Does TRT Cause Infertility? Understanding Fertility and Testosterone Use

Testosterone Replacement Therapy (TRT) is a medical treatment that helps men with low testosterone. It improves energy, libido, and overall vitality. Testosterone helps with many body functions. It keeps bones strong, helps make red blood cells, and controls sexual function.

But there’s a question some men have before starting testosterone therapy: Can you have kids while on TRT? And the follow-up: Does TRT cause infertility?

If you care about your health, this guide is for you. It will help you plan for having a family or growing your family while on TRT.

Key Takeaways

• Sperm count, sperm health, testosterone levels, and hormone balance all affect male fertility.
• Testosterone replacement therapy and testosterone supplementation can reduce sperm production, but it’s often reversible.
• There are fertility-preserving strategies available, including enclomiphene, hCG, and sperm banking.
• Preserving fertility is possible when you plan proactively and get medical support before and during TRT.
• Medical professionals can help you plan your TRT and fertility goals.
• When you make lifestyle changes, you can support testosterone and fertility naturally.

Understanding Male Fertility

Male fertility is complex, and it doesn’t just rely on testosterone to work. Healthy sperm production needs balance across different systems, which include:

• Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH): These hormones come from the pituitary gland. They help with sperm production.
• Sperm count: Measuring how many sperm are present in a semen sample.
• Sperm motility and morphology: How sperm move and whether they are structurally normal for conception to take place.

TRT (Testosterone Replacement Therapy)

• Also known as: Testosterone therapy, testosterone treatment, male fertility treatment, hormone therapy.
• Purpose: Used to treat men diagnosed with clinical testosterone deficiency (hypogonadism), confirmed by symptoms and low testosterone levels.
• Medical Supervision: Prescribed and monitored by healthcare providers.
• Goal: Increase testosterone levels back to an optimal range to help with symptoms like tiredness, low sex drive, sadness, and weak muscles.
• Long-Term: Typically a lifelong therapy if the underlying cause is not reversible.

Testosterone Supplementation

• Purpose: This term is used more broadly to mean any use of testosterone. It includes TRT, but also covers off-label or non-medical use, like muscle-building or performance enhancement.
• Medical Oversight: Not always used under medical guidance.
• Goal: May aim to increase testosterone above normal levels for athletic or aesthetic goals rather than for health reasons.
• Temporary Use: Often used cyclically or short-term, especially in non-therapeutic settings.

Low Testosterone and Male Fertility

Low testosterone, also known as hypogonadism or low T, can cause a lower sex drive. It can also lead to erectile dysfunction and lower sperm quality. If you have low T, your healthcare provider may do a semen analysis to check for male infertility. Knowing your sperm count helps your healthcare provider understand your fertility potential before starting treatment.

Your healthcare provider will also check your body mass index (BMI), as it can impact your reproductive health.

It's important to know that low testosterone levels don't always cause infertility or sexual problems. Also, high testosterone levels don't always mean the best fertility. Your testosterone levels are just one aspect of your fertility.

The Impact of Testosterone Replacement Therapy on Fertility

When you use testosterone replacement therapy (TRT), your body knows it's getting enough testosterone from outside. As a result, your brain reduces the signals it usually sends to your testicles to produce testosterone and sperm. These signals are hormones called LH (luteinizing hormone) and FSH (follicle-stimulating hormone) released by the pituitary gland. When TRT lowers these hormone levels, it can lead to reduced or even completely stop sperm production.

Does TRT Affect Fertility?

Testosterone replacement therapy can lead to temporary infertility by lowering or even stopping sperm production. But in many cases, this is reversible. When you stop TRT, your hormone production can normalize, and sperm production may resume. Many men can restore sperm production and fertility after discontinuing TRT with medical guidance. However, it could take up to a year to return.

Does the Method of TRT Matter?

Yes. Different ways of taking testosterone can have different effects:

• Testosterone injections. One of the side effects of testosterone cypionate and testosterone undecanoate can be lower sperm production, compared to gels or patches. If you’d like to know more about the differences between different forms of testosterone, read this article on Oral Testosterone vs Injection.
• Topical testosterone, such as testosterone cream or gel, may have a less severe effect on fertility, but it still carries risk.

Every man’s body responds differently to TRT. That’s why your healthcare provider will monitor your hormone levels. Always let your doctor know about your future plans, so he or she can balance your TRT treatment with your fertility goals.

Reproductive Medicine and Testosterone Replacement Therapy

If you're considering or currently on testosterone replacement therapy (TRT) and planning to have children now or in the future, consult a reproductive endocrinologist or medical professional. An endocrinologist will discuss different fertility preservation strategies with you if you want to have kids.

1. Sperm Banking

Freezing your sperm before starting testosterone replacement therapy is a reliable way to preserve fertility. It’s best to check your sperm count beforehand to ensure you can produce the highest quality sample. If your sperm count is adequate when you bank it, you have a better chance of conceiving later on.

2. hCG Therapy

Human Chorionic Gonadotropin (hCG) is a hormone. It acts like luteinizing hormone (LH). hCG can be used with medical testosterone. This helps keep sperm production going. It supports natural testosterone production and protects testicular function. hCG therapy can be helpful for men who have low sperm counts as a result of testosterone therapy.

3. Clomiphene Citrate

Clomiphene citrate can be used as a standalone treatment or as part of a fertility preservation plan. It stimulates your body’s natural testosterone production and may help maintain sperm health. This approach can help your body produce more testosterone naturally while preserving fertility. 

Enclomiphene is a specific type of selective estrogen receptor modulator (SERM) from clomiphene citrate. It helps your body use its own hormonal signals instead of providing outside testosterone. It blocks estrogen receptors in the brain and helps release luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

Unlike traditional TRT, which can lower sperm production, enclomiphene can increase testosterone levels. It does this while helping to maintain or even boost sperm production and overall fertility. Find out more about the benefits of enclomiphene in this blog article.

4. IVF and IUI

In vitro fertilization (IVF) and intrauterine insemination (IUI) are good fertility treatments. They help couples when the male partner has a low sperm count. These procedures are types of assisted reproductive technology. They can help couples get pregnant when they cannot conceive naturally. IVF and IUI have higher success rates when the male partner has an adequate sperm count.

5. TESE/Micro-TESE

For men who produce ejaculate without sperm, testicular sperm extraction (TESE) may be an option. This procedure helps doctors get sperm directly from the testes. This is for men who cannot produce sperm in their ejaculate. This can happen due to TRT or other reasons. This is often combined with intracytoplasmic sperm injection (ICSI) to achieve fertilization.

6. Temporarily Stopping TRT 

When you stop TRT with a doctor’s help, your body can start making testosterone and sperm again.

Low Testosterone and Decreased Libido

Low testosterone can affect your confidence, your drive, and your relationships. A lower sex drive is a common sign of low testosterone. It can also affect intimacy in your relationship and your sexual function. 

TRT can:

• Improve sexual function
• Increase libido
• Improve your mood and cognitive function

Birth Control and Family Planning on TRT

If you’re on testosterone replacement therapy and not trying for kids, discuss birth control with your partner. TRT isn’t a guaranteed contraceptive. While TRT can lower sperm count and affect fertility, some couples may still get pregnant after stopping treatment. Pregnancy can still occur while you are actively on TRT, as well as after stopping treatment.

However, if you’re planning to start a family, get proactive:

• Schedule a semen analysis before and during TRT.
• Work with a fertility specialist.
• Speak to your healthcare provider about the timing and method of TRT.
• If natural conception is not successful, discuss IVF programs and other assisted reproductive technologies with your provider.

Increasing Testosterone Naturally

Here are some other ways you can support testosterone production. These lifestyle changes may help you naturally increase testosterone levels and support your overall reproductive health.

• Exercise Regularly: Especially strength and resistance training.
• Follow a healthy diet: Include healthy fats, protein, and foods rich in zinc and vitamin D.
• Prioritize Sleep: Aim for 7–9 hours per night.
• Reduce Stress: Chronic stress raises cortisol, which can suppress testosterone.
• Supplements: Consider supplements such as zinc, magnesium, vitamin D, and ashwagandha (after consulting with your doctor).

These strategies can help you naturally increase testosterone levels and increase sperm production.

Frequently Asked Questions About Male Infertility and Hormone Therapy

Can TRT Make You Permanently Infertile?

TRT can lead to reduced or even stopped sperm production, making it harder to conceive. However, in most cases, this effect is temporary. With proper medical guidance, sperm production often resumes after men stop taking exogenous testosterone. Permanent infertility is rare. However, it can happen if treatment is not managed well. It can also occur if there are other fertility issues.

Are There Ways To Preserve Fertility While on TRT?

Yes. There are several strategies to protect fertility while using TRT:

• Sperm banking before starting treatment.
• hCG therapy to keep the testicles producing sperm.
• Clomiphene citrate stimulates natural testosterone and sperm production.
• Assisted reproductive technologies such as IVF and IUI, if needed. These options should be discussed with a reproductive endocrinologist before beginning TRT.

How Long Does It Take to Restore Sperm Production After Stopping TRT?

Sperm production can start to recover a few months after stopping TRT. However, full recovery may take six to 12 months or longer, depending on the person. Recovery time depends on how long you were on TRT. It also depends on your age and overall health. Fertility-preserving measures used during treatment can affect recovery, too.

Is It Safe To Conceive While Using TRT?

Some men can still conceive while on TRT. However, it is not a safe or reliable choice for those trying to have children. TRT often suppresses sperm production, and couples may have trouble conceiving. If you want to get pregnant, talk to your doctor. They can help you decide if you should stop TRT for a while or use it with treatments like hCG that support fertility.