Testosterone replacement therapy (TRT) can be life-changing. Widely recognized as the best treatment for low testosterone, TRT can significantly improve mood, energy, and libido, helping you feel like yourself again. With these benefits, it’s no surprise that between 2003 and 2013, androgen prescriptions increased fourfold.
But while TRT does have incredible benefits for men who experience symptoms caused by low testosterone, it’s not right for every man. Importantly, if you’re already struggling with infertility, this treatment could make things worse. And if you’re planning to father children in the future, TRT might seriously inhibit your ability to do so.
Does testosterone therapy make you sterile? In some cases, yes. Most men experience a significant decrease in sperm count when taking TRT—which is why testosterone is being studied as a form of male birth control. While a lower sperm count doesn’t necessarily cause infertility, the lower it goes, the more difficult it will be for you and your partner to conceive. Some men even reach a sperm count of zero while on testosterone. For most individuals, this infertility is only temporary and their sperm count rises to normal levels when treatment is discontinued. But some men never recover their sperm count after treatment.
For hypogonadal men who do not plan to have biological children in the future, TRT may be the best path to addressing the symptoms of low testosterone. But if you’re concerned about your fertility, you need to seriously consider the risks of TRT before taking any medications that supplement testosterone.
How Does Testosterone Therapy Make You Sterile?
The male body naturally produces testosterone through a complex process of hormone interactions. To simplify, the brain constantly monitors the body’s level of testosterone and produces gonadotropin-releasing hormone (GnRH) when it detects that levels are low. In turn, the pituitary gland secretes follicle stimulating hormone (FSH) and luteinizing hormone (LH), signalling sperm and testosterone production in the testes.
When you take exogenous testosterone in the form of medication, this process is disrupted; if brain never detects a low level of testosterone, so it doesn’t produce more GnRH. Without GnRH, the body doesn’t produce its own testosterone—nor does it produce more sperm. Depending on how long you use testosterone replacement therapy and which dose you’re taking, your sperm count could completely zero out.
It’s common for men on TRT to experience significantly diminished fertility and to struggle with conceiving due to low or zero sperm count. This is how men can become sterile by taking testosterone. In most cases, this infertility is temporary. The effects can be reversed by stopping TRT and waiting for sperm and internal testosterone levels to rise again. This process can take six weeks, six months, or a couple of years. But some men never recover their fertility at all.
The Misuse of Testosterone as a Fertility Treatment
If the risks of TRT were widely known and talked about openly by doctors and patients alike, this wouldn’t be such a big problem—each man could decide for himself is the risk is acceptable. But many men don’t know that their testosterone medications could be impacting their fertility in both the short and long term. Even worse, some doctors are still prescribing testosterone to treat infertility. One survey of practicing American Urological Association members found that 25% of respondents were prescribing TRT to infertile men who were actively pursuing pregnancy. International studies have had similar results and indicate that a significant number of practitioners incorrectly believe that testosterone therapy increases sperm count.
In some ways, the thought process makes sense. Testosterone plays some part in the reproductive function of the male body. If a man is found to be infertile, why not administer doses of this incredibly accessible treatment?
It’s all a matter of education. The doctors who prescribe TRT as male infertility treatment aren’t aware of the consequences and may not have the necessary qualifications to be administering complex hormone treatment in the first place. More education on the effects of exogenous testosterone on male fertility could help reduce this unfortunate occurrence.
If you are struggling with infertility—either naturally or due to previously administered testosterone—it’s important to know that there are alternate therapies available that could help you and your partner achieve pregnancy. For instance, studies show that the high testosterone levels and resultant infertility associated with obesity can be reversible through nutritional and lifestyle changes. It’s also possible that taking GnRH hormones, estrogen receptor modulators, aromatase inhibitors, or beta hcg may help increase spermatogenesis.
The Benefits of Expert Guidance
If having biological children is a priority for you, it is best to not take testosterone replacement therapy. But if you have no desire to have biological children, if that time in your life has already passed, or if the potential benefits of testosterone outweigh the risk of infertility, TRT could be the best choice. For the right men, the advantages of testosterone therapy are significant and may include:
- Higher energy
- Increased muscular strength
- Higher libido
- Reduced depression
- Improved sleep issues
If you’re interested in the possibility of testosterone replacement therapy, we highly recommend speaking with a qualified hormone health practitioner before beginning treatment. They’ll be able to assess your symptoms and adequately measure your testosterone levels to see if you’re a good candidate for this therapy. If you decide to try TRT, they can provide ongoing monitoring to track your progress and make adjustments as necessary. If TRT isn’t your best option, they can help you identify a more appropriate treatment method.
By partnering with real experts, you can avoid all the pitfalls that are possible with inappropriate or poorly-administered hormone treatment. The right practitioner will be fully knowledgeable on the potential side effects and risks of hormone replacement therapy and can help you weigh the pros and cons. Regardless of your ultimate decision, the best practitioners will support you in achieving your health and lifestyle goals.
The BodyLogicMD network is comprised of experts in male hormone health, helping men find relief from the symptoms of low testosterone and recapture their sense of vitality through hormone medications and nutritional/lifestyle counseling. BodyLogicMD-affiliated practitioners are dedicated to making sure that every patient receives the individual attention and one-on-one consultation time they need for the best possible outcomes. Contact a local practitioner to schedule your first appointment and find out whether testosterone replacement therapy is right for you. Or, take the BodyLogicMD Hormone Balance Quiz to learn more about how testosterone (or lack of testosterone) may be impacting you.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended diagnose, treat, cure or prevent diseases.
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.