Testosterone replacement therapy and fertility – can you have both?

You may be thinking about starting TRT, but perhaps you want to have a family sometime in the near future? Perhaps you’ve heard that having testosterone replacement therapy and fertility isn’t possible? You want to sort all of these life-destroying symptoms but you also want a family when the time comes.

Before you lose hope and resign yourself to a life of grumpiness and depression – unable to have sexual relations, mounting stress and a growing midriff by the day – read ahead, is TRT as bad for fertility as you think? And if so, what can I do about it?

I thought testosterone was good for fertility?

Men with naturally low levels of testosterone have lower sperm counts and quality than men with normal or high testosterone.

So you would think that increasing your testosterone levels with TRT would improve fertility, right?

Unfortunately, it is not that simple. Whilst the level of testosterone present in the testes is important for sperm levels this testosterone is produced by the body, and not replaceable by TRT.

Normally a man’s brain produces hormones called gonadotropin-releasing hormones (GnRH). These hormones tell the testes to make more testosterone, which is critical for a healthy sperm count.

When you’re getting testosterone replacement therapy, testosterone is added into the bloodstream from another source.

TRT sperm production

Your brain interprets this rise in testosterone levels as a sign that you now have enough testosterone. So it stops sending signals (LH and FSH) to the testes to make more testosterone. But when your testes don’t make more testosterone, (because there is less LH and FSH being released by the pituitary gland) your sperm production also goes down.

So what can I do?

There are three options to help with fertility.


1. Try to get pregnant anyway!

Although TRT will likely reduce your sperm count it does not automatically make you infertile. Many men find that they are still able to have babies whilst being on testosterone replacement therapy. (Don’t assume you don’t need contraception just because you are on TRT).

This is a risky solution because there is no guarantee you will remain fertile and in most cases TRT use will reduce your fertility if not used with other medications to prevent this.

2. Freeze your sperm and store it for when you want to have children

Not all men who start TRT are immediately thinking about having children. This option is a good safeguard that ensures fertility at a later date. However many men will be put off by the price involved with this option. For these men there is a third, effective option… (this option is still a good idea anyway).

Testosterone Replacement Therapy Fertility

3. Use HCG and or HMG therapy to ensure continuous production of testosterone in the testes and therefore excellent fertility in most men

HCG has been shown to act as an LH (luteinizing hormone) analogue (acts in the body in the same way) which causes the body to produce testosterone again in the testes. This causes an increase in sperm production (can be helped further by HMG which replicates FSH) and also stimulates testicular growth.

There are many studies that support HCG’s use for improving male fertility in previously fertile men supplementing testosterone:

See here, here, here, here, here and here (there are more).

HCG is commonly used in the USA in TRT using men. However, in the UK it is much rarer. It is mainly reserved for expensive Harley Street TRT providers and cannot be found on the NHS.

At OptiMale we can help suitable patients to achieve normal testosterone levels alongside great fertility at very competitive prices by using a combination of new pioneering protocols, testosterone compounds and HCG.


You can have both testosterone replacement therapy and fertility. Enjoy the benefits testosterone has on your sex life, muscle mass, mood and enjoyment of life in general, without worrying about the future and being able to start a family.
Fertility and Testosterone Replacement Therapy
Dr Chris Airey

Dr Chris Airey

Medical Director

This article has been medically reviewed for accuracy by Dr Airey on 12th September 2020.

Dr Chris Airey is a fully registered UK doctor with the GMC (General Medical Council) Reference No: 7490533.
He trained at the University Hospital Southampton and graduated as a Doctor with a joint Bachelor of Medicine and a Bachelor of Surgery, plus a Masters in Medical Science, completing his research project in the Medical Neurosciences Department.
He is undertaking a Master of Science course in Endocrinology and is a member of the European Society for Sexual Medicine, and the Androgen Society.
He has personal experience with taking Testosterone Replacement Therapy and is a pioneer in UK treatment protocols for Testosterone Deficiency Syndrome.