Does TRT Cause Infertility? The Truth About Testosterone Replacement and Fertility

Doctor preparing syringe with testosterone for TRT injection.

Testosterone replacement therapy (TRT) is a common treatment for men with low testosterone levels. Low testosterone levels can cause a range of symptoms, including low libido, fatigue, and depression. TRT is a common treatment for these symptoms, and it can improve quality of life for many men.

However, some men may be concerned about the impact of TRT on their fertility. This is because testosterone plays an important role in the production of sperm, and low testosterone levels can lead to reduced sperm count and motility.

Some studies suggest that TRT may reduce sperm count and motility, while others show no significant effect. This article will explore the relationship between TRT and male infertility, providing a clear and neutral overview of the current research.

Does TRT Impact Fertility?

Can taking testosterone therapy lead to sterility? Sometimes it can. A notable drop in sperm count is often observed in men undergoing Testosterone Replacement Therapy (TRT). This is why researchers are actually studying testosterone as a potential male contraceptive.

Even though a reduced sperm count does not guarantee infertility, the lower it gets, the more challenging it could be to conceive. Some men even experience a 0% sperm count while using testosterone. However, in most cases, this infertility is temporary, and sperm count normalizes after discontinuing the therapy. Nevertheless, some men may not regain their usual sperm count post-therapy.

For men dealing with hypogonadism, and who have no plans of fathering biological children, TRT could be the best solution to manage low testosterone symptoms. However, if you’re worried about fertility, it’s crucial to weigh the risks of TRT before starting any testosterone supplementing medications.

How TRT Impacts Fertility

Testosterone is a hormone that plays a crucial role in male fertility. It’s responsible for the development and maintenance of male reproductive organs, as well as the production of sperm. Low testosterone levels can lead to a decrease in sperm production and a decrease in fertility.

TRT involves the use of exogenous testosterone to supplement the body’s natural testosterone production. While TRT can help increase serum testosterone levels and improve symptoms of low testosterone, it can also suppress the body’s natural testosterone production, leading to a decrease in sperm production and  decreased fertility.

Here are some of the ways that TRT affects fertility and the mechanisms behind them:

Effect on Sperm Count

TRT can decrease sperm count in some men. This is because testosterone is essential for sperm production, and TRT can suppress the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are necessary for sperm production.

Influence on Hormonal Balance

TRT can disrupt the hormonal balance in the body, which can impact fertility. TRT can suppress the production of gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland to produce LH and FSH. This can lead to a decrease in sperm production and testosterone levels. TRT can also increase estrogen levels, which can further suppress testosterone production and negatively impact fertility.

Impact on Sexual Function

TRT can improve sexual function in some men, but it can also cause erectile dysfunction and decreased sex drive in others. This is because TRT can disrupt the delicate balance of hormones in the body, leading to negative effects on sexual function.

So, while TRT can improve testosterone levels and sexual function in some men, it can also decrease sperm count and disrupt the hormonal balance in the body. Men who are considering TRT should discuss the potential impact on fertility with their healthcare provider and consider alternative treatments if fertility is a concern.

Is TRT’s Effects on Fertility Permanent?

In the majority of cases, the fertility problems experienced due to TRT are temporary and not permanent.

Men who discontinue taking TRT (a decision that should only be made with his doctor’s counsel), typically experience testosterone and sperm counts that return to their pre-TRT levels – particularly in those receiving testosterone replacement therapy for only a brief amount of time.

Nonetheless, in a rare number of cases, fertility does not bounce back post-TRT treatment.

Alternatives to TRT

While TRT can have negative effects on fertility, there are several ways to mitigate these effects. If you are experiencing low testosterone levels, there are alternatives to TRT that may help. These include:

Lifestyle Modifications

Making certain lifestyle changes can also help mitigate the negative effects of TRT on fertility and may help increase testosterone levels naturally. Here are some tips to consider:

It’s important to note that these lifestyle modifications may not be enough to address severe cases of low testosterone, and consulting with a specialist is always recommended.


Some medications, such as clomiphene citrate, can help boost testosterone levels without negatively impacting fertility. In addition to these options, there are also medications such as aromatase inhibitors that can be used to mitigate the negative effects of TRT on fertility.

However, it’s important to consult with a specialist and undergo regular blood tests to monitor hormone levels and ensure that treatment options are effective.

Testosterone Supplements

Testosterone supplements, or “testosterone boosters”, are supplements that are designed to increase the levels of testosterone in the body. They are commonly used by men who want to increase their enhance their testosterone levels and overall health without having testosterone replacement therapy. Additionally, testosterone supplements do not appear to have any negative effects on fertility.

These supplements typically contain natural ingredients like herbs, vitamins, and minerals that are known to help boost testosterone levels. Some popular ingredients include fenugreek, D-aspartic acid, Tribulus Terrestris, and zinc.

Some of the more notable testosterone booster brands include:

It’s important to note that while testosterone boosters can help increase your testosterone levels, they should not be used as a replacement for a healthy lifestyle. Regular exercise, a balanced diet, adequate sleep, and minimal stress are all crucial for maintaining healthy testosterone levels.

Image of testosterone supplement bottles on black background

Consult With A Specialist

If you are considering TRT and are concerned about its effects on fertility, it’s important to consult with a specialist who can help identify and treat underlying health conditions that may be contributing to low testosterone levels. The American Urological Association recommends that men who desire fertility should have a semen analysis before starting TRT to establish a baseline and monitor changes over time.

In addition to consulting with a urologist, it may be helpful to involve a family physician or endocrinologist in your care. These specialists can provide additional guidance and support, as well as monitor any potential side effects of TRT.

According to at least one study, testosterone replacement therapy can decrease sperm count and motility in some men, but not all. It’s important to note that the effects of TRT on fertility can vary depending on individual factors such as age, underlying medical conditions, and dosage.

Seeking professional guidance and support can help you make informed decisions about TRT and its potential effects on fertility. By working with a team of specialists, you can receive personalized care and monitoring to ensure the best possible outcomes for your health and fertility.

Assisted Reproductive Technology (ART)

Finally, utilizing an assisted reproductive technology, such as in vitro fertilization, may be an option for couples struggling with infertility due to TRT. This procedure involves fertilizing an egg outside of the body and then implanting it in the uterus.


There is clear evidence that TRT can be a cause for infertility in men, with studies suggesting a potential link between TRT and a decrease in sperm count. However, keep in mind that there are many factors that can affect fertility, including age, lifestyle, and medical conditions.

It’s important to note that TRT should only be used under the supervision of a qualified healthcare professional. Men who are concerned about their fertility should speak to their doctor about their options.

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