Does TRT Make You Infertile?

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With its promise to improve vitality, libido, and well-being, testosterone replacement therapy (TRT) has become a popular and sought-after solution for men with low testosterone (low T).

However, amidst this increasing popularity, concerns have been raised regarding the impact of TRT on male fertility. As more men choose TRT to deal with low T symptoms, understanding the connection between TRT and fertility has now become more important than ever.

This article sheds light on the relationship between male fertility and TRT, providing evidence-based insights and addressing misconceptions.

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The connection between TRT and men’s fertility

Men with low testosterone levels can have low sperm production and poor libido (sex drive).

Since TRT increases testosterone levels in the blood, it is often believed it can increase fertility as well. But in reality, the opposite is true. The truth is, TRT negatively impacts fertility by diminishing natural testosterone production and sperm count.

How does TRT make you infertile?

TRT involves the administration of exogenous (external) testosterone, which increases testosterone levels in the blood but not in the testes, where it is required for sperm production.

So even if a hypogonadal patient has normal testosterone levels in his blood but low testosterone levels in the testes, he will still have a low sperm count.

TRT can further reduce your sperm count by reducing the production of endogenous (internal) testosterone.

Serum testosterone creates a feedback loop that controls the production of luteinising hormone (LH), follicle-stimulating hormone (FSH), and gonadotropin-releasing hormone (GnRH) from the brain.

A normal serum testosterone level promotes negative feedback. It sends signals to the brain, telling it that the body has enough testosterone, so there is no need to produce LH, FSH, or GnRH anymore.

Resultantly, the production of LH, FSH, and GnRH diminishes.

As testes do not receive any signal in the form of LH to produce testosterone, testicular testosterone levels decline.

Data shows men undergoing TRT have LH and FSH levels less than one-half of their original levels. Not only that, but the lack of hormonal signals (in the form of LH and FSH) also makes testicular muscles less active. As a result, testicles shrink in size, which further impacts fertility.

A large study in China tested TRT as a form of male birth control. They gave men testosterone undecanoate. And after only about 3 months of treatment, 93% to 99% of men had no sperm (azoospermia).

Due to its ability to negatively influence fertility, exogenous testosterone is often considered a male contraceptive.

If you plan to start TRT and have children in the near future, you should speak to a specialist TRT doctor, as they will help you find a suitable solution to maintain fertility and expand your family.

Is TRT infertility irreversible?

TRT-induced infertility is temporary in most of the cases. You can reverse it by stopping testosterone administration.

Your intratesticular testosterone levels will start rising again, which can take anywhere from months to years, depending on the duration of your treatment and the amount of testosterone you used during it.

In one study, for instance, 64% to 84% of patients restored their fertility within 110 days of stopping TRT while others took 2 years to fully restore fertility.

Men with shorter durations of testosterone use are more likely to recover sperm production naturally after stopping treatment.

In other cases, medical intervention may be required and in rare cases, infertility may be irreversible, especially if high-dose testosterone is taken for several years or it’s taken without medical supervision.

Do this before starting TRT if you plan to have children later

For men planning to start TRT without losing their ability to have children in the future, here is what they should do to achieve this goal:

Go for cryopreservation (sperm freezing)

Another method to protect your fertility is to preserve healthy sperm by freezing them.

It is a simple process during which your semen sample is analysed, and healthy sperm are put in liquid nitrogen storage tanks.

Frozen sperm can then be used for in vitro fertilisation (IVF), in which sperm and egg are fertilised outside the body, or intrauterine insemination (IUI).

Preserved sperm stays healthy for years or even decades. According to the new law, you can preserve them for up to 55 years in the UK.

Consider natural ways of increasing testosterone

Improving lifestyle and adopting healthy habits can help some men increase their natural testosterone. This approach may work for you if your testosterone levels are borderline low and your symptoms are mild.

Some of the effective ways of increasing testosterone naturally include:

• Getting quality sleep at night
• Managing stress
• Reducing alcohol intake
• Maintaining healthy body weight
• Regular exercise

Talk to an experienced healthcare provider

Make sure you choose an experienced TRT provider who guides you properly according to your fertility goals. They may give you the option of preserving your sperm, delaying TRT, or simply having another medication alongside testosterone to support internal testosterone production.

A knowledgeable doctor can provide personalised advice and design a bespoke plan based on your specific needs.

Check your fertility

Knowing your fertility status before starting TRT will help you determine your current sperm health.

If it’s good, freezing your sperm may be the right choice. And if it’s already low, starting TRT may exacerbate it further, so your doctor may prescribe fertility-preserving medications with testosterone.

How to protect fertility while on TRT?

If you have already started hormone replacement therapy TRT but now want to preserve fertility, here is what you should do:

Consider hCG supplementation

Human chorionic gonadotropin (hCG), also known as pregnancy hormone, is released by trophoblast cells throughout pregnancy in women.

It shows structural similarity to LH and binds to the same receptor in humans as LH. Because of this reason, it can mimic the functions of LH.

hCG has been approved by the FDA for the treatment of male infertility and other medical conditions. Like LH, it can stimulate testosterone and sperm formation in men.

Combine TRT with clomiphene citrate (Clomid)

Clomiphene citrate is a selective estrogen receptor modulator (SERM). It blocks estrogen receptors in the brain and tricks the brain into thinking that estrogen levels are low.

As a result, brain produces more of LH and FSH, which naturally increases testosterone levels and sperm production.

Get your hormone levels checked regularly

Regular monitoring of important hormones like testosterone, FSH, and LH will help you maintain hormonal balance and adjust your hormones when needed.

You can test your levels by getting a testosterone blood test kit that can even be done in the comfort of your own home!

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How to test male fertility?

The most common way to test male fertility is through a semen analysis test. It involves taking your semen sample in sterile container and examining it under a microscope.

A semen analysis test can measure your sperm concentration, mobility, morphology (shape), and various other aspects of the semen.

Can a man on testosterone get a woman pregnant?

As explained earlier, TRT diminishes fertility. So a man on testosterone may get a woman pregnant but this is less likely to happen, particularly if you have been on testosterone for several years.

However, using fertility-preserving strategies may help some men restore sperm production, improving their chances of fathering children while on TRT.

Should I take TRT if I want a family soon?

If you are planning to start a family in the near future, it is usually best to delay TRT if possible.

That said, the right approach depends on your individual situation such as your current testosterone levels and symptoms.

If having children soon is a priority, it is worth discussing your options with a specialist before starting treatment, rather than trying to reverse the effects later.

How can men use hCG to maintain fertility on TRT?

hCG is given by injection, and its half-life is approximately 2 days. Protocol for hCG injections differs from patient to patient based on individual needs, but generally, 2 to 3 injections are given weekly.

Doctors usually start with low hCG doses like 125, 250, and 500 IU. They can increase your dose based on your body’s response.

You can inject hCG injection either subcutaneously or intramuscularly. The best subcutaneous sites for these injections are:

• Upper outer arm
• Upper outer buttock

The best intramuscular sites for hCG injections are:

• Front of thighs
• Lower abdomen
• Side of upper arms

Benefits of using hCG with TRT

1. HCG can significantly increase intratesticular testosterone levels in men undergoing TRT. Studies show that men who received testosterone noticed a 94% reduction in their intratesticular testosterone levels. But when they used testosterone in combination with 250 IU hCG, intratesticular testosterone dropped by only 7%. Increasing the hCG dose to 500 IU increased their intratesticular testosterone levels by 26%.
2. Data reveals TRT can cause azoospermia (complete absence of sperms in ejaculations) within 10 weeks of starting the therapy. When hCG is used in combination with testosterone, it can significantly reduce TRT-induced azoospermia.
3. TRT can reduce the production of GnRH by the hypothalamus, leading to testicular atrophy (shrinkage). You can reverse this effect by using hCG, which increases endogenous testosterone levels and resists testicular shrinkage.
4. Additionally, hCG can help men with low testosterone improve their sex drive, cognitive functions, and exercise capacity.

FAQs about TRT’s effects on fertility

Women often ask: My husband takes testosterone injections. Can I still get pregnant?

Testosterone injections can reduce sperm count in men. If you want to conceive, you should consider hCG with TRT to prevent TRT-induced infertility or restore your sperm count. Discuss your plans of having children with your doctor before starting TRT to find out what fertility options you have.

Should you try TRT and hCG?

Testosterone therapy is an FDA-approved procedure used to treat testosterone deficiency in men. It is very effective in managing low T symptoms and improving overall health. However, despite all these benefits, it has the potential to make men infertile.

If you are starting TRT and are concerned about your fertility, you should consider having hCG injections as they can maintain your fertility and reverse some TRT side effects.

How much does hCG increase testosterone?

Data reveals that men having hCG monotherapy can experience a 49.9% increase in testosterone levels, while men having it with testosterone can expect their testosterone levels to rise up to  26%.

Your results can vary depending on your hCG dosage.

How long does hCG take to work in males?

This depends on various factors, including your hCG dose, testosterone dose, and health condition when you start taking hCG. You can expect the treatment to show its results within 3 to 6 months of starting it.

How much hCG to take with TRT?

Each patient has different hCG needs depending on his specific health condition and health-related goals. Hence, your doctor will formulate a customised hormone therapy (HT) for you according to your individual needs.

Conclusion

Testosterone’s negative impact on fertility is a well-established fact in clinical research. That’s why you must consider it before starting TRT.

Testosterone can lower your fertility or even render a man infertile by:

• Stopping internal testosterone production
• Lowering sperm formation
• Shrinking testicles

Men who want to increase their testosterone levels without compromising fertility may benefit from alternative treatment options.

If you still go for TRT, make sure you freeze your sperm beforehand or take fertility-preserving medications with testosterone to maintain your sperm count.

Book your online consultation with our TRT specialists to discuss your hormone levels, fertility concerns and treatment options.

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References/Bibliography/Citations/Scientific studies/Further reading 

Tsametis, C.P. and Isidori, A.M., 2018. Testosterone replacement therapy: For whom, when and how?. Metabolism, 86, pp.69-78.

Lee, J.A. and Ramasamy, R., 2018. Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men. Translational andrology and urology, 7(Suppl 3), p.S348.

El Meliegy, A., Motawi, A. and Abd El Salam, M.A., 2018. Systematic review of hormone replacement therapy in the infertile man. Arab journal of urology, 16(1), pp.140-147.

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