{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T05:06:59Z","timestamp":1781932019861,"version":"3.54.5"},"reference-count":43,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T00:00:00Z","timestamp":1620172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Recently, the role of lifestyle factors in testicular function has developed into a growing area of interest. Based on cross-sectional data on 3283 Taiwanese men, we investigated whether interactive effects of unhealthy lifestyle behaviors were associated with testicular function. The men were recruited from a private screening institute between 2009 and 2015. Lifestyle behaviors (smoking, alcohol drinking, physical activity (PA), sleeping habits, and diet) were obtained by a validated self-reported questionnaire. The men provided a semen sample and had blood drawn for sex hormone measurement. Men who smoked and drank had higher testosterone (T) levels (\u03b2 = 0.81, p &lt; 0.001) than those who neither smoked nor drank. Men who smoked and had high Western dietary pattern scores had higher T levels\u2014by 0.38 ng\/mL (p = 0.03). Those who drank and did not get enough sleep or had high Western dietary pattern scores had elevated T levels\u2014by 0.60 ng\/mL (p = 0.005) or 0.45 ng\/mL (p = 0.02), respectively. Light PA and insomnia were associated with decreased T levels\u2014by 0.64 ng\/mL (p &lt; 0.001). Those who smoked and drank or had light PA or had high Western dietary pattern scores had lower normal sperm morphologies (NSMs)\u2014by 2.08%, 1.77%, and 2.29%, respectively. Moreover, drinkers who had high Western dietary pattern scores had higher sperm concentrations\u2014by 4.63 M\/mL (p = 0.04). Awareness and recognition of the long-term impact of lifestyle behaviors and better lifestyle choices may help to optimize the chance of conception amongst couples.<\/jats:p>","DOI":"10.3390\/ijerph18094925","type":"journal-article","created":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T11:06:01Z","timestamp":1620212761000},"page":"4925","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Interactive Effects of Unhealthy Lifestyle Behaviors on Testicular Function among Healthy Adult Men: A Cross-Sectional Study in Taiwan"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9809-1953","authenticated-orcid":false,"given":"Adi Lukas","family":"Kurniawan","sequence":"first","affiliation":[{"name":"Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Yeh","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3610-9580","authenticated-orcid":false,"given":"Jane C.-J.","family":"Chao","sequence":"additional","affiliation":[{"name":"School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan"},{"name":"Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei 110, Taiwan"},{"name":"Nutrition Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7240-4176","authenticated-orcid":false,"given":"Li-Yin","family":"Lin","sequence":"additional","affiliation":[{"name":"Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, Taipei 110, Taiwan"},{"name":"School of Public Health, College of Public Health, Taipei Medical University, Taipei 110, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2222-7137","authenticated-orcid":false,"given":"Rathi","family":"Paramastri","sequence":"additional","affiliation":[{"name":"School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1178-1626","authenticated-orcid":false,"given":"Hsiu-An","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Information Engineering, Tamkang University, New Taipei 251, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan-Chen","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan"},{"name":"Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Fang Vivienne","family":"Wu","sequence":"additional","affiliation":[{"name":"Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan"},{"name":"College of Nursing, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1093\/humupd\/dmx022","article-title":"Temporal trends in sperm count: A systematic review and meta-regression analysis","volume":"23","author":"Levine","year":"2017","journal-title":"Hum. 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