When considering testosterone replacement therapy (TRT), it’s crucial to understand how it can impact fertility. Testosterone is an essential hormone, not only for energy, muscle mass, and sexual health but also for sperm production. However, while TRT can bring many benefits, it may also affect a man’s ability to conceive children naturally.
At Leger, we focus on giving expert care to men who need testosterone treatment. We help manage the symptoms of low testosterone. But we also understand that for many men, starting or growing a family is a key priority.
This blog looks at how testosterone treatment affects fertility. It also gives helpful tips for those wanting to protect their fertility while on or considering TRT.
Contents
- Can TRT impact male fertility?
- 4 recommendations before starting TRT
- Protecting fertility while on TRT
- Long-term fertility considerations
- Is TRT for me if I want a family soon?
Can TRT impact male fertility?
Supplementing testosterone through TRT can negatively affect sperm production. TRT introduces synthetic testosterone into the body, leading the brain to think that the body is already producing enough. As a result, the brain can reduce its signals to the testes, which are responsible for sperm production. Over time, this may lead to a reduction in sperm count and, in some cases, infertility [1].
Testosterone deficiency can contribute to fertility problems as well. So, you might already be thinking about fertility treatments alongside TRT. Low testosterone levels can cause erectile dysfunction and affect sexual function.
For older men or men who have completed their family, this may not be a concern. If you plan to have children in the future, it's important to know how TRT can impact your fertility and what steps you can take to reduce this risk.
4 recommendations before starting TRT
If you’re considering TRT but are also thinking about starting or expanding your family, here are several important steps you should consider before beginning treatment.
1. Explore lifestyle changes to boost testosterone naturally
For men concerned about their fertility, lifestyle changes should be the first line of action before turning to TRT. There are many natural ways to boost testosterone levels, which could improve your fertility without the need for medical intervention.
Lifestyle changes that may help increase your testosterone:
- Maintain a healthy weight: Obesity has been shown to negatively impact testosterone levels. By losing excess weight through a balanced diet and regular exercise, you can naturally boost your testosterone.
- Exercise regularly: Weight training and high-intensity interval training (HIIT) are particularly effective at increasing testosterone levels.
- Improve your diet: A diet rich in lean proteins, healthy fats (like omega-3 fatty acids), and zinc can promote healthy testosterone production. Avoid processed foods, excessive sugar, and refined carbohydrates.
- Manage stress: Chronic stress increases cortisol levels, which can reduce testosterone. Incorporating stress management techniques such as mindfulness, meditation, or yoga can help.
- Prioritise sleep: Poor sleep is directly linked to lower testosterone levels. Aim for 7-8 hours of quality sleep per night to support your hormonal health.
2. Discuss your goals with your doctor
Communication with your healthcare provider is crucial. Before starting TRT, discuss your fertility goals with your doctor to ensure the treatment plan is tailored to your needs.
At Leger, we make it a priority to understand your circumstances and work with you to develop a comprehensive plan that takes both your health and fertility into account.
You'll go through pre-screening blood tests and talk through any medical conditions that you have. We'll also monitor your risk of developing any health conditions, such as your prostate cancer risk.
3. Check your sperm count
Before starting TRT, we recommend checking your sperm health. A sperm count helps you understand your fertility. It shows how many sperm you produce and their quality.
Companies like ExSeed and Mojo offer at-home sperm kits.
While checking your sperm count is ideal, we understand it may be less accessible for some due to cost and accessibility.
4. Sperm freezing
Even with measures to protect fertility during TRT, there’s no guarantee that your sperm count will remain unaffected.
Freezing sperm before starting TRT is another step some men take to safeguard their future fertility. It gives you the option to conceive later using assisted reproductive techniques like IVF. Modern freezing techniques are highly effective, and sperm can remain viable for many years. However, very few men go through this process because of the cost.
Protecting fertility while on TRT
While TRT can affect sperm production, strategies can help preserve fertility. At Leger, we offer treatments alongside TRT to protect and maintain fertility in men who still wish to have children.
Here’s what we may recommend in consultation:
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hCG (human chorionic gonadotropin, brand name Zivafert)
Human chorionic gonadotropin (hCG) is a hormone that mimics the signals sent from the brain to the testes to maintain sperm production.
When used in combination with testosterone therapy, hCG can help preserve fertility by stimulating the testes to continue producing sperm [2]. The standard protocol involves injections of 250 or 500 IU of hCG three times a week, although your doctor will determine the exact dosage based on your specific needs.
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Clomifene
In some cases, especially when fertility is the top priority, we might recommend a combination of hCG and Clomifene. Clomifene is a medication that encourages the body to produce more testosterone naturally, rather than relying solely on synthetic testosterone. This combination treatment may help improve fertility outcomes for men undergoing TRT.
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Periodically stopping TRT
If preserving fertility is critical, some men may need to temporarily stop TRT. The only time this might be recommended is if you're actively trying to conceive. During this period, hCG and Clomifene can be used as well to boost sperm production. Stopping TRT should only happen with a healthcare professional's help. This is important to manage any symptoms of low testosterone that may come back.
Long-term fertility considerations
For some men, TRT can result in a permanent reduction in fertility. This is why it’s so important to take proactive steps before and during treatment to protect your reproductive health. Even if you’re not planning to have children for several years, it’s worth taking steps now to safeguard your fertility for the future.
Is TRT for me if I want a family soon?
By taking proactive steps such as getting a sperm count, freezing sperm, making lifestyle changes, and discussing fertility preservation treatments like hCG, you can protect your future family-building goals while benefiting from the advantages of TRT.
Before considering TRT, you'll first need to check your testosterone level. Find out more about how TRT works with Leger.
If you’re considering TRT and have questions about your fertility, we’re here to help. Get in touch to explore your options and create a tailored plan that supports both your hormonal health and your fertility aspirations.
References
- Fink J, Ide H, Horie S. Management of Male Fertility in Hypogonadal Patients on Testosterone Replacement Therapy. Medicina (Kaunas). 2024 Feb 5;60(2):275. doi: 10.3390/medicina60020275. PMID: 38399562; PMCID: PMC10890669.
- Rajkanna J, Tariq S, Oyibo SO. Successful fertility treatment with gonadotrophin therapy for male hypogonadotrophic hypogonadism. Endocrinol Diabetes Metab Case Rep. 2016;2016:150124. doi: 10.1530/EDM-15-0124. Epub 2016 Jan 7. PMID: 26807263; PMCID: PMC4722247.
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