Testosterone levels can impact the quality of life in both men and women. Low testosterone can lead to numerous problems such as low sex drive, sexual dysfunction, and reduced energy levels. Furthermore, it can put you at an increased risk of osteoporosis and depression.
The only effective treatment for low T is testosterone replacement therapy (TRT), which involves the administration of an exogenous hormone into your body. Once you start therapy you can expect improvements in mood, energy levels, sexual function, bone density, and even insulin sensitivity.
However, TRT is not recommended if you do not have any symptoms of low testosterone (hypogonadism) or you and your partner are trying to conceive due to testosterone treatment effect on fertility.
In this article, we will reveal more about the effect of TRT on fertility, sperm count, and the methods for preventing infertility during the treatment.
How testosterone therapy affects your fertility?
There is a strong relationship between testosterone and fertility. Proper sperm development depends on the normal function of the testicles and the regulation of two endocrine glands in your brain – the hypothalamus and the pituitary gland.
These glands secrete many hormones including:
- gonadotropin-releasing hormone (GTRH)
- luteinizing hormone (LH)
- follicle-stimulating hormone (FSH)
These are the hormones stimulating the production of testosterone inside the testicles.
However, if testosterone production is overstimulated, its elevated levels suppress GTRH and LH release in order to return testosterone levels back to normal. This mechanism is called negative feedback.
Since testosterone therapy leads to an increase in blood testosterone levels, this suppresses the glands in your brains and your testicles no longer have the stimulus to produce testosterone.
Unfortunately, TRT cannot increase the intratesticular levels of testosterone. Without the presence of the hormone inside the testicles, growth and maturation of the sperm is disrupted, which can lead to infertility.
TRT is successfully used in postmenopausal women to treat sexual dysfunction and low sex drive
Since infertility is already present in postmenopausal women, the suppression of LH and FSH does not lead to negative consequences.
Can a woman get pregnant while the man is taking testosterone?
Depending on the duration of the TRT, men might still be fertile while taking testosterone. A study published in The Lancet with 271 healthy fertile men showed, that it takes 3 months on average for a man to become sterile while on testosterone replacement therapy.
On the other hand, there were men excluded in the study, where sperm cells were still present in their semen after 6 months of TRT. Thus, the chance for your partner to become pregnant while you are on testosterone is highest during the first 3 months of starting a TRT.
However, everyone responds differently, and depending on the dosage some men might still preserve their fertility after 6 months of testosterone therapy. Even though 119 men in the other study had no sperm cells detected in their semen for 12 months, one of these participants still got their partner pregnant.
Does taking testosterone lower sperm count?
Testosterone injections affect the sperm count since the spermatozoids cannot develop properly without intratesticular testosterone.
The normal sperm count in your semen should be at least 15 million per ejaculate according to the normal references determined by the World Health Organization. Values below this number are diagnosed as oligospermia. When there are no spermatozoids in your semen, the condition is termed azoospermia.
Once TRT is initiated, the sperm count slowly starts to decrease, and can even reach zero after 2-4 months of therapy on average. The exact period depends on the dose and varies significantly between individuals.
Can you recover sperm count after stopping testosterone?
Scientific evidence suggests that in most male patients on TRT there is a spontaneous recovery of the normal spermatogenesis some period after the treatment is discontinued.
In one study it took the participants 4 months to return to baseline and become fertile again, and 6 to 9 months for their sperm count to finally recover back to normal
However, some men might not recover to their normal levels of testosterone and sperm count. Others might not tolerate the amount of time it takes for recovery. In these cases, it is advised for using various pharmacological agents that can reverse or even prevent the occurrence of infertility in the first place.
Currently, human chorionic gonadotropin (hCG) and selective estrogen receptor modulators (SERMs) are the most effective pharmacological agents. The hCG is a hormone normally produced in women during pregnancy. However, it has similarities to the LH, which allows him to stimulate ovulation in the ovaries as well as testosterone production in the testes.
SERMs are estrogen antagonists acting on the pituitary gland. They stimulate the release of LH and FSH which contributes to normal intratesticular levels and spermatogenesis.
How to prevent infertility during TRT?
Fortunately, it is possible to reverse or even avoid infertility while on testosterone therapy.
Studies have suggested that discontinuation of TRT and administration of hCG for 3 months or more can restore normal spermatogenesis and even maintain normal testosterone levels inside the testicles. In reversing infertility, hCG can be combined with SERMs.
According to small trials, hCG is also effective in preventing infertility when used during testosterone replacement therapy. Different studies revealed that using low-dose hCG in combination with TRT leads to a significant increase in blood testosterone levels without any suppression of the normal spermatogenesis and fertility.
If you have symptoms of low testosterone, TRT might be your best treatment option. However, one of the few side effects of the therapy is infertility, due to the suppression of natural testosterone synthesis.
While this effect is considered generally reversible, you might want to avoid testosterone therapy if you plan to have biological children
At HRTGuru Clinic, you can receive full assistance from our medical specialists and endocrinology experts to maximize the benefits and avoid the side-effects of testosterone replacement therapy.