'Sperm-maxxing' is trending, but what actually improves male fertility?

Male fertility is now a major topic among patients on social media.

So, is fertility really declining?

Partially, yes. There seems to be a legitimate concern behind this trend, but the scale of the decline is debated. A large global meta-analysis found that sperm concentration fell 51.6% between 1973 and 2018 and total sperm count fell by 62.3% overall between 1973 and 2018.^[] 

More recent studies, however, have produced mixed findings, including a 2024 Danish cohort that found stable sperm count over a 6-year period.^[]

What is 'sperm-maxxing'?

“Patients are increasingly coming in with information they’ve seen online suggesting that a particular peptide, supplement, hormone, or combination of products can dramatically increase sperm count, improve motility, or boost testosterone and fertility,” says urologist Arthur L. Burnett II, MD, FACS.

“I understand why these claims are appealing. When a man wants to improve his fertility, he wants to know that there is something he can do about it. But I always remind patients that a compelling claim on social media is not the same thing as good clinical evidence,” he adds.

Where do peptides fit? 

“Peptides are short chains of amino acids—typically 2–50 amino acids in length—and have been used in medicine for many years," Michael DeShields, MD, tells MDLinx. "The body makes peptides like insulin, [which is] used to manage diabetes. Other peptides have been introduced that regulate libido (PT-141) and growth hormone (Tesamorelin). Many of the peptides currently being discussed in the men’s health space are considered off-label and experimental."

For fertility, the distinction is important. Established treatments such as hCG, gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors have specific roles in selected patients with male-factor infertility.^[]

Kisspeptin also has a legitimate biological role. Kisspeptin stimulates GnRH neurons and influences LH, FSH, and downstream gonadal function. Small human studies show increases in reproductive hormones following administration.^[]

PT-141 and Melanotan II are discussed more often for libido and erectile function.^[]

However, none should be treated as interchangeable, and online use does not establish a medical indication. 

The testosterone trap

Testosterone is an important distinction in the online fertility conversation. Raising serum testosterone does not necessarily improve sperm production. Exogenous testosterone suppresses gonadotropin secretion and intratesticular testosterone, which can reduce or stop spermatogenesis.^[] 

Endocrine Society guidelines recommend against testosterone therapy in men who are planning fertility in the near term.^[] 

“That’s why I’d like to find out if you’re using testosterone (or other products), anabolic steroids, peptides, supplements, or cannabis before I assume that you have a low sperm count and need yet another product,” he adds. 

Patient evaluation

For clinicians, start with the fertility evaluation rather than the product. Dr. Smith notes that semen analysis is part of the core evaluation and advises against treating an isolated laboratory number without establishing the underlying problem. 

“If your patients are following a ’sperm-maxxing’ protocol, my advice [for them] is, don’t optimize a lab number before you know what problem you are treating. Fertility involves multiple factors, including but not limited to sperm production, endocrine function, anatomy, medications, heat and toxic exposures, substance use, and reproductive health of both partners,” Dr. Smith says. “Therefore, the safest course of action prior to starting hormones or injectable compounds is to be evaluated by a physician who has experience in male reproduction."