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Q: I am 68 years old and in good health. The past few years I noticed a decline in the amount of my semen, which is really only a few drops.

I did have biopsies of my prostate three times about five years ago, and no cancer or enlargement of the gland was found. I have a digital rectal exam every year. My last PSA was 4.0.

Sometimes I think that having the biopsies may have had an effect on my semen. I'm worried that in a few years I won't have any semen at all.

-- Anonymous
A: Before talking about low amounts of sperm, I'd like to suggest that you talk with your doctor about how beneficial an annual digital rectal exam is for you. Although such exams are commonly recommended, they are much less important for someone who's had a normal exam for years and who is also tracking his PSA.

Sperm is produced in the testes (testicles) and stored in the epididymis -- a coiled tube that lies next to each testis. During intercourse, another tube, the vas deferens, transports the sperm to the prostate and seminal vesicles. Here the sperm is added to the seminal fluid (also called semen), which is formed in the seminal vesicles. There is a much greater volume of semen than of sperm.

This mixture of semen and sperm is then sent through the urethra and expelled through the erect penis at ejaculation. The semen is usually clear to white.

The amount of sperm and seminal fluid produced is primarily controlled by the amount of testosterone in the blood stream. As you probably know, testosterone levels fall as men get older.

Because it takes time to produced seminal fluid -- and the older you get, the longer the time -- the amount of ejaculate also depends on the frequency of ejaculation. An active sex life combined with lower levels of testosterone could very well explain why you ejaculate small amounts of fluid.

Theoretically, taking testosterone might increase the amount of your ejaculation. But other than slight changes in sensations during ejaculation, you probably wouldn't notice much difference anyway. And, as with all medications, there is a chance of negative side effects. If you talk with a doctor about using testosterone, please ask your doctor to explain all of the benefits, risks and cost before agreeing to a prescription.

It's unlikely that a biopsy of the prostate, if done correctly, would have had any effect on the amount of your semen. But, since you did not have an enlarged prostate, the major reason I would guess for your three biopsies would be an inflammation of the prostate (called prostatitis). This may be a cause of decreased semen.

It's also important to know that one of the most common problems experienced with semen is called hematospermia -- blood in the ejaculate. Hematospermia can be a disconcerting symptom and cause plenty of anxiety in sexually active men and their partners.

Hematospermia may be the result of inflammation, infection, obstruction of the tubes, cysts, tumors, vascular abnormalities, and systemic disorders. However, it's usually the result of inflammation of either the prostate or the seminal vesicles.

Did you have any blood in your semen five years ago? I suggest that you talk with the doctor that did the biopsiess.

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