My Husband Takes Testosterone Injections: Can I Still Get Pregnant?

‍Woman looking down thoughtfully at a pregnancy test.

If your husband takes testosterone injections, you might be wondering if starting or growing your family is still an option. The short answer is yes, but it’s not always that straightforward. Testosterone therapy (TRT) can affect fertility, and understanding how it works will empower you to make the best decisions for your relationship and your future family.

TRT's impact on fertility varies, with some men experiencing rapid changes and others a more gradual decline in sperm production, depending on their body's response. We've created this guide to help you navigate family planning while exploring treatment for low testosterone.

Key Takeaways:

• Testosterone replacement therapy (TRT) often leads to a reduced sperm count by disrupting hormone signals that regulate sperm production.
• Sometimes fertility can be restored by stopping TRT or switching to alternative treatments.
• Pregnancy may be possible, but timing and medical guidance are part of the journey.

What is Testosterone Replacement Therapy?

Testosterone replacement therapy can help men who are dealing with low testosterone levels (low T). It can improve energy levels, libido, mood, and mental clarity. But testosterone has side effects: it can also interfere with male fertility.

When men start TRT, they're more focused, leaner, and have the energy to take on the world. But when couples are trying to conceive, some find they have lower sperm production. TRT helps to restore quality of life for men who have the symptoms of low testosterone, but it also suppresses the body's natural processes that produce sperm.

Testosterone therapy suppresses the body's natural production of testosterone in the testes, which can lead to reduced sperm production (Ramasamy et al., 2014). For couples, this can make getting pregnant very difficult. Taking testosterone supplements can also reduce sperm production significantly, making conception less likely.

If you're still thinking about testosterone use and want to have a family, it's best to discuss your long-term plans with your healthcare provider.

My Husband Takes Testosterone Injections; Can I Still Get Pregnant?

The Effects of Testosterone on Fertility

To create testosterone, the brain releases follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These are messengers that signal the testes to make testosterone and sperm. However, when a man takes testosterone injections (or exogenous testosterone), the brain recognizes elevated testosterone levels and doesn't release FSH and LH. Without FSH and LH, there can't be any sperm production (Coviello et al., 2005; Thirumalai et al., 2021).

What this means is that testosterone treatment can decrease sperm count, potentially leading to infertility. Clinically, this condition is called azoospermia, and it's a common side effect for men on testosterone therapy. It doesn't affect every man to the same extent, but for many, TRT can reduce fertility. On the positive side, these effects can usually be reversed when the man stops treatment.

TRT can sometimes act as a form of male birth control in the way it shuts down important reproductive hormones. This isn't its intended purpose, but couples should be aware that their ability to conceive could be impacted, even to the point of temporary infertility.

Can TRT Be Reversed?

For the majority of men, stopping testosterone allows the body to restart natural testosterone production, but it can be a slow process. It may take months, sometimes up to a year or longer, for sperm counts to return to pre-TRT levels (Liu et al., 2016).

The recovery process from TRT will depend on factors such as your husband's age, the duration of testosterone treatment, and whether medical interventions are used.

Your healthcare provider can help you navigate this process. He or she will monitor hormone levels and the weaning period to stop TRT. Sometimes your healthcare professional may recommend an alternative that preserves fertility.

Fertility-Safe Alternatives to Testosterone Injections

Men who want to maintain their fertility and get the benefits of testosterone have other options. These are some alternatives to support testosterone production and sperm count while managing the symptoms of low T:

Clomiphene Citrate

This is an oral medication that makes it seem as though testosterone levels are low. This encourages the body to produce more follicle-stimulating hormone and luteinizing hormone. Clomiphene citrate helps to stimulate sperm production while increasing testosterone levels (Taylor & Levine, 2010).

Human Chorionic Gonadotropin (hCG)

Human chorionic gonadotropin hormone (hCG) behaves like LH: by encouraging the testicles to produce testosterone and sperm. It can stimulate sperm production in men whose fertility has been affected by testosterone therapy. It’s often used alongside clomiphene or as a standalone therapy for men who want to preserve fertility (Coviello et al., 2005; Wenker et al., 2015).

Combination Therapy

Men who have been taking injectable testosterone, such as testosterone cypionate, may benefit from the combined effects of clomiphene citrate and hCG. Combination therapy has an added advantage: it may also prevent testicular atrophy and protect testicular function, another long-term side effect of testosterone therapy (Hsieh et al., 2013; Kaminetsky et al., 2015).

Preserving Fertility Before Starting TRT

If you and your partner want to have kids in the future, it's best to speak to your doctor before starting testosterone therapy. Here are some tips to help you:

• Sperm banking: As the name suggests, sperm banking is the process of banking sperm samples before you start testosterone replacement therapy. It's also called cryopreservation, and some couples use it as a precaution.
• Customized treatment plans: Your healthcare professional may adjust your partner’s testosterone dose or recommend other therapies that have a lesser impact on sperm count.
• Regular monitoring: When your healthcare provider monitors your husband’s testosterone levels, FSH, LH, and sperm count, you can make proactive decisions together.

Fertility Challenges and Solutions

If your husband has been taking injectable testosterone, you may have concerns about conception, but don't worry, there are other options available:

• Stop or pause TRT: This can restore natural testosterone and maintain sperm production over time.
• Use medications that support fertility: Clomiphene and human chorionic gonadotropin hormone can help increase sperm count.
• Consult a fertility specialist: A reproductive endocrinologist can offer personalized strategies, including hormone therapy, sperm retrieval, or assisted reproductive technologies (ART).
• Explore fertility treatments: Medications and assisted reproductive techniques can help couples affected by TRT and male infertility improve their chances of conception.

Remember: sperm count is just one aspect of conception. Sperm motility (how they move), morphology (shape), and DNA integrity also influence conception (Evenson & Wixon, 2006; WHO, 2010). Getting a semen analysis can tell you about sperm count and quality when your medical professional evaluates your partner's fertility.

The Impact of Testosterone on Pregnancy

Another common concern among couples is whether testosterone therapy can impact pregnancy after conception has taken place.

The current research scope is limited, but there's no strong evidence to suggest TRT directly causes birth defects (Ramasamy & Stahl, 2016; Salonia et al., 2021). Other studies in clinical endocrinology have focused on the effects of testosterone therapy on reproductive health, including fertility and pregnancy outcomes. However, because TRT may lower sperm quality, some believe there could be indirect effects (Ramasamy et al., 2014; Parris et al., 2023).

When you work with your healthcare provider, you can monitor and manage any potential risks.

FAQs

How Long After Stopping Injectable Testosterone Can We Try to Conceive?

It depends. Some men resume sperm production three to six months after stopping TRT, but for others, full recovery may take 12 to 18 months or longer. Speak to your healthcare provider for advice specific to your situation.

Can My Husband Continue Testosterone Therapy While Trying to Conceive?

Generally, no, because TRT suppresses sperm production. Taking an alternative such as clomiphene citrate and hCG therapy (or a combination of the two) may provide testosterone support while maintaining fertility.

Is It Possible to Get Pregnant Naturally While My Husband Is on TRT?

It is possible, but it's rare. The majority of men on TRT experience lower sperm count or azoospermia, which can make natural conception difficult. Having a sperm analysis will show if TRT has impacted your husband’s fertility.

Can Testosterone Levels Affect the Health of the Baby?

So far, the research indicates that testosterone therapy doesn't directly affect fetal development, but studies are ongoing. It's best to discuss your concerns with your healthcare provider.

References

1. Patel, A. S., Leong, J. Y., Ramos, L., & Ramasamy, R. (2019). Testosterone is a contraceptive and should not be used in men who desire fertility. The World Journal of Men's Health, 37(1), 45–54.
2. Thirumalai, A., & Amory, J. K. (2021). Effect of testosterone on male fertility. Current Opinion in Urology, 31(6), 598–603.
3. Hsieh, T. C., Pastuszak, A. W., Hwang, K., & Lipshultz, L. I. (2015). Testosterone therapy increases intratesticular testosterone levels in men with secondary hypogonadism. The Journal of Urology, 194(6), 1709–1713.
4. Coviello, A. D., Matsumoto, A. M., Bremner, W. J., et al. (2005). Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression. The Journal of Clinical Endocrinology & Metabolism, 90(5), 2595–2602.
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7. Parris, D., et al. (2023). Testosterone replacement therapy and spermatogenesis in reproductive-aged males. Nature Reviews Urology.
8. Liu, P. Y., Swerdloff, R. S., & Anawalt, B. D. (2016). Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use. (Review of timelines and outcomes after exogenous testosterone).
9. Wenker, E. P., Dupree, J. M., Langille, G. M., Kovac, J. R., & Lamb, D. J. (2015). hCG monotherapy for men with hypogonadism and infertility: a review. Asian Journal of Andrology, 17(2), 239–242.
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