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Does Low T Cause Infertility?

Does Low T Cause Infertility?

By Mike Kocsis | 7 minutes read | Last updated: October 27, 2023
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  • Medically Reviewed by Dr. George Touliatos

    Evidence Based Research

    Testosterone deficiency, known as hypogonadism or low T in medical terms, affects millions of men around the world. It not only influences their health but also affects their family and social lives.

    Low T generally produces the following symptoms in men.

    Low testosterone levels may or may not affect your fertility. In this article, we explain the relationship between low T and infertility to help you understand how low T affects fertility and what you can do to resolve the issue.  


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    Effect of low T on men’s fertility

    Testosterone is a sex hormone and it is involved in many sexual functions, such as sperm production, sexual desire, etc. A man can have testosterone deficiency but still be able to produce sperm and have no difficulty conceiving.

    Your testicles need a small amount of testosterone and follicle-stimulating hormone to produce sperm. Testosterone levels are measured using a blood sample. If your serum testosterone level is low, that does not mean your testicles also have the same low testosterone level.

    They may have much higher testosterone levels and still be able to produce sperm; however, the number of sperm will most likely be low, reducing your odds of conception.  

    Low T can also cause erectile dysfunction and low sexual desire, which can further reduce your chances of conceiving.


    How to treat low T?

    You can treat low T using natural ways or medical procedures depending on what the cause of the problem is and how low your testosterone levels are. Before going for testosterone replacement therapy (TRT), you should first try changing some lifestyle habits.


    Lifestyle changes

    Adopt the following habits to improve your testosterone levels naturally.


    Get enough sleep

    You should get plenty of restful sleep as it helps repair tissues and boost testosterone levels. Sleeping for only a few hours or oversleeping can impair testosterone production.

    A study shows that older men who sleep 9.9 hours per night have higher testosterone levels than men who sleep more than the mentioned duration.


    Eat a balanced diet

    Eating well is required to maintain healthy testosterone levels. A large portion of your diet should be based on whole foods as they help optimise hormone levels. Try to have a balanced diet consisting of all the essential nutrients, i.e., fats, carbohydrates, and proteins.

    Protein will help you lose fat, which is also good for increasing testosterone. Healthy fats also support testosterone production.


    Get physically active

    Studies prove that increasing physical activity increases testosterone levels. Make exercise a part of your lifestyle. It is beneficial in many ways. But make sure you don’t overdo it, as it can increase stress and lower testosterone levels.


    Shed those extra fats

    As you gain weight, your body also starts gaining fat tissues that convert testosterone into oestrogen and disturb the hormonal balance in the body. Studies show that overweight men have 50% less testosterone than men with healthy body weights.


    Manage stress

    Stress elevates the level of cortisol hormone. When cortisol levels rise in the body, testosterone levels automatically come down. You should try different stress-relieving techniques to manage your daily stress.


    Avoid alcohol abuse

    Excessive consumption of alcohol produces many adverse effects, including the reduced production of testosterone. If it is done for a long duration, the size of your testicles may reduce, leading to reduced testicular function.


    Change your medications

    While medications can help you manage several health conditions, they can also reduce your testosterone levels. Statins, anti-anxiety pills, and opioids are known to reduce testosterone production. If you suspect your low T is due to medications, you should discuss this matter with your doctor to find a solution.


    Testosterone replacement therapy (TRT)

    In addition to lifestyle changes, there is another option you can use to increase testosterone levels.

    Testosterone replacement therapy (TRT) is the administration of exogenous testosterone into the body to increase serum testosterone levels and manage low T symptoms. 

    You can take testosterone in different ways, such as through tablets, injections, gels, and patches. There are different ways to use them; hence, each method produces different effects. You should evaluate their pros and cons to choose the one that suits you the best.


    TRT and fertility

    Although TRT increases testosterone levels, it may not improve your fertility. In fact, data shows it lowers sperm count.

    When you take exogenous testosterone, the serum testosterone level rises, which sends signals to the brain to reduce the production of luteinizing hormone (that stimulates endogenous testosterone production). As a result, testicles stop receiving signals from the brain to produce endogenous testosterone, leading to low testicular testosterone levels and eventually reduced sperm production.

    That is why doctors do not prescribe TRT to patients who want to get their partner pregnant and have babies. Some men preserve their sperm before starting TRT.


    TRT with hCG

    If you want to maintain your fertility, you can combine TRT with human chorionic gonadotropin (hCG). This hormone mimics the luteinizing hormone and encourages testicles to produce sperm. It may also prevent some other TRT side effects, such as testicular shrinkage.


    How to select a TRT doctor?

    TRT is a life-long procedure that may cause serious side effects if not optimised and monitored well. That is why selecting a knowledgeable and qualified professional is very important.

    You can find several TRT doctors on the internet. They offer different services and have different rates. You should note their key characteristics like location, treatment cost, work experience and reviews. Compare these characteristics to shortlist 2 to 3 doctors who best suit your needs.

    Visit their clinics for consultation, discuss your current health condition with them, and find out what they have to offer. Select the one who you think is the most sincere to his/her patients and has plenty of work experience.

    Here are the traits of a good TRT doctor.

    • They offer personalised treatments according to the needs, goals, and health conditions of each patient.
    • They perform a series of tests to make sure you are the right candidate for TRT.
    • They guide you on how you can manage TRT side effects and make the most out of the treatment.

    You should ask the following questions to the doctor before you choose them for a life-long procedure.

    • For how many years have you been treating low T?
    • Which TRT forms do you prescribe?
    • How do you design a treatment plan for your patients having different health-related goals?
    • I want to preserve my fertility. Do you offer solutions for it?
    • What will be the cost of TRT?
    • How many follow-up sessions will I have per year?



    What happens if I don’t have a low T treatment?

    It is normal for men to experience testosterone deficiency as they get older. Some men don’t even realise they have low T, while others experience short-term and long-term symptoms.

    If you do not start a TRT, you will keep experiencing these symptoms. Your risk of developing long-term symptoms like osteoporosis may increase.


    Which TRT method is the best?

    All forms of TRT are effective in increasing testosterone levels. However, since their administration routes are different, they produce different effects on the body.

    One TRT form that is suitable for a patient may not be as suitable for another patient. That is why it is suggested to discuss each form in detail with your physician.


    What is the difference between TRT and performance-enhancing steroids?

    TRT is an FDA-approved procedure prescribed to men who have low T and want to bring their testosterone levels within the normal range.

    In contrast, performance-enhancing steroids are not approved by the FDA. Athletes and bodybuilders take them to increase their testosterone levels even when they do not have testosterone deficiency.


    Is TRT safe?

    TRT has been studied by scientists for decades. It shows many beneficial effects. TRT does have potential side effects, although the risk of experiencing one is small. You should learn about them to find out whether it is a safe procedure for you. Some of the side effects of TRT are:

    • Breast swelling
    • Testicular atrophy
    • Infertility
    • Increased red blood cells production


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    Summing it up

    Low T does not always cause infertility, but it reduces the chances of conceiving. You should discuss your low T symptoms with your doctor to find the best suitable solution.

    TRT is a helpful low T treatment, but it may reduce your sperm count and cause infertility. However, taking hCG injections with TRT can help prevent this problem. You should discuss your health goals and current condition with hormone specialists to start a suitable treatment soon.


    References/Bibliography/Scientific Studies/Further reading

    Bruce, J., HCG with TRT for Fertility and Testicular Atrophy.

    Herati, A.S., Kohn, T.P. and Kassiri, B., 2020. New frontiers in fertility preservation: a hypothesis on fertility optimization in men with hypergonadotrophic hypogonadism. Translational Andrology and Urology9(Suppl 2), p.S171.

    Patel, A.S., Leong, J.Y., Ramos, L. and Ramasamy, R., 2019. Testosterone is a contraceptive and should not be used in men who desire fertility. The world journal of men’s health37(1), pp.45-54.

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    Evidence Based Research

    This article has been researched and written based on scientific evidence and fact sheets that have then been crossed checked by our team of doctors and subject matter experts.

    References, sources and studies used alongside our own in-house research have been cited below, most of which contain external clickable links to reviewed scientific paper that contain date stamped evidence.

    Our team of healthcare experts and GMC registered doctors are licensed to UK GMC standards. We strive to provide you with the latest evidence based, researched articles that are unbiased, honest and provide you with accurate insights, statistics and helpful information on the discussed topic to ensure you gain a better understanding of the subject. You can read more about our Editorial Process by clicking here.

    We value your feedback on our articles, if you have a well-researched paper you would like to share with us please contact us.

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    About the Author: Mike Kocsis

    Mike KocsisMike Kocsis has an MBA with a focus on healthcare administration and is an entrepreneur and medical case manager for Balance My Hormones Ltd which offers medical services in the UK and Europe. Mike has over 20 years of experience in the healthcare sector, much of that working with people who have hormone imbalances. Mike has appeared on podcasts and radio and is an expert speaker on the subject of hormone imbalance. He specialises in Testosterone Replacement Therapy (TRT) and Hormone Replacement Therapy (HRT) and has helped thousands of people suffering from hormone imbalances recover and regain control of their lives. You can follow him on LinkedIn and on the Balance My Hormones YouTube Channel.

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