Testosterone therapy suppresses sperm production in most men, sometimes to almost zero. That happens because external testosterone shuts down the natural signal from your brain to your testicles. If you want children, you need to know this before starting TRT, because the effect is real but usually reversible.
This may be the most important warning around TRT that is too often missing. Testosterone from outside acts as a brake on your fertility.
Why does TRT lower your sperm production?
Your testicles make sperm under the direction of the hormones LH and FSH from your pituitary. External testosterone switches off that signal through negative feedback, so your testicles make less testosterone and sperm. The intratesticular testosterone needed for sperm formation therefore drops sharply (Crosnoe, 2013).
This is not a side effect but a direct consequence of how the system works (Fusco, 2021).
Is the effect permanent?
In most men sperm production recovers after stopping, but it can take a long time. Studies show that most men see their sperm production return within roughly a year, though for some it takes longer (Crosnoe, 2013). Recovery is therefore usually good, but not guaranteed to be fast.
| Phase | What happens |
|---|---|
| During TRT | Sperm production often strongly suppressed |
| After stopping | Usually recovery, median within months |
| With longer use | Recovery can take longer |
Which blood values do you track when trying to conceive?
When trying to conceive, you look at the hormones that reflect your fertility signal. LH and FSH show how strongly your brain drives your testicles, and testosterone gives the overall picture. A semen analysis also belongs here, but that is not a blood test.
Options exist to protect fertility, such as supervised treatment with hCG or certain medication, but that is always tailored work with a doctor (Crosnoe, 2013).
What does this mean for your choice?
If you have a current or future wish for children, discuss that before you start TRT. There are alternatives and additional treatments that can spare your fertility, but they require a plan upfront. Correcting afterwards is harder than choosing the right route in advance.
To track your hormones, look at our TRT monitoring blood test. Also read stopping TRT and estradiol on TRT.
My advice: never let a wish for children be an afterthought in your TRT decision. Discuss your options with a doctor or andrologist before you start, not when it already feels too late.
References
- Crosnoe LE, Grober E, Ohl D, Kim ED. Exogenous testosterone: a preventable cause of male infertility. Translational Andrology and Urology. 2013. PMID: 26813847.
- Fusco F, Verze P, Capece M, Napolitano L. Suppression of spermatogenesis by exogenous testosterone. Current Pharmaceutical Design. 2021. PMID: 33292112.
- Rasmussen JJ, Selmer C, Ostergren PB, et al. Former abusers of anabolic androgenic steroids exhibit decreased testosterone levels and hypogonadal symptoms years after cessation: a case-control study. PLoS One. 2016. PMID: 27532478.
Disclaimer
Every blood test result includes a professional assessment by a BIG-registered doctor. This article gives general information and is not a substitute for medical advice. A blood test is a tool to walk into the conversation with your GP better informed, not a diagnosis in itself. For treatment decisions, discuss your results with your GP.
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