Testosterone Replacement Therapy and Infertility in Men

Ben BA(Hons), PGCert

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Hormones and Fertility

LAST UPDATED: November 2018.

Author: Ben graduated from university in 2015. After working in the corporate sector for over 10 years starting life as a graduate, he realized his passion lay in physical fitness and how we can improve performance.

Does testosterone replacement therapy use in men affect fertility?

What does testosterone do?

Quite often you will here testosterone being referred to as T or test.

Testosterone is the male sex hormone and is produced in men by the testicles.

However, it is not just all about sex, T has an effect on many bodily functions and processes – much more than you may appreciate.

Testosterone is responsible for muscle and bone growth. It has an effect on hair growth, sex organ development, sexual function and even feelings of well being.

Plus, it is responsible for sperm production.

What’s the effects of low T?

When a man has abnormally low levels of testosterone, this is called hypogonadism.

However, it can be fairly hard to draw a line at what a normal range of testosterone is and a test is performed by gathering a sample of blood.

You may be unsure about your test levels, however, there are a few warning signals that can trigger you to go and get that blood test.

If you are feeling low on energy, your libido has taken a hit, erections are becoming problematic, your muscle mass has reduced and you have noticed more abdominal fat you could be suffering from low test.

It is important to realize that decreasing levels of natural T are completely natural and normal as men hit 30 years old, so it could just be andropause setting in – this is the normal decline of testosterone.

What you need to understand is whether it is andropause or hypogonadism that you may be suffering from.

Andropause = natural decline of testosterone as you age

Hypogonadism = abnormally low levels of testosterone

Yet, it can be treated.

Testosterone levels need to be checked twice in the morning, and if you have abnormally low test levels, the test will highlight this on two separate occasions to confirm.

This is due to test levels varying throughout the course of a day, so it is best to take two separate readings in the early morning when levels should be at their highest.

What’s the treatment for low T?

There are a variety of treatments available for low testosterone levels.

There’s natural test boosters that utilize a number of different vitamins and minerals that are known to stimulate more natural test production.

Or there’s testosterone replacement therapy (TRT) which involves prescription use of patches, gels, injections and even implant pellets.

The difference between the former and the latter. The latter involves offering replacement testosterone whereas the former is about stimulating more production of your natural testosterone.

Is fertility affected by low testosterone treatments?

It is important to understand that having a lower level of testosterone doesn’t cause infertility.

While testosterone is required for the production of sperm, sperm requires other hormones too.

Yet, it is also important to understand that sperm is created in the testes where testosterone is, so the levels found there will be much higher than found in the blood.

So, even if you have abnormally low testosterone, it is much more likely to be enough to create sperm.

Now, this is where the water starts to get a little muddier…

Low testosterone is very unlikely to cause fertility issues.

However, one side effect of TRT can cause infertility.

It is imperative to understand that this is not the natural test boosters that can cause it, but the prescription testosterone patches and gels that can be administered.

TRT which involves providing more testosterone in to your system rather than stimulating more of your natural testosterone production decreases sperm production.

This is because the TRT decreases levels of follicelstimulating hormone (FSH) which is another important hormone required for sperm production.

Thankfully, for most, this is reversible. and if you have been receiving testosterone replacement for a shorter period of time, this will then allow you to recover more quickly.

However, for a very small amount of men this recovery and side effect is not reversible.

The worse form of treatment for infertility?

There are strong theories that any TRT that is administered by injections and implant pellets are the worse offenders and are more likely to cause fertility problems in men.

That said, all form of testosterone replacement can disrupt the hormone balance and cause issues for sperm production in men.

What’s the options for men on TRT who wish to father children?

Firstly and fore mostly, if a man is wanting to father a child, he should avoid taking any testosterone replacement until their efforts to reproduce are finished.

Once their efforts are over, he can then reintroduce the replacement therapy.

These decisions should be discussed with a male reproductive specialist.

I’m infertile and taking TRT, what can I do?

You need to seek advice from a reproductive specialist because tests and physical examinations are required.

Hormone examinations and analysis will be required, as will the semen.

Further tests and examinations will be required periodically and testosterone replacement should be stopped immediately.

It may take a number of months before the sperm level returns to baseline.

Are there any other possible treatments?

Yes.

You can try to use a natural testosterone booster that does not replace testosterone but helps increase your own natural production.

This can be helped more by incorporating resistance training, in particular compound exercises which utilize multiple joints such as the bench press, squat and deadlift.

A more ‘off-piste’ option is to take further medications such as clomiphene citrate,
letrozole, and fertility injections of pituitary hormones.

These can also help increase testosterone levels.

However, these latter three options can potentially cause abnormalities of the hormones and, occasionally cause a reduction of sperm numbers.

As such, hormone and semen levels should be monitored closely.

Conclusion

If you have low testosterone levels but are looking to have children, it is imperative that you do not take any testosterone replacement therapy as this can disrupt further hormones that are required for sperm production.

Even if you have hypogonadism, it is likely that there is enough baseline testosterone to produce sperm.

Natural testosterone boosters are unlikely to cause any problems as they do not replace hormone levels, yet encourage more natural testosterone to be produced.