• Blog
  • How Does TRT (Testosterone Replacement Therapy) Impact Fertility ?

How Does TRT (Testosterone Replacement Therapy) Impact Fertility ?

Written by

Science & Humans

Medically approved by

Maria Jacob

Last updated

Tuesday, July 27, 2021

The same testosterone that helps deal with ED (Erectile Dysfunction), increase libido, build muscle tone, improve mood and reduce fatigue has a downside – infertility. A paradox, that the same hormone that positively impacts sexual function negatively impacts fertility when administered externally. It acts more as a contraceptive when it is not produced by the body itself.

External source of testosterone disrupts the hypothalamic-pituitary gonadal axis, (HPG axis) which is like a traffic cop directing traffic. This in turn inhibits production of luteinizing hormone and follicle stimulating hormone which suppresses natural synthesis of testosterone affecting sperm generation in the testes.

Lack of natural testosterone also causes testicular shrinkage which affects the leydig cells that synthesize testosterone in the testicles. This intra-testicular process of testosterone synthesizing also plays an important role in sperm quality & motility, which is affected by the suppression of follicle stimulating hormone.

All forms of testosterone supplement – creams, injections or gel affect sperm generation due to hormone disruptions. Although, it is believed gels do not affect fertility as much. An experimental nasal spray still undergoing trials seems to hold promise in terms of not affecting fertility by reducing sperm generation.



Take our online test and check if you are eligible for our hormone therapy

This allows our medical team to analyse your blood test and confirm if you’ve qualified for treatment


What are the treatment options available to remedy infertility from TRT?

Infertility caused by TRT is reversible in most cases by stopping T-therapy. Reversal is quicker if the duration of testosterone replacement therapy is shorter, longer if TRT has been administered for a longer period.

For a small percentage of men, infertility from TRT may not be reversible. Age is a factor that impacts reversal. For older men, reversal from TRT induced infertility may not be feasible.

Consulting a male reproductive specialist is important before starting TRT. This facilitates thorough understanding of risks and options available if pursuing TRT and wanting children.

A baseline semen analysis with routine serum total testosterone, LH, and hematocrit before starting TRT helps identify decreased baseline sperm count and provides a baseline value for future semen analysis after TRT use.

Avoiding testosterone replacement therapy until after having children is better. Else, freezing sperm mitigates risk to a certain extent. Pregnancy via IVF or artificial insemination can be induced using the frozen sperm is another way to have children while on TRT.

Human chorionic gonadotropin(HCG) , a pituitary hormone, helps treat low T if a pituitary disorder is the cause, without affecting sperm generation.

Clomid or clomiphene citrate, an infertility treatment oral drug for women, is prescribed off-label for men desiring children who are on TRT. This medication helps luteinizing hormone and follicle stimulating hormone production which in turn helps the body produce testosterone naturally, to augment sperm generation.

If someone is on testosterone but infertile and wants children, a thorough physical exam, and history is captured by the reproductive specialist. Hormone testing, and at least two semen analysis with other tests as required. Along with stopping testosterone completely, semen and hormone analysis has to be repeated periodically, since it will take many months for sperm count to reach levels before TRT is initiated.


Further reading

Unlocking the Power of Testosterone: Boost Muscle Gain Naturally

Unlocking the Power of Testosterone: Boost Muscle Gain Naturally

A key factor in the growth of muscle mass and strength is the male sex hormone testosterone (T). By promoting protein synthesis in muscle cells, which leads to the develo ...

Learn More
How Does TRT Therapy Impact Chronic Fatigue?

How Does TRT Therapy Impact Chronic Fatigue?

Chronic fatigue syndrome is characterized by persistent fatigue and difficulty carrying out routine everyday tasks. TRT therapy is a tried-and-true method for raising tes ...

Learn More
Impact of Testosterone Replacement Therapy (TRT) on Low Libido

Impact of Testosterone Replacement Therapy (TRT) on Low Libido

Low libido in men can be caused by various factors, such as ageing, illness, medications, hormonal abnormalities, psychological factors, and substance abuse. TRT can help ...

Learn More

© 2022 Science & Humans. All Rights Reserved.