Sperm is having a moment. RFK Jr. is talking about it. The BBC is talking about it (1). And BabyMoon Family is talking about it.

In this article, I wanted to focus on the positive changes gay intended fathers can make to improve their sperm health before embarking on IVF and surrogacy.

Change is hard. How long do I have to do this for?

The good news is that you can change the health of your sperm in as little as 3 months. While men are making new sperm all the time, lifestyle changes will not take effect on the sperm immediately. The full life cycle of sperm (or spermatogenesis) takes between 72 and 120 days (2).

In this process, the testes take immature cells (spermatogonia) and have them undergo several stages of cellular division and differentiation in order to become mature sperm (or spermatozoa), as shown in the figure above.

Changes you make today will affect the quality of your sperm in 3 to 4 months. That’s not a long time, and there are certain changes before donating sperm that can make a huge difference in the overall health and viability of your sperm, affecting your subsequent embryos and children.

What are the two most important changes to make for sperm health?

The biggest change one can make for sperm health is to stop smoking.

Smoking cigarettes is one of the worst things a person can do for their health in general, and they are terrible for fertility. Smoking leads to reduced semen quality in terms of volume, motility, viability, and morphology. Smoking also disrupts reproductive hormones, further damaging spermatogenesis and sperm maturation (4).

Smoking is a particular issue for queer people. According to the Centers for Disease Control and Prevention (CDC), about one in six lesbian, gay and bisexual adults smoke cigarettes, compared with about one in nine heterosexual/straight adults (5).

Quitting smoking is not easy, but, remember, you only have to make changes for a few months to affect sperm health. Nicotine replacement therapy (NRT) or prescription medications like varenicline (Champix) can help. While there is less research on electronic cigarettes (e-cigarettes) and sperm health, they are likely to be less harmful than tobacco cigarettes. However, it would be better to stop cold turkey, use any number of cognitive behavioral therapy (CBT) apps, and/or utilize NRT or a prescription medication to quit tobacco cigarettes rather than transfer to e-cigarettes.

The second and equally important change that gay men can make before donating sperm is to stop all steroids. Anabolic androgen steroids (AAS) disproportionately impacts gay, bisexual, and queer men, with 5% to 13.5% of these men reporting use, and up to 25% considering use (6). Some data shows that usage of AAS among queer men is up to 6 times more than that of straight men (7).

Using steroids may help build muscle mass and get that ‘perfect’ gym body, but it can also shut down sperm production by suppressing follicle stimulating hormone (FSH). The good news is that sperm production can return to pre-steroid levels, but this generally takes about 1 year, with some men requiring up to 2 years (8).

What are some other changes to increase male fertility in gay men?

In addition to stopping smoking and steroids, gay men should also cut down or stop drinking alcohol (9) and using cannabis. While there is less evidence than for smoking, there is growing concern about the effect of cannabis on male fertility (10).

Reducing alcohol and/or cannabis can have another beneficial effect for male fertility: Weight loss. Losing weight has been shown to increase testosterone levels and improve male fertility (11). Today, weight loss is more achievable than ever with GLP-1 medications like Mounjaro and Wegovy. New research also suggests that GLP-1 receptor activation through these medications may even play a direct role in improving sperm health (12).

I’m not saying you have to take a GLP-1 medication to lose weight, but if you are overweight or obese and unable to lose weight with diet or exercise (13), it may be something to consider to optimize your fertility and benefit your overall health.

Increasing sleep and decreasing stress (14) are two other changes that have been shown to increase sperm health. However, as a physician and a chronically sleep deprived and stressed human being myself, I am realistic that telling someone to ‘sleep better’ and ‘stress less’ is like asking my corgi not to eat the peanut butter she found on the floor. It’s next to impossible, so be kind to yourself and try to do your best with these things.

To recap, here are changes you can make (for at least 3 months) to increase your sperm health:

Quit smoking
Stop taking steroids (this may have to be for up to 2 years)
Decrease or stop drinking alcohol
Decrease or stop using cannabis
Loose weight (with or without GLP-1 medication)
Improve sleep hygiene (as most of our testosterone is produced during sleep (15))
Decrease stress

Are there any medications or supplements that can help with sperm health?

There are two supplements that have been shown to improve sperm and male fertility:

Vitamin D
Zinc

A 2022 study analyzed 58 men with unexplained infertility and found they had decreased serum vitamin D levels and increased sperm DNA damage (16). In another study, zinc supplementation was found to significantly increase the semen volume, sperm motility, and the percentage of normal sperm morphology (17).

Again, we are talking about 3 months of changes here, so I would recommend supplementing with both vitamin D (400 to 800 IU daily with 40 IU equal to 1 mcg) and zinc (8 to 12 mg daily) before starting IVF and surrogacy as a gay man.

Final Thoughts

Sperm is important. We are talking about your future children here. Unfortunately, gay men are disproportionately affected by lifestyles that can decrease testosterone and male fertility as queer men are more likely to have substance abuse (18) and utilize anabolic steroids. We are also a stressed out community, especially with a Trump White House.

If you are planning on having children through IVF and surrogacy as a gay man, do yourself a favor and make as many of these changes as possible for at least 3 months in order to optimize the success of your embryo creation and future pregnancies. It’s not easy, but it will be worth it.

References:

How Gay Intended Dads Can Get Healthier Sperm

Why Gay Intended Fathers Should Care More About Their Sperm