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?
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 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.
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 fertility.
Any testosterone which is added to your body (exogenous testosterone) will reduce fertility levels.
How can I maintain Fertility on Testosterone Replacement?
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 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.
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).
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 supplementing testosterone:
HCG is commonly used in the USA in TRT using men. However, in the UK it is much rarer.
It is mainly reserved for specialist 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.
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 is an at-home test which has been validated by the WHO.
This test can be done without any training, in about 15 minutes, without embarrassing visits to a clinic and from the comfort of your home.
You can find this test here on our site.
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 find them here.
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. 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.
- Sharpe RM. Sperm counts and fertility in men: a rocky road ahead. Science & Society Series on Sex and Science. EMBO Rep. 2012;13(5):398-403. Published 2012 May 1.
- Matsumoto AM, Snyder PJ, Bhasin S, Martin K, Weber T, Winters S, Spratt D, Brentzel J, O’Dea L. Stimulation of spermatogenesis with recombinant human follicle-stimulating hormone (follitropin alfa; GONAL-f): long-term treatment in azoospermic men with hypogonadotropic hypogonadism. Fertil Steril. 2009 Sep;92(3):979-990.
- Wenker EP, Dupree JM, Langille GM, Kovac J, Ramasamy R, Lamb D, Mills JN, Lipshultz LI. The Use of HCG-Based Combination Therapy for Recovery of Spermatogenesis after Testosterone Use. J Sex Med. 2015 Jun;12(6):1334-7.
- Coviello AD, Matsumoto AM, Bremner WJ, Herbst KL, Amory JK, Anawalt BD, Sutton PR, Wright WW, Brown TR, Yan X, Zirkin BR, Jarow JP. Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression. J Clin Endocrinol Metab. 2005 May;90(5):2595-602.
- Hsieh TC, Pastuszak AW, Hwang K, Lipshultz LI. Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. J Urol. 2013 Feb;189(2):647-50.
- Kim ED, Crosnoe L, Bar-Chama N, Khera M, Lipshultz LI. The treatment of hypogonadism in men of reproductive age. Fertil Steril. 2013 Mar 1;99(3):718-24. doi: 10.1016/j.fertnstert.2012.10.052. Epub 2012 Dec 7. PMID: 23219010.
- Bouloux P, Warne DW, Loumaye E; FSH Study Group in Men’s Infertility. Efficacy and safety of recombinant human follicle-stimulating hormone in men with isolated hypogonadotropic hypogonadism. Fertil Steril. 2002 Feb;77(2):270-3. doi: 10.1016/s0015-0282(01)02973-9. PMID: 11821082.