Does Taking Testosterone Make You Infertile? Here's What You Need to Know

Testosterone replacement therapy (TRT) has become common in the US among men in recent years. From improving muscle mass to sexual function, testosterone plays many roles in the body. But many men overlook a critical concern: Does taking testosterone make you infertile​? Whether you are planning to start TRT for low testosterone levels or are already on it, this article will break down what science says — and how to protect your reproductive health.

Does Taking Testosterone Make You Infertile​?

If you are wondering, can testosterone therapy cause infertility? The answer is yes. According to a study: 

• Testosterone therapy can suppress natural sperm production.
• It may cause temporary or even permanent infertility depending on the dosage, duration, and individual health. 

TRT is typically used for improving levels of testosterone, a hormone crucial for sperm production.

But, high testosterone levels from TRT and even testosterone supplements can lower sperm production and potentially cause azoospermia (where semen contains zero sperm), leading to infertility.

But don't worry, for men planning future fatherhood, there are smart options available, like sperm freezing, and also, some medical alternatives that can boost testosterone without harming fertility.

How Does Testosterone Replacement Therapy Affect Fertility?

TRT works by suppressing the natural release of testosterone in the body. This external supplementation of testosterone interrupts the functioning of the hypothalamic-pituitary-gonadal (HPG) axis, which regulates sperm production.

When the testosterone hormone is delivered from outside the body:

• The brain detects the elevated testosterone levels.

• It signals the pituitary gland to reduce or stop producing follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These two hormones are essential for sperm production in the testes.

• Without LH and FSH, sperm production drops drastically or stops entirely — a condition called azoospermia (no sperm in semen).

This means TRT can severely lower sperm count and quality, making natural conception difficult or impossible.

Can Testosterone Therapy Cause Permanent Infertility?

Testosterone-induced infertility is not always permanent, but it can be in some cases. Most men regain their fertility after discontinuing the testosterone therapy or supplements. However, the recovery period can vary:

• Some men regain fertility within a few months.

• Others, particularly older men, may take up to 2 years.

• TRT can lead to permanent infertility (in rare cases), particularly in men who use high doses or for a prolonged period.

Factors That Affect Recovery:

• Age: Older men might have a slower recovery of sperm production.

• Duration of use: Longer use = higher risk. Prolonged use of testosterone therapy or supplements might increase the chances of permanent infertility.

• Overall health: Diabetes, obesity, or other underlying health problems can lead to slow recovery and an increased chance of withdrawal symptoms.

• Type of testosterone used: Longer-acting forms (like pellets or injections) may suppress sperm production longer than gels or patches.

Planning for Kids? Preserve Your Fertility First

If you are planning for testosterone replacement therapy and may want to have kids in the future, consider semen cryopreservation, also called sperm freezing, to preserve fertility. This is how it is done:

• Your sperm is collected and analyzed.

• The sperm sample undergoes flash-freezing using a technique called vitrification that preserves sperm viability (live sperm cells percentage in a semen) to protect sperm quality.

• The frozen sperm samples are then stored for years and can be used for future fertility treatments like IUI or IVF.

This simple step ensures you have options later, even if TRT temporarily affects your fertility.

Treatments for Reversing Testosterone-Induced Infertility

If you are already on TRT and want to restore your sperm production, the first step usually is to discontinue or slowly reduce the therapy (under medical supervision). This allows the body to gradually produce testosterone naturally and maintain the level of this hormone. However, it can take time, and the success rate can vary. You can then choose these medical treatments to improve your testosterone levels without significantly affecting fertility:

1. Clomiphene and Enclomiphene Citrate

Potent medicines that stimulate the pituitary gland to produce LH and FSH that regulate testosterone levels, helping with sperm production. 

2. hCG Therapy (Human Chorionic Gonadotropin)

Involves the use of human chorionic gonadotropin (hCG) hormone that can mimic Luteinizing Hormone (LH). LH is responsible for stimulating the testes to release testosterone, which helps with sperm production.

Never self-medicate or stop TRT on your own. Always consult an endocrinologist or urologist for proper evaluation and treatment.

Natural Ways to Boost Testosterone

If you want to improve testosterone levels without affecting fertility, try these science-backed strategies:

• Exercise Regularly: Practice aerobic exercise, cardio, and strength training. But avoid excessive exercise, as it increases cortisol hormones, which are responsible for reducing testosterone levels.

• Eat a Balanced Diet: Eat foods rich in healthy fats, antioxidants, lean proteins, and vitamin D. Avoid sugary foods, saturated fats, and processed foods as they decrease testosterone levels.

• Get Proper Sleep: Sleep for at least 7 to 9 hours every day. Also, follow a good sleep schedule by sleeping and waking at the same time each day.

• Manage Stress: Practice deep breathing, meditation, and yoga to reduce stress. Also, spend time with friends, family, and in nature.  

• Limit Alcohol Intake: Excessive alcohol consumption can negatively affect testosterone levels, according to research.

• Consider Supplements: Vitamin D and zinc may help, but always check with a doctor first.

What Causes Low Testosterone (Hypogonadism) in Men?

Understanding the cause of low testosterone levels, also called hypogonadism, can help manage it effectively. Here are the possible contributing factors:

• Aging (starts around the age of 30 years, with testosterone levels reducing by 1% each year).

• Medical conditions like diabetes, obesity, liver disease, kidney disorder, infection or injury in the testicles, pituitary or hypothalamus issues, or cancer treatments.

• Lifestyle factors like excessive alcohol use, medications like steroids or opioids, poor diet, stress, sleep issues, or lack of exercise.

• Genetic conditions such as Klinefelter syndrome and Kallmann syndrome.

Busting Common Myths About Testosterone & Fertility

Here we have cleared some myths:

Final Thoughts

So, does taking testosterone make you infertile? Yes, it often does, though the infertility is usually reversible if addressed early. If you’re planning to have children in the future, consult your doctor before starting TRT. Options like sperm freezing or medications like Clomiphene or hCG, can help balance your testosterone levels while keeping your fertility intact.

Talk to a fertility specialist or endocrinologist before making decisions that could impact your reproductive future.