed in Spanish men with proven fertility.  See the study here in Journal of Urology.

Semen quality may be the most sensitive marker of adverse environmental exposures, and a particular decline has been noted in many countries including Finland.

More information about male infertility, vasectomy reversal, erectile dysfunction at the Center for Male Health and Reproduction of Connecticut

Bottom line: The most recent sperm concentration values in Spanish and French men could be linked to an unknown environmental cause (for example, pesticides or components of plastic).  Additional studies will be needed to determine if this decline is occurring in all nations, the causes, and whether the decline will continue.

There are many difficult-to-control confounding factors in the highly variable nature of semen, and comparability of populations from different time periods in secular-trend studies, the quality of laboratory methods for counting sperm, and geographic variations in semen quality.  All of these complicate the interpretation of the available evidence.   More high quality studies are needed to definitively identify semen quality trends throughout the world.

Quit Smoking to Improve Male Fertility and Erection

Smoking and Male Fertility: Cigarette smoking (including second-hand by being near a smoker) may negatively affect a man’s semen. This is important especially if a man is trying to have children. Some studies have shown decreased sperm count (average approximately 20% decreased and based on how much one is exposed to), motility (movement), abnormal sperm shape and sperm maturation have been described (more). Smokeless tobacco is not any better and also has the same negative effect on semen parameters (more). Further cigarette smoking has been shown to change sperm DNA packaging and changes in gene expression which may certainly affect fertility (more).

Cigarette Smoking and Male Infertility and Erectile Dysfunction Just as DNA damage can occur in women’s eggs from smoking, it has been identified that sperm DNA may be bound directly by tobacco smoke components. Sperm additionally have increased chance of getting an extra Y chromosome (DNA) with increased concentrations of smoking byproducts in the urine (more). DNA damage is transmitted from parents who smoke (fathers may play a more significant role than mothers) to offspring and can lead to miscarriages and birth defects. Even for those couples that seek in vitro fertilization (where sperm and egg are united outside the body and then replaced in the female’s uterus), smokers require twice as many attempts to conceive as nonsmokers.

Smoking and Erection: Severity of erectile dysfunction (ED) significantly correlates with the level of exposure to smoking regardless of increased cardiovascular risk (more). ED has been reported in 3.7% of current smokers, 2.0% of former smokers, and 2.2% of men who never smoked. Quitting smoking could prevent ED worsening in 25% of cases. Cigarette smoking causes arterial tightening (constriction), with reduction in oxygen supply and increased damage to healthy tissues (called endothelial tissues). Within 24-36 hours of stopping smoking, the bloodflow characteristics were improved in one study (more).

Bottom Line: While the overall effect of smoking remains difficult to assess on men’s fertility (due to factors including partner issues and other unhealthy habits of smokers that cannot be sorted out with available studies), data exists to discourage smoking in couples that desire children. Stop smoking and improve not just your breathing and fertility, but also possibly your sex life.

For tips on quitting smoking, see the CDC (Centers for Disease Control, US Government) website. Due to popular request, we will soon be posting info on the cancer risks of smoking (including bladder and kidney cancer).

Vasectomy Reversal by Leading Urologist and Microsurgeon

Vasectomy reversal involves reconnecting the ends of the vas deferens tubes which were separated during vasectomy.  Many factors affect vasectomy reversal including use of the operating microscope for precise microsurgical reconnection to allow sperm to flow again following vasectomy reversal.

The most important factors for success of vasectomy reversal:

Keys to successful outcome include duration since vasectomy and quality of specimens from the sperm transport tube during the vasectomy reversal procedure.  Learn more about the vasectomy reversal procedure being offered by leading urologist Dr. W.  More information about Dr. W’s clinical expertise and publications about vasectomy reversal are available by clicking here.

Leader in Male Fertility and Men’s Health Treatment

The microsurgical multi-layer approach to vasectomy reversal involves 4 layers of stitches on the vas deferens: the gold-standard for reversal of vasectomy.Vas mucosaVaricoceles cause increased heat around the testis, harming sperm and testosterone production for men. Click to learn more.

Varicocele diagram
Mobile devices and laptops may affect male fertility.  Learn more about the research which indicates that common devices could be harming your sperm.Reception-Pic
Did you know?
Being overweight or obese could have a negative effect on a man’s fertility and sexual health.
The choice of lubricant for sexual intercourse is important for fertility!  See recent Everyday Health article citing Dr. Wosnitzer.


EH Logo

Learn more about genetics of male infertility and non-obstructive azoospermia with this recently published research article in PLOS One by Dr. Wosnitzer.Globe
Penile prosthesis is an option for men with erectile dysfunction who have not been successful with medical therapy including oral and injectable medications.

Men with low (<5 million sperm/ml) or no sperm in the ejaculate without blockage require genetic workup to examine changes in chromosomes or genes.


Male infertility, vasectomy reversal, and men’s health treatment options are available from the Center for Male Health and Reproduction of Connecticut. Click here to learn more about possible ways to improve male fertility, hormonal levels, and sexual function at CMHR of Connecticut.

Current patients:


Click here to access your Northeast Medical Group/Yale New Haven Health MyChart records.

Our Mission:

Welcome to the Center for Male Health and Reproduction of Connecticut.  We are pleased to provide expert and compassionate care for men’s health issues including male infertility and vasectomy reversal.  We offer gold-standard procedures based on the extensive publications and texts which Dr. Wosnitzer has authored for microsurgical procedures for male infertility and microsurgical vasectomy reversal including vasovasostomy, vasoepidymostomy.  Dr. Wosnitzer will create a customized treatment plan for male infertility or sexual dysfunction issues.

Our Center, within Northeast Medical Group/Yale New Haven Health System welcomes patients from Connecticut, throughout the United States and abroad with convenient options for consultation in person or by telemedicine.  Call today to learn more from our team.

Male Infertility: The Background

Male infertility can occur due to many causes such as obesityprescription medicationstobaccoalcohol, marijuana, environmental toxins, and genetics.  Additionally, genital defects, sperm transport blockage, erection and ejaculation dysfunction, deficient sperm production and function, and prior surgery can affect male fertility.

Male infertility requires a coordinated effort for couples trying to have children.  One of every five couples seeks treatment for infertility, and in up to 50% of cases, the male partner is identified to be a cause of infertility.  Male infertility may occur when there are abnormalities in sperm identified by abnormal semen analysis testing.

Semen analysis describes sperm count, sperm concentration, sperm shape (morphology), sperm movement (motility), acidity (pH), and quantity (volume).  Normal reference values are defined by the World Health Organization (WHO) criteria and include total sperm count of 39 million sperm per ejaculate, sperm concentration of 15 million/ml, 40% total motility, 4% morphologically normal, 1.5 ml volume.  Infertility may occur may occur above these values or when there is decreased sperm number (oligospermia, <20 million sperm per milliliter), decreased quality of sperm (abnormal shape, movement, sperm DNA), or complete absence of sperm (azoospermia).  For more information about the male infertility workup, click here.

Oligozoospermia (low sperm count) can have many causes, often unknown, and is usually identified along with abnormalities in the sperm (movement, shape, or DNA issues).  Azoospermia (no sperm in the ejaculate) is identified in 15% of infertile men.  There are two general categories which explain the cause of having no sperm in the ejaculate: obstructive azoospermia (OA, 40% of all cases of azoospermia) and non-obstructive azoospermia (NOA) which includes the rest of men with azoospermia.  These are exactly what they sound like: obstructive azoospermia (OA) results from a blockage along the genital tract somewhere between the testicle (where sperm are produced) and the ejaculatory duct (where the semen enters the urethra during ejaculation) to leave the body.  Other parts of the genital tract can also be blocked (the technical names include the rete testis, efferent ducts, epididymis (sperm maturation takes place here), vas deferens, and ejaculatory duct). Non-obstructive azoospermia (NOA) involves impairment or absence of sperm production (spermatogenesis) due to a variety of causes.  For more detail see our blog posts on specifics of OA and NOA.

Please continue reading for more details about semen analysis,  obstructive azoospermia or non-obstructive azoospermia.

We are pleased to discuss the workup of male infertility further with you.  Please contact CMHR for additional information and to schedule a consultation.  We welcome our patients from Connecticut, New York, New Jersey, Rhode Island, Massachusetts, Pennsylvania, Delaware, Maryland, Washington DC, throughout the United States, and internationally.

Tomatoes- Prostate Cancer and…Sperm Quality


Anti-oxidants such as pomegranate are often in the news for possible health benefits.  Lycopene is another anti-oxidant known as a carotenoid, which is most often found in tomatoes and tomato-based products.

Some older studies have identified decreased risks of various types of cancer (prostate, lung, stomach) with increased lycopene intake, while others did not show such a benefit.   Recently, however, multiple studies show that there is a likely benefit to including lycopene in your diet: a decreased risk of prostate cancer as well as improved sperm shape (morphology).

Semen quality and antioxidants:

You can read more about the effects of antioxidants such as lycopene on sperm quality in our blog post here.

Prostate cancer and lycopene:

In terms of prostate cancer risk, let ‘s discuss the evidence for this finding.  Specifically, a Harvard and Ohio State University study noted that increased dietary lycopene intake is associated with decreased risk of prostate cancer (10-25% decreased risk), including lethal forms (highest intake group had 28% decreased compared to lowest lycopene intake) of prostate cancer in a recent study of  nearly 50,000 male health professionals.  Earlier and higher lycopene intake is associated with improved outcomes including decreased blood vessel (angiogenic) growth in tumors.

systematic review from China in 2013 identified that the greatest raw tomato intake had a 19% decreased risk of prostate cancer vs. those with the lowest intake.  Cooked tomato intake also had benefit with a 15% decreased risk.

Another recent study from 2014 from Italy indicated that low lycopene levels in the prostate are most frequently associated with prostate cancer.  In this study, 32 men took 20-25 mg/day of lycopene for six months, and then had prostate biopsy.  Prostatic lycopene level was significantly lower among men with prostate cancer than in men with  prostatitis (inflammation) or HGPIN (which is a pre-cancerous prostatic tissue).  Nearly 78% of the men with prostate cancer had a lycopene level <1 ng/mg, while only 6% of the HGPIN men  and none of the men with prostatitis had such a low lycopene level in the prostate.

While increased lycopene consumption seems to be beneficial, additional study of prostatic levels and intake should be studied in a variety of populations to confirm these findings.