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TRT and Fertility: What Men Need to Know

TRT and Fertility: What Men Need to Know
Dr. Constance Odom, MD Picture of Dr. Constance Odom, MD

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Written by our editorial team.

Last Edited 5 min read

Testosterone replacement therapy (TRT) is a life-changing treatment for many men. It helps increase testosterone levels, while boosting energy and enhancing other aspects of a man’s life. However, it comes with one undesirable side effect: infertility.

Testosterone replacement therapy (TRT) comes with many benefits, including better mood, better bone density, increased muscle mass, and an increased sex drive. According to The American Society of Reproductive Medicine, low testosterone (Low T) is present in men with hypogonadism. Low testosterone levels typically below a range that is normal for men. Low testosterone levels can cause low sex drive and erectile problems that, in many cases, affect many aspects of life.

Low T in itself does not cause infertility. Hormones other than testosterone regulate sperm production. While testosterone is needed for the production of sperm, the level of testosterone in the testes is typically much higher than testosterone levels in the blood. Men with slightly lower T levels still have the ability to produce sperm. 

However, TRT has the potential to cause infertility. TRT reduces sperm count by elevating levels of follicle stimulating hormone or FSH. FSH plays a critical role in stimulating the body to produce sperm. For the most part, infertility that is caused by TRT can be reversed. 

Men who receive TRT for a shorter period of time typically are able to replenish their sperm count more quickly than men who receive TRT for an extended period of time. Only a small percentage of men are unable to regain their fertility. Some people think that only men who receive pellets and injections lose fertility quickly. However, such is not the case. 

According to experts, any type of testosterone supplement has the potential to cause infertility, whether it is temporary or permanent. Testosterone supplements alter the regular balance needed to produce sperm in a normal fashion, according to MedlinePlus. 

But what happens if a man takes TRT and wants to have kids?

The first thing a man should do if he wants to have kids is to meet with a reproductive professional. This professional will perform a full physical exam and medical history analysis to determine how to proceed. Two semen samples and hormonal testing may be required. The man will need to stop receiving TRT and may require occasional hormone tests. It could potentially take months for a man’s sperm count to return to normal levels.   

It is not uncommon for men on TRT to have trouble conceiving. This can be the result of a lowered sperm count or a nonexistent one. According to experts at Mind Body Logic, testosterone is being considered as a possible male birth control. A lowered sperm count doesn’t necessarily mean you are infertile, but some men never recover from having a low sperm count. 

While sperm count eventually recovers after stopping TRT, recovery can take time. Many people grow impatient. The truth is that it could potentially take six to nine months after stopping treatment for sperm levels to return to normal. 

According to PubMed, men who want to have children should not use testosterone as a contraceptive method. Research has found that men with Low T typically have a harder time getting erections and maintaining a healthy libido. Both of these are necessary to facilitate conception. Because low T can cause exhaustion and weight gain, a man probably doesn’t feel like having sex. Depression can also contribute to Low T. This makes it more difficult for his partner to become pregnant.

If a man has Low T and receives TRT, it is highly likely that his ability to have children will be impaired. Decreased sperm count is more likely if a man receives testosterone injections, instead of a gel or cream. A man’s sperm production is prompted by a number of hormone signals.  

When testosterone levels are low, the brain triggers the pituitary gland to release follicle stimulating hormone (FSH) and luteinizing hormone (LH). This causes the testes to produce sperm. However, there is a potential for this process to be disrupted. While fertility is eventually restored, there is no baseline or required amount of time for sperm count to replenish. 

Everyone is different, and what is normal for one person may not be normal for another. A growing number of men have been taking testosterone for many years, and even men who do not need extra   testosterone are taking it anyway. Low T levels may not seem like too much of a problem, but declining sperm levels can threaten the human population. Many couples are now opting not to have children.

But it’s also important to note that there are several causes of Low T. These can include kidney or liver disease, type 2 diabetes, an underactive pituitary gland, or certain medications. Another potential cause is Klinefelter syndrome, which is a genetic condition. Whatever the cause may be, hormones are necessary to the proper development of sperm. 

Because TRT is beneficial for many men with hypogonadism, couples trying to conceive should explore other testosterone assistance methods when trying to conceive. The first step, however, is to stop receiving TRT. As stated earlier, sperm levels are likely to restore with time. However, if your levels don’t return, your doctor may suggest alternative options for testosterone restoration. These methods may help your hormones achieve a healthy balance.  

If months pass, and you are still having trouble conceiving IVF treatments may benefit you. An endocrinologist can help you learn more about IVF. Short for in-Vitro Fertilization, IVF is a process in which an embryo is created outside of the body, often in a lab setting. With IVF, your doctor collects a sperm sample and gets one of the woman’s eggs. After this, the doctor creates an embryo and implants it in the woman’s womb. 

While IVF produces positive results in many cases, it does come with risks. Your doctor will be able to inform you of any potential problems you may encounter with IVF. Of course, it is always important to think about what is best for you. If making trips to and from a healthcare facility for IVF is burdensome, it may not be the best option for your situation. 

If you are considering TRT, it’s important to remember that TRT comes with other consequences. According to experts, supplemental testosterone can cause birth defects in a fetus. Testosterone treatments in men can restrict the growth of a fetus in the womb. This can also lead babies to be born underweight and smaller than normal. 

Many men wonder if TRT is going to affect their fertility prior to taking it. Because of this, it may help to freeze your sperm before starting TRT to ensure you have ample sperm for conception. Also, there’s no harm in trying to get pregnant, if you are already receiving TRT. 

While most people go to the doctor for fertility tests, that is not your only option. According to Optimale, you can purchase at-home fertility tests. While these may not always be available at local retail establishments, some online medical companies sell them. Home fertility tests typically cost about $40 and can be done easily and safely at home. 

You can also visit a fertility specialist. Many clinics provide semen testing. It may be worthwhile to get fertility and semen testing if you are concerned about your fertility. Though fertility testing is relatively inexpensive in the UK, the cost of testing in the United States remains quite high. 

There are other methods to reduce your risk of infertility while receiving TRT. You can stop receiving TRT altogether, if you are truly concerned. However, you can also try using enclomiphene, as opposed to TRT. According to publications, enclomiphene is an oral medicine that comes without significant side effects. Plus, enclomiphene citrate may promote your body's natural testosterone restoration, preserve testicular volume, and promote sperm restoration.

Additionally, enclomiphene citrate boosts testosterone and treats Low T symptoms. Enclomiphene may help with erectile dysfunction (ED) and loss of libido, and is taken orally.




This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your physician about the risks and benefits of any treatment. Nu Image Medical may not offer the medications or services mentioned in this article.