Can Testosterone Replacement Therapy Affect Fertility?

Testosterone Replacement Therapy (TRT) is widely used to treat symptoms of low testosterone, such as fatigue, low libido, and muscle loss. However, one important consideration for men of reproductive age is how TRT impacts fertility.

In this article, we’ll discuss how TRT affects sperm production, the potential risks for fertility, and important considerations for men who want to preserve or enhance their ability to father children.


🧬 How Testosterone and Fertility Are Connected

Testosterone is the primary male sex hormone, critical for:

  • Developing and maintaining male secondary sexual characteristics
  • Regulating libido and sexual function
  • Supporting spermatogenesis—the process of sperm production in the testes

However, the relationship between testosterone levels and fertility is complex.


🏭 The Hypothalamic-Pituitary-Gonadal (HPG) Axis

Sperm production is regulated by the HPG axis:

  • The hypothalamus releases gonadotropin-releasing hormone (GnRH), which signals
  • The pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
  • LH stimulates the testes to produce testosterone
  • FSH supports sperm production in the seminiferous tubules

Testosterone produced within the testes (intragonadal testosterone) is essential for sperm development, while circulating testosterone levels contribute to other functions.


💉 How TRT Affects Sperm Production

When you receive exogenous (external) testosterone via TRT, your body senses high testosterone levels in the bloodstream. This triggers a negative feedback loop that suppresses the hypothalamus and pituitary gland, leading to:

  • Reduced secretion of LH and FSH
  • Decreased intratesticular testosterone production
  • Impaired spermatogenesis

The result: TRT commonly causes a significant drop in sperm production, sometimes leading to temporary or even long-term infertility.


🔬 Clinical Evidence on TRT and Fertility

Studies show:

  • Approximately 30–90% of men on TRT experience oligospermia (low sperm count) or azoospermia (no sperm).
  • Fertility usually decreases shortly after starting TRT and may recover months after stopping, but in some cases, it may be delayed or incomplete.
  • TRT is generally not recommended for men actively trying to conceive.

🧩 Fertility Considerations Before Starting TRT

1. Men Planning to Have Children Should Avoid TRT

Because TRT suppresses sperm production, it is usually contraindicated in men seeking fertility.

2. Alternative Therapies for Hypogonadism and Fertility

For men with low testosterone who want to maintain fertility, doctors may recommend:

  • Selective Estrogen Receptor Modulators (SERMs): e.g., clomiphene citrate, which stimulates the HPG axis to increase natural testosterone production without suppressing sperm.
  • Human Chorionic Gonadotropin (hCG): mimics LH, stimulating intratesticular testosterone and spermatogenesis.
  • Combination therapies using hCG and SERMs can maintain testosterone levels while preserving or improving sperm production.

3. Sperm Banking

Men who need TRT but plan to have children later might consider sperm cryopreservation (freezing) prior to starting treatment.


⏳ Recovery of Fertility After TRT

  • After stopping TRT, LH and FSH levels typically recover within weeks to months.
  • Sperm production may take 3–6 months or longer to return to baseline, depending on the duration of TRT and individual factors.
  • Some men may need medical assistance with fertility recovery.

⚠️ Important Safety Notes

  • Using TRT without medical supervision increases the risk of permanent infertility.
  • TRT should never be used as a treatment for male infertility—this is a common misconception.
  • If fertility is a priority, consult an endocrinologist or fertility specialist before initiating therapy.

✅ Summary

AspectEffect of TRT
Testosterone levelsIncrease (exogenous supplementation)
LH & FSH secretionDecrease (due to negative feedback)
Intratesticular testosteroneDecrease (impairs sperm production)
Sperm countTypically decreases (oligospermia/azoospermia)
FertilityOften reduced, sometimes temporarily
Recovery timeMonths after TRT discontinuation

💡 Final Thoughts

Testosterone Replacement Therapy can significantly impair sperm production and male fertility. For men who desire children, it’s crucial to discuss fertility goals with a healthcare provider before starting TRT. Alternative treatments exist that support testosterone levels without compromising fertility, and sperm banking is an option for preserving future reproductive potential.


Get Consultancy

More insights

Asian Double Eyelid Surgery in Korea

Treatment OverviewAsian Double Eyelid Surgery is a specialized cosmetic procedure designed to create or enhance the upper eyelid crease, tailored to the unique anatomical features of Asian eyelids. It results in a natural-looking crease that makes the eyes appear larger and more expressive. Purpose & BenefitsThe surgery defines or forms a double eyelid crease, improving eye shape, symmetry, and facial harmony. Benefits include enhanced eye

Read more >

Gentle, Precise Vision Correction with Next-Generation Laser Technology with SMILE Eye Surgery

For those seeking a safe, effective, and minimally invasive alternative to traditional LASIK, SMILE (Small Incision Lenticule Extraction) eye surgery is quickly becoming a preferred choice — especially among international patients visiting Korea for premium vision correction. This next-generation laser procedure offers clear, sharp vision with less discomfort and a faster recovery time. What is SMILE Eye Surgery? SMILE is a state-of-the-art laser refractive eye

Read more >

Restore Youthful, Alert Eyes with Expert Care with Ptosis Correction

Are you tired of looking tired — even when you’re well-rested? Drooping eyelids can make you appear older, fatigued, or less alert. If this sounds familiar, ptosis correction surgery may be the solution you’ve been looking for. With Korea’s world-renowned expertise in eyelid surgery, patients from around the world are turning to Korean plastic surgery clinics for natural, rejuvenating results. What Is Ptosis? Ptosis (pronounced

Read more >