Is male infertility the next global crisis in the making?

Why low sperm count matters at any age—and how to avoid becoming its next victim

It will be months, if not years, before the world fully recovers from the aftermath of the coronavirus pandemic.

But if we look to history as our guide, the good news is that eventually, we will recover.

And just like every deadly outbreak we’ve suffered before it, civilization will continue—hopefully stronger, smarter, and healthier than before. That’s why I want to take some time to discuss another serious problem gripping our society right now.

It’s a crisis with consequences that threaten to be much more far-reaching than even the most infectious virus. And one that, if we don’t take steps to reverse course now, could ultimately prove to be every bit as devastating…

The modern freefall of male fertility

As a doctor who lives and works in New York City, I have a lot of patients who have chosen to have children later in life. And I’ve spent a fair amount of time treating fertility problems in my practice because of it.

That fact probably isn’t too surprising. But what might surprise you is that many of these patients struggling with fertility aren’t women—they’re men.

And that’s no coincidence, either. Because the fact is, male fertility among Western populations is in the midst of a serious freefall.

In fact, just last year, a report in the British Medical Journal sounded the alarm on this very issue—as steep drops in sperm counts have affected men worldwide over the last 30 years. And to make matters worse, statistics show sharp increases in testicular cancer over the same time period.1

A recent meta-analysis showed that sperm counts dropped by more than 50 percent over the last three decades among North American, European, Australian, and New Zealand men.2

This is a trend that should concern men of any age or stage of life… for reasons I’ll circle back to in a bit.

But first, I want to talk about what’s causing this decline. Because scientific research points to a reliable list of prime culprits. And odds are, you encounter at least one—perhaps, all three—on a daily basis.

Estrogens are everywhere

Our world is completely saturated with estrogen—from the daily care products we use, to pesticides, plastics, and pretty much every chemical we come into contact with… not to mention the food we eat.

In fact, since World War II and the booming oil and chemical industries, there have been thousands of chemicals brought to market. And many of those chemicals contain endocrine-disrupting xenoestrogens and phytoestrogens—which, even in small traces, can cause problems like decreasing sperm counts and testosterone production.

Plus, chemicals like phthalates and bisphenol A are everywhere now—in water bottles, food containers, sales receipts, coatings of pills and nutritional supplements, gelling agents, lubricants, binders, nail polish, liquid soap, hair spray, milk, yogurt, sauces, fruits, pasta, and noodles… to name a few.

Indeed, these hormone-hijacking environmental toxins are lurking in our very own water supply. So it’s not surprising the Centers for Disease Control and Prevention (CDC) has confirmed that just about everyone in this country has a measurable amount of phthalates—a chief component of modern plastics—in their system.

But here’s one reason that’s so dangerous: Men with higher concentrations of phthalates have less testosterone (T) and lower sperm counts. And in pregnant mothers gestating a male baby, higher phthalate levels can also lead to smaller penis size and lower levels of testosterone.

In other words, men can inherit the fertility-crushing consequences of these endocrine disrupting chemicals—chemicals that were once considered virtually harmless. But we now know they affect not only us, but also our children, on a genetic level.

And they’re not the only supposedly “harmless” chemicals with links to infertility, either. In fact, recent research shows that popular over-the-counter (OTC) painkillers pose a threat to fertility in otherwise young, healthy men, too.

Fertility crushers in your medicine cabinet

This study looked at 31 male volunteers—all between the ages of 18 and 35 years. Roughly half received a 600 mg twice-daily dose of ibuprofen—a common dose for athletes, and the maximum dosage limit according to the labels of your typical generic bottles. The other half took a placebo.

Within just two weeks, the men taking ibuprofen saw their levels of luteinizing hormone (LH) rise along with blood levels of the drug.3 (LH originates in the pituitary gland, and is the hormone responsible for stimulating testosterone production.)

Meanwhile, ratios of testosterone to LH plummeted, indicating a clear problem with testicle function. (And resulting in a condition called “compensated hypogonadism”—or subclinical low T—where very high levels of LH manage to keep testosterone just barely in the normal zone.)

It’s worth pointing out that this study comes on the heels of previous research that showed intake of any of the three main OTC painkillers—acetaminophen, aspirin, or ibuprofen—had effects on the testicles of male babies.

But this complication isn’t limited to cases of fetal exposure. Healthy, grown men are also very much at risk, too.

That’s because these supposedly “safe” OTC pain drugs are “anti-androgenic” male hormone disruptors that suppress testosterone secretion.

Of course, it’s not just drugs that put fertility in the crosshairs…

Sugar also kills your sperm count

Another concerning study recently appeared in the journal Epidemiology. And it found that couples who consume sugar-sweetened beverages have a 20 percent reduction in the odds of conception during any given month. (And the fertility prognosis was particularly grim in the case of energy drink consumption.)4

Yes, that’s either partner. And yes, it only takes a single sugary drink daily to trigger reproductive problems.

This is yet another example of how sugar kills, in more ways than one.

But even if having a baby isn’t on your agenda, don’t think this problem doesn’t affect you. Because the fact is, low sperm counts signal a whole lot more than just infertility…

Infertile men face three lethal threats

At the 2018 meeting of The Endocrine Society, researchers presented the largest study of semen quality to date. And the news was dire, to say the least.

This study looked at more than 5,000 male partners of infertile Italian couples. And it discovered that low sperm count was an independent predictor of a laundry list of serious health threats—including metabolic syndrome, heart disease, and osteoporosis.5

Specifically, male partners with low sperm count were 1.2 times more likely to have more body fat, high blood pressure, high triglycerides, and low HDL (“good”) cholesterol. Metabolic syndrome and insulin resistance were also more prevalent in this group of men.

And that’s just for starters. Men with low sperm counts had a 12-times higher risk of low testosterone. And a good 50 percent of the men with low testosterone in this study also had osteoporosis—proving that brittle bones aren’t just a problem for older women.

Now, this study doesn’t prove that low sperm counts send your health into a tailspin. But whatever the cause, it’s clear that there’s a major missed opportunity on the table where men’s health is concerned. And patients’ lives could be needlessly cut short because of it…

Low T affects more than sexual function

Throughout my entire career, I’ve always monitored testosterone levels in men. And they have never been lower across the board than they are today. These days, when I see a patient with levels even close to what they should be for his age, it’s practically cause for celebration.

Needless to say, low testosterone is a huge problem. Because the effects reach way beyond erectile dysfunction (ED).

Some men experience low sex drive, difficulty with erections, and low semen volume. Others suffer from fatigue, loss of muscle mass, poor workouts at the gym, increased body fat, decreased bone mass, irritability, depression, anxiety, and insomnia.

The fact is, there’s a reason I evaluate testosterone levels as a matter of routine. It really is that important. So don’t be afraid to ask your doctor about getting tested, too. (And really, I highly recommend a visit to the fertility clinic, followed by a consult with someone who can get testosterone levels back on track, if results come back low.)

Optimal testosterone levels are dependent on age. The younger you are, the higher it should be. Ideal levels for a 20-year-old man (when testosterone is at its peak) are usually somewhere around 1,500 ng/dL. That would drop to 1,200 ng/dL at age 30, 1,000 ng/dL at 40, 800 ng/dL at 50, 700 ng/dL at 60, 600 ng/dL at 70, and so on.

I normally recommend starting with 100 mg/gram testosterone dosages for men. I also use bioidentical compounded testosterone almost exclusively.

But really, all testosterone is bioidentical. It’s just the delivery system that makes up the “patentable” part of the formulation. The difference ultimately boils down to price. If your insurance doesn’t cover testosterone replacement therapy, bioidentical compounded products will be significantly cheaper than commercial brands.

But the most important thing to remember is that testosterone therapy should always be individualized. And since your dosage will depend on your baseline numbers and other clinical factors, you should work with a doctor who knows what they are doing.

If you don’t already have one, the American College for Advancement in Medicine (ACAM) is a great resource for locating an experienced holistic practitioner in your area. Simply plug your zip code into their search engine at to find a list of physicians near you.

In the meantime, there are a lot of proactive steps that you can take on your own—starting today—to help get your testosterone levels back on track. Starting, as usual, with your diet.

From Western to Mediterranean

Obviously, ditching sugary drinks is a must. But unsurprisingly, studies also show that a Western diet in general—packed with refined grains, starches, sugars, and processed meat—is linked to low sperm count and testicular impairment, too.6

And with all the hormone residue, heavy metals, and other toxins you’ll find in your typical packaged and processed fare, it’s not hard to imagine why.

The Western diet may not offer much in the way of nutrients—but it will flood your body with free radicals. And when that happens, all your cells are vulnerable to DNA damage, including your sperm cells.

In other words, a steady stream of junk food degrades sperm quality and motility. But this is one trend that, fortunately, is simple to reverse by eating fresh, whole foods.

A clean, balanced, whole-food diet—rich in healthy fats, protein, veggies, and water, much like my A-List Diet—helps to regulate free radical production and balance hormone levels. (Particularly estrogen, which is detrimental to testicular function and sperm creation.)

And this helps boost sperm quality. On the other hand, research has linked high intakes of alcohol, caffeine, soy, sugar, and red and processed meat to lower fertilization rates.

Though, for me, the jury is still very much out on red meat. I wouldn’t assume anything from that particular finding, because of the fact that they never account for the quality of the meat—organic, grass-fed and -finished versus conventionally raised—in this research. (And when we’re talking about hormones, it most certainly matters.)

But either way, the bottom line is still crystal clear: Lifestyle—and dietary choices, in particular—have a profound impact on male reproductive health. And you can’t choose better than a Mediterranean-style eating plan like my A-List Diet.

Not just because of the junk you won’t be eating on this diet. But also because of the foods you will be eating—and enjoying—in abundance, including one food in particular…

Nuts are good for your “nuts”

Go ahead and laugh, but the results of a recent study—aptly called FERTINUTS—speak for themselves.

This randomized, controlled trial looked at a group of healthy young men—between 18 and 35 years old—for 14 weeks to see how consumption of nuts (in this case, a raw mix of walnuts, almonds, and hazelnuts) influenced sexual function and sperm quality.

Researchers randomly assigned subjects to eat 60 grams of nuts (a little over two ounces) per day, or to stick with a typical nut-free Western diet.

They found better sperm count and quality among the men who included nuts in their diet.7 They also found that the men who included nuts in their diet benefited from significantly better orgasmic function and higher sexual desire. Which I think you’ll agree, isn’t exactly nothing.

But nuts aren’t the only thing I stand behind to help support men’s health…

Boost sperm quality with the sunshine vitamin

Research shows that levels of vitamin D can impact both sperm quality and quantity, as well as testosterone concentrations. Which is yet another reason why I always advocate for this crucial nutrient.

Indeed, I recommend taking at least 2,000 to 5,000 IU of vitamin D3 daily, year-round. But that dosage may need to be as high as 10,000 IU, depending on the season and how often you get outside.

It may sound like a lot, but I personally take 10,000 IU myself every day—and you can safely take that amount as well, provided your doctor is monitoring your levels regularly. (All you have to do is ask for a simple blood test called the 25-hydroxyvitamin D test, every six months.)

I shoot for blood levels around 80 ng/mL in my patients—and that’s what I recommend you to aim for, too.

Of course, you may be wondering if the arrival of summer—and more sunshine—means you can reduce or even eliminate your vitamin D supplement. Because, as I’ve mentioned many times before, sunshine is an effective way to boost your vitamin D levels naturally.

So, here’s what I suggest…

You can supplement with lower doses of D during the summer IF you get full, mid-day sun exposure over most of your body—without toxic sunscreen—for 20 minutes every day. But in order to eliminate it altogether, you’d also have to live in South Florida or the very Southern part of Texas.

If you don’t, you absolutely must keep taking your vitamin D, every single day.


  1. Skakkebaek N. “Sperm counts, testicular cancers, and the environment.” BMJ. 2017 Oct 10;359:j4517
  2. Levine H, et al. “Temporal trends in sperm count: a systematic review and meta-regression analysis.” Hum Reprod Update. 2017 Nov 1;23(6):646-659.
  3. Kristensen DM, et al. “Ibuprofen alters human testicular physiology to produce a state of compensated hypogonadism.” Proc Natl Acad Sci U S A. 2018 Jan 23;115(4):E715-E724.
  4. Boston University School of Medicine. “One or more soda a day could decrease chances of getting pregnant.” Science Daily, 02/13/2018. (
  5. The Endocrine Society. “Low sperm count not just a problem for fertility: New research links sperm count to other health problems.” Science Daily, 03/18/2018. (
  6. European Society of Human Reproduction and Embryology 35th Annual Meeting: Abstract O-178. Presented June 25, 2019.
  7. Salas-Huetos A, et al. “Effect of Nut Consumption on Erectile and Sexual Function in Healthy Males: A Secondary Outcome Analysis of the FERTINUTS Randomized Controlled Trial.” Nutrients. 2019 Jun 19;11(6).