Does Testosterone Affect Fertility? Testosterone, TRT and Fertility.

Testosterone plays a major role in sperm development, but not in the way most people think. Sperm production does not rely on blood testosterone levels. It depends on testosterone inside the testes, where concentrations must be 50–100 times higher than in the bloodstream.

The hypothalamus and pituitary, acting as a command center for hormone balance, sends LH (a hormone signal) to the Leydig cells of the testes to produce on-site testosterone. The brain also sends another signal called FSH to stimulate the Sertoli cells within the testes to produce sperm. This balanced signaling and local production results in fertility.

When a man begins using exogenous testosterone, whether through creams, injections, or even orally, the hypothalamus and pituitary reads the testosterone levels in the blood. 

When blood testosterone rises, the brain senses this and reduces LH and FSH output. Without these signals, the testes stop producing testosterone and sperm.

The key question here is whether exogenous testosterone (TRT) can suppress spermatogenesis for those interested in TRT treatments who may also want to preserve fertility, among other benefits of maintaining natural testicular function.

In short, replacing testosterone can suppress fertility. However, this can be counterbalanced with therapies that allow the body to maintain either natural brain signaling or that promote direct testicular function. These adjunct therapies include oral Enclomiphene, injectable Human Chorionic Gonadotropin (HCG), injectable Follicle Stimulating Hormone (FSH), or even a cutting-edge peptide such as Kisspeptin.

• Gold Standard: injectable hCG acts like LH and restores intratesticular testosterone
• Enclomiphene: oral agent acting on the brain to stimulate LH/FSH release
• FSH: injectable used only if fertility is an active priority
• Clomiphene: oral agent that is less favored than enclomiphene due to side effects
• Kisspeptin: injectable boosting GnRH upstream

Another strategy is to periodically stimulate testicular function using enclomiphene, hCG, or FSH for cycles throughout the year.

For those who are interested in TRT, we recommend reaching out or taking a look at our TRT subscriptions for more information, but more importantly, to ensure a medical professional is helping guide your therapy.

The Impact of Testosterone on Fertility 

Exogenous testosterone boosts levels of in the blood. This results in negative feedback. When the hypothalamus and pituitary senses high levels in the blood, it reduces the signaling through the hypothalamic-pituitary-gonadal (HPG) axis, resulting in the decreased release of Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) levels, which are necessary for sperm production. 

This can result in oligospermia, a lower than normal sperm count, and difficulty causing pregnancy. This suppression can lead to temporary or in some cases longer-term reduced fertility, so TRT does in fact have a negative impact on fertility, although these effects are not permanent.  

Myths about Testosterone use and Fertility

The two biggest questions we get regarding testosterone replacement therapy (TRT) and fertility (or maintaining testicular function) are the following:

If I am on Testosterone, do I have to be on it for life?

No. Many men who use TRT and later decide to stop can see their own testosterone and sperm production return over time. Recovery depends on age, underlying testicular health, how long and how aggressively TRT was used, and other medical factors. For some men, levels return close to their personal baseline. For others, they recover only partially. Most men recover within months.

With the right medical guidance, time, and sometimes medications that stimulate the testes, natural function can often be improved or restored. Men who used fertility-preserving add-ons while on TRT may have an easier path back. Total testosterone levels after recovery may be lower than they were before starting TRT because of normal aging or other environmental factors.

If I am on testosterone, can I maintain or regain fertility even while still on it?

Possibly. Exogenous testosterone usually suppresses sperm production, so it often acts as a form of male contraception. However, under the care of a knowledgeable clinician, many men can maintain or regain fertility with a personalized plan that may include adjusting the dose, using medications such as hCG and FSH analogs, or transitioning temporarily off TRT. The best approach depends on how long someone has been on therapy, their baseline fertility, their goals, and their budget for adjunct therapies.

TRT and Fertility: How Do Lifestyle and Life Planning Fit In?  

While addressing the physiological impact of exogenous T is necessary, it’s also important to consider this question more from a lifestyle and life planning perspective.

TRT tends to be a good fit for men in their 30s, 40s, 50s, 60s and beyond in some respects because these individuals may be at a stage in their life when they are no longer as concerned with fertility. In some not-so-rare cases due to physiological or functional detriments, men in their 20s may also benefit from testosterone replacement.

If you are actively engaged in having children, it is often recommended to hold off on TRT until conception has been achieved. 

Few doctors would recommend starting a TRT regimen for individuals who are actively trying to achieve pregnancy. However, given that fertility levels can possibly be restored (or maintained) for those actively on therapy, it may be worth talking to an expert before simply stopping your therapy as this may result in poor function, libido or drive, energy, and may have some detriment to those attempts. 

The Role of HCG in TRT and Fertility  

HCG can also play a fairly large role in balancing the endocrine system for those also on TRT. 

HCG stimulates the natural endogenous production of testosterone. It’s often used in addition to TRT to counteract the suppression of sperm generation and to help maintain the size of the testes. HCG dosages can also be custom tailored to account for the levels of fertility. 

Using hCG alone for the treatment of low testosterone can overstimulate the testes and does not replace FSH, making it unsuitable as a primary therapy.

If the goal is to maintain testicular function while on TRT, to boost fertility, or as a combination therapy, and if overseen by a medical professional, then HCG may be a solid choice. 

It’s important that anyone interested in hormone replacement get in touch with a doctor to discuss the various impacts of TRT and HCG and how HCG serves to balance out TRT, as well as with regard to balancing dosages both initially and overtime. This also depends on the endocrine profile of the particular patient as well as his goals, including those related to family planning.

TRT with Lucidity Health   

Whether your goal is to explore the possibility of testosterone replacement, health optimization, fertility, or a combination therein, Lucidity Clinic is primarily a provider of TRT among other therapies. 

In regard to fertility, we supply affordable at-home sperm kits that give same-day results shared with your practitioner.

Our team also provides a number of peptides focused on fertility, weight loss, performance and body composition, enhanced cognition, and cellular optimization. 

Reach out to us for more information about TRT and to learn more about our therapies.

References

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. https://doi.org/10.5534/wjmh.180036

Kupelian, V., & Shabsigh, R. (2015). The Journal of Sexual Medicine, 12(6), 1334–1335. https://doi.org/10.1111/jsm.12900