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What to Know About Testosterone Therapy and Fertility

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Fast Facts

  • Having low testosterone can make it harder to conceive.
  • Testosterone replacement therapy (TRT) can relieve symptoms of low T, but it can affect fertility.
  • If you are concerned about the link between TRT and fertility, ask your doctor about treatment options that ease symptoms without impacting your ability to father children.

If you’re undergoing testosterone replacement therapy (TRT)—or considering starting a course of TRT because you’ve been diagnosed with a testosterone deficiency—you may have questions surrounding how the therapy can affect your sperm count, fertility, and more. Here, everything you need to know about TRT and fertility.

What Is Testosterone?

Testosterone is a vital hormone and the primary sex hormone in men. It’s a key player in regulating sex drive, muscle mass and strength, fat distribution and storage, red blood cell production, processing emotions, and development during puberty. It’s also integral for your fertility. (Want more information on T? Read our explainer on testosterone.)

What Is Low Testosterone?

As men age, their testosterone naturally drops, about 1 percent per year after the age of 35. However, if your testosterone levels continue to dip at a higher rate than this normal decline, it’s a sign of a condition called hypogonadism, where the testes don’t produce enough testosterone and you experience symptoms of low testosterone.

Hypogonadism can throw your whole body out of whack. You’ll start to notice a host of symptoms, including a decline in your sex drive, a lack of energy, and a loss of muscle mass.

The only way to truly know if your testosterone levels are adequate or low is to test your hormone levels at least once a year. Hone’s at-home test  provides a definitive look at your hormones and allows you to consult with a doctor about what the results mean and how you’re feeling.

Related: How To Talk To Your Doctor About Low T

What’s the Relationship Between Low T and Fertility?

A handful of hormones are required for sperm production, and testosterone is among them. But having low testosterone doesn’t mean you’re infertile, nor does it cause infertility. Even among men with low T, testosterone levels in the testes are often high enough to produce effective sperm and conceive normally.

TRT and Fertility: Understanding The Link

If a test shows that you have low T and your doctor prescribes testosterone replacement therapy, the treatment can lead to a decrease in sperm count.

What you need to understand about trt and fertility: When your brain registers an influx of testosterone, it sends a signal to a small gland called the pituitary gland to decrease another hormone, follicle stimulating hormone (FSH), which triggers sperm production. A lower sperm count does not necessarily cause infertility but it can make it more difficult to conceive.

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TRT can lead to a decrease in sperm count

Is the Impact of TRT On Fertility Permanent?

In most cases, infertility caused by TRT is not permanent. When TRT is stopped (which should only be done under medical guidance), infertility usually reverses, especially if testosterone replacement therapy has only been underway for a short amount of time.

However, for a very small percentage of men, fertility doesn’t return after stopping TRT.

How Quickly Does TRT Impact Fertility?

When it comes to trt and fertility, you should know that everyone’s body is different, so there’s no baseline amount of time for TRT to affect a man’s fertility. For some, it can happen quickly; others may notice a more gradual decline in sperm production. It all depends on how well—and fast—the body responds to the additional testosterone from the therapy.

Yes, You Can Treat Low T AND Preserve Fertility

Hone’s at-home assessment measures your testosterone levels. If you have low T, you can speak a Hone physician about treatment options that preserve fertility. 

How Long After Stopping TRT Does Your Sperm Count Increase?

Usually, your sperm level will return to pre-TRT levels within one year of ceasing TRT. However a small number of men still have low sperm production after stopping testosterone replacement therapy. The length of time before fertility is regained also involves factors like how long you were on TRT, what dose you were on, and your age. 

An older man who was on TRT for a longer time can expect a longer sperm recovery time frame than a younger one who was on TRT for a shorter period of time.

If You Want Kids and You Have Low Testosterone, What Should You Do?

Your doctor will be able to help you determine whether your low T can be rectified by TRT or by alternate hormone therapy. For example, there could be a problem with your pituitary gland, in which case pituitary hormone supplementation or another prescription medication be enough to rectify the low testosterone levels while leaving your sperm production unaffected.

If You’re on TRT and You Want Kids, Should You Stop?

You should never stop TRT without the guidance of your doctor. But if your physician determines that stopping TRT is the best course of action because of concerns about TRT and fertility, he may prescribe medications including FSH or Clomid to help speed up the return of fertility.

Can Clomid Increase Fertility?

If you and your physician decide stopping TRT is the right option, he or she may prescribe another medication to help raise your testosterone and preserve or enhance your fertility.

One, Clomid, helps male fertility in a couple of ways. The drug modulates your estrogen system tricking your body into producing more FSH and luteinizing hormone (LH), both of which trigger sperm production.

Related: Yes, Men Need Estrogen Too. Here’s Why.

Clomid can also increase testosterone and help with libido and erectile dysfunction. The caveat: high doses of Clomid can negatively impact sperm count and motility, so work with your doctor to find the right dose for you.

TRT Alternatives for Future Fathers

If you’re hoping to have children soon, your doctor may be able to prescribe medications that help with the symptoms of low T without affecting sperm counts, such as human chorionic gonadotrophin (hCG), which research (1) suggests can reverse low sperm counts brought on by TRT and also help maintain testosterone levels in the testes.

The Bottom Line

If you have been prescribed TRT for low testosterone and want to have children, speak to your doctor, since TRT can affect fertility. Other treatments can relieve the symptoms of low testosterone without impacting fertility.