a couple with a toddler at home

TRT and Fertility: What Every Couple Needs to Know

It is possible to treat low T if kids are in your future.

Fast Facts

  • If a man has low testosterone it can make it harder for a couple to conceive.
  • Testosterone replacement therapy (TRT) can relieve symptoms of low T, but it can affect fertility.
  • Couples who are concerned about the impact of TRT and fertility should talk to a doctor. There are treatments that can improve symptoms of low T without hampering the ability to have children. 

When a man has low T, he doesn’t suffer alone. Mood swings, low libido, and erectile dysfunction are symptoms that can seriously impact your relationship. 

The good news: starting testosterone replacement therapy (TRT)—can solve for some of these symptoms and help couples feel closer than ever. 

But as a couple, if you’re thinking of having kids now, or down the line, you should know that TRT can impact fertility. In fact, some researchers have even looked into it as a form of birth control (1).

The good news: Plenty of men with low testosterone are able to have kids, even while being treated for low T.

Confused? Don’t be. Here, everything you need to know about TRT and fertility.

What Is Low Testosterone?

As men age, their testosterone naturally drops, about 1 percent per year after the age of 35 (2). If a guy’s testosterone levels fall faster than this, it’s a sign of a condition called hypogonadism, where his testes don’t produce enough testosterone and he experiences symptoms of low testosterone.

Hypogonadism can throw a man’s whole body out of whack. If he has low T, he’ll start to notice a host of symptoms, including a decline in sex drive, a lack of energy, and a loss of muscle mass. He might have mood swings or even depression.

The only way to truly know if a man’s testosterone levels are adequate or low is for him to test his hormone levels. Hone’s at-home test provides a definitive look at a man’s hormones and allows him to consult with a doctor about what the results mean.

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Hone tests for and treats low testosterone from the comfort and privacy of your home.

What’s the Relationship Between Low T and Fertility?

Men’s bodies needs a handful of hormones to churn out sperm, and testosterone is definitely on the list. But having low testosterone doesn’t make a man 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.

If a Guy Has Low T, Can it Make it Harder for His Partner to Get Pregnant?

Sperm and testosterone production aside, having low T can impact libido and erections—two ‘must haves’ when it comes to conception. 

Low T can also cause weight gain, fatigue, and mood swings, and when a guy feels exhausted, heavy, and depressed, sex probably isn’t top of mind.

Can a Couple Still Get Pregnant With Testosterone Injections?

If a test identifies that a man has low T and his doctor prescribes testosterone replacement therapy, the treatment can lead to a decrease in sperm count, especially if testosterone is given via injection (instead of a cream or gel). (1)

Here’s why: Sperm production is triggered by a complex set of hormone signals. Men’s brains track how much testosterone is in their system. When it detects that levels are low (because of stress, diet, or other factors), it sends a signal to a small gland called the pituitary gland to pump our two hormones called luteinizing hormone (LH) and follicle stimulating hormone (FSH), which triggers the testes to product sperm. 

When exogenous testosterone is taken in the form of TRT, this process is disrupted. The brain thinks there’s plenty of T in the system, so it doesn’t send a message down the chain to produce sperm. 

A lower sperm count does not necessarily cause infertility but it can make it more difficult to conceive.

Is Low T Impacting Your Relationship?

Find out with Hone’s at-home assessment. It’s fast, painless, and can be done at home.

Is the Impact of TRT On Fertility Permanent?

In most cases, infertility caused by TRT is not permanent.

If a man stops TRT (which he should only do under his doctor’s guidance), his testosterone levels and sperm count should go back to where they were before he started TRT, especially if he’s only been on testosterone replacement therapy for a short period 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, 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.

How Long After Stopping TRT Does Sperm Count Increase?

Again, there’s no hard and fast rule here. How quickly sperm levels return depends on how long a guy was on TRT, his age, and the dose.

But usually, sperm levels return to pre-TRT levels within a year of stopping TRT.

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.

Yes, Fertility Can be Preserved While Treating Low T.

Hone’s at-home assessment measures testosterone levels. If low T is detected, our doctors can suggest treatment options that preserve fertility. 

Options for Men with Low T Who Want to Have Kids

If low T has been diagnosed but having kids is on the radar (even if its years off), this should be part of the doctor consult. 

This information will help them determine whether TRT is the best option to address low T, or whether a different form of hormone therapy is a better fit. 

The doctor will also use a man’s test results to pinpoint the cause of his low T. For example, there could be a problem with his pituitary gland, in which case pituitary hormone supplementation or another prescription medication can elevate testosterone levels while leaving his sperm production unaffected.

Expert Tip: Do These 2 Things Before Starting TRT

In a live chat with the Hone community, hormone specialist James Staheli, D.O., gave this piece of advice to couples who might want children.

“Before the man starts TRT, he should do two things,” says Staheli. “Get a baseline sperm count to know what his natural levels are and consider banking sperm in case his sperm count doesn’t return if he stops treatment.”

 

Can Clomid Increase Fertility?

Clomid, helps male fertility in a couple of ways. 

The drug modulates a man’s estrogen system. When the body thinks that estrogen is high, it also thinks testosterone is high. 

Clomid blocks estrogen receptors and tricks a man’s body into producing more FSH and luteinizing hormone (LH), both of which trigger sperm production 

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 and cause side effects including bloating, nausea and fatigue, so he’ll need work with the doctor to find the right dose.

TRT Alternatives for Future Fathers

If as a couple, you’re hoping to have children soon, a 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 (3) suggests can reverse low sperm counts brought on by TRT and also help maintain testosterone levels in the testes.

Yes, Fertility Can be Preserved While Treating Low T.

Hone’s at-home assessment measures testosterone levels. If low T is detected, our doctors can suggest treatment options that preserve fertility. 

1. Patel AS, et al. (2019). Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility
2. Travison TG, et al (2006). A population-level decline in serum testosterone levels in American men. 
3. Ramasamy, Ranjith et al (2015). Preserving fertility in the hypogonadal patient: an update. 
2012/06/120625124914.htm
3. Riachy, Ruba et al (2020). Various Factors May Modulate the Effect of Exercise on Testosterone Levels in Men. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739287/
4. Peter Y Liu (2019). A Clinical Perspective of Sleep and Andrological Health: Assessment, Treatment Considerations, and Future Research. https://academic.oup.com/jcem/article/104/10/4398/5481939

The Bottom Line

If a man has been prescribed TRT for low testosterone and wants to have children, that should be a part of the conversation with his doctor, since TRT can affect fertility. Other treatments can relieve the symptoms of low testosterone without impacting fertility.

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