TRT Cause Infertility? What Men Need to Know Before Starting Testosterone
Testosterone replacement therapy (TRT) can be beneficial in men, but it can also impact fertility. Thankfully, the effects are reversible in many cases, but fertility goals should be carefully considered before starting treatment.
Exogenous high-dose testosterone, or TRT, can potentially lead to infertility in men. This can occur because high levels of testosterone suppress the HPT axis and reduce follicle stimulating hormone (FSH) production. This ultimately causes decreases spermatogenesis, which is the process in which sperm develops.
This phenomenon is evidenced by a study that evaluated men on TRT and their clinical characteristics. The study found that men had normalized hormone and sperm levels after discontinuing TRT for eight months. Additionally, there were several improvements in sperm motility, sperm concentration, and serum FSH levels (1).
In addition to lowering FSH, testosterone may also impact luteinizing hormone (LH) secretion. Another study found that around 73 percent of men included in the study on TRT experienced low levels of LH at some point. However, it is important to note that only 22 percent of men maintained suppressed levels throughout their whole treatment (2).
While TRT can certainly affect fertility, the effects are not necessarily permanent or long-term. Stopping testosterone therapy can lead to sperm recovery after testosterone-associated infertility.
One study evaluated 66 men that experienced infertility after using testosterone. Patients were stopped on their testosterone therapy while also receiving selective estrogen modulator (SERM) therapy and high-dose human chorionic gonadotropin (hCG) therapy. Patients were evaluated to see if they achieved more than a 5 million sperm count within 12 months of stopping TRT.
The study found that 70 percent of men were able to achieve a sperm count of greater than 5 million. An individual’s ability to recover their sperm count was correlated with both increased age and their duration of testosterone use (3).
These findings indicate that it is certainly possible for sperm count to normalize and fertility to be restored after stopping testosterone therapy. However, factors such as age and duration of treatment can impact the likelihood of sperm recovery. Thus, individualized treatment planning before starting therapy is paramount. When starting TRT, healthcare providers may consider:
Timing of TRT is important, especially for men that want to have children within the next one to three years.
HCG is an effective method in restoring spermatogenesis. It can be used both alone or with Selective Estrogen Receptor Modulator (SERM) therapy. HCG is structurally similar to LH, and thus, can be efficacious in restoring endogenous testosterone in those that are testosterone suppressed (3).
Although TRT can certainly impact fertility, its effects are not necessarily permanent. However, men should still discuss their fertility goals with their provider before beginning TRT.
At Weight Loss & Vitality, we believe hormone optimization should never follow a one-size-fits-all approach. Testosterone levels, symptoms, metabolic health, recovery, sleep quality, body composition, and long-term wellness goals can vary significantly from person to person. That is why individualized lab interpretation, physician oversight, and personalized treatment planning are essential when evaluating whether testosterone therapy may be appropriate.
If you are experiencing symptoms of low testosterone or would like a comprehensive hormone evaluation, our medical team can help guide you through a detailed assessment designed around your individual physiology, health history, and long-term goals.
Learn more at Weight Loss & Vitality here or call 571-550-9000.
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