Testosterone Replacement Therapy & Fertility

TRT fertility Optimale
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TRT alone reduces your fertility as your body shuts off signals to the testicles when exogenous testosterone is detected. Luckily HCG can be used to replicate one of those signals. This causes the testicles to continue working, producing semen, testosterone and staying at normal size. HMG is an even more potent fertility medicine which can be used in rare cases when HCG doesn’t help. Testing fertility on TRT is important. Optimale can provide HCG to appropriate men whilst on TRT to maintain fertility.

TRT and Fertility - the best of both worlds?

You may be thinking about starting TRT, but perhaps you want to have a family sometime in the near, or even distant, future? Like most people you may have heard that TRT and fertility don’t really mix. But is this completely true? Is it possible to get rid of the symptoms that are impacting you each day with considerable symptoms whilst also starting a family when the time comes?

Is TRT as bad for fertility as you think? And if so, what can you do about it?

Before you lose hope and resign yourself to a life of grumpiness and depression – read ahead for more information and advice on how best to avoid infertility whilst on TRT.

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ADAM Questionnaire

Low Testosterone Test

The ADAM questionnaire has been shown to have 88% sensitivity in testing for low testosterone.

But isn't Testosterone 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 might think that increasing your testosterone levels with testosterone replacement therapy would improve fertility, right?

Unfortunately, it is not that simple. TRT and fertility do not usually go hand-in-hand. 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.

TRT and fertility

When you’re taking testosterone replacement therapy, testosterone is added into the bloodstream from another source, such as injections, gels etc.

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.

This leads to a reduction in sperm quality and therefore your fertility.

Any testosterone which is added to your body (exogenous testosterone) will reduce fertility levels, even if it is at lower doses. The testosterone dose does not have to be a really high dose to impact your natural production and fertility.

How can I maintain Fertility on Testosterone Replacement?

There are three options for fertility whilst on TRT:

1. Try to get pregnant anyway!

Although TRT will likely reduce your sperm count it does not necessarily 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).

However, 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. Whilst fertility usually comes back after stopping TRT, this is not always the case, and the longer you are on TRT the greater the risk of your fertility not returning to normal.

At Optimale we do not recommend this as an approach, but it is worth mentioning that fertility levels can still remain whilst on TRT at high enough levels for conception.


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.

This is also recommended as a safeguard for all men regardless whether they are using other medications to improve or maintain fertility.

For men who don’t want to pay for storage, there is a third, effective option… (this option is still a good idea anyway).

3. Use HCG and/or HMG therapy to ensure continuous production of testosterone in the testes and therefore maintain 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 who are now supplementing testosterone on TRT.

A study of 26 men who took HCG alongside injectable and transdermal testosterone maintained their fertility over greater than a year’s follow up (this means that it is likely fertility was maintained after this time period).

In this 49 man study of men with azoospermia by Wenker et al (2015) 47 of the men had normal sperm counts by the end of the study with the 48th man reporting a documented pregnancy on follow up despite their previously low sperm counts.

Kim et al (2012) found that HCG use maintained fertility even with concurrent testosterone administration (this is particularly important for men on TRT).

Matsumoto et al (2009) studied 36 men with severe hypogonadotropic hypogonadism (low testosterone) and found that HCG was effective at improving and maintaining fertility.

Bouloux et al(2002) studied 26 men with severe hypogonadotropic hypogonadism. They found that HCG was effective at returning sperm production to decent levels.

There are more studies coming out regularly to support HCG use for fertility. HCG is also useful on TRT because it maintains other hormone pathways that are otherwise lost when you suppress natural production. Not only does this make men feel better, it also improves their lipids and makes them healthier.

Blood Test

Testosterone test kits

Order an at-home test kit to get started.

How can I test for fertility?

There are a few ways that men can get their fertility tested. One of the easiest and best value options is an at-home test that we sell on our website. This test has been validated by the WHO (World Health Organisation) as being accurate.

This male fertility test can be done without any training, in about 15 minutes, without embarrassing visits to a clinic and from the comfort of your home.

How much does it cost to see if a man is fertile?

Our fertility tests cost only £39.99 and can be done safely and easily at home.

You can also visit specialist fertility clinics to have semen testing, but some clinics can cost a lot of money. You may wish to get more thorough semen analysis if you are concerned about your fertility and want further specialist support. In this case, please get in contact and we can advise on the best value fertility clinics in the UK.

Where can I get HCG in the UK?

HCG use to be commonly used in the USA alongside TRT to maintain a man’s fertility levels. Now, it is much less common, because of new rules that have made it much more expensive to obtain in the US. They now use Clomid as an alternative, but this is not as effective.

In the UK it is becoming easier to find in specialist clinics. It is mainly reserved for specialist TRT providers and cannot be found on the NHS for use alongside TRT in men.

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


TRT is an amazing treatment. For a long time, it was something that was only recommended to older men and those with very low levels due to its effect on fertility.

These men had to weigh up the benefits knowing that they may never be able to have children after starting treatment.

With new medications such as HCG, there are now options that men can use to ensure that they remain fertile whilst improving their chances of being able to have a family in the future.

Contact us to learn more about starting TRT and HCG.

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