The Good And Bad Of TRT

Testosterone replacement therapy (TRT) has become increasingly popular for men experiencing low testosterone symptoms like fatigue, decreased libido, and reduced muscle mass. The therapy has been popular in older men, but some as early as 35 are turning to TRT. While effective for these issues, a critical side effect has to do with male fertility. Studies show that TRT can dramatically reduce sperm production, making conception difficult or impossible. Understanding this fertility impact before starting TRT is essential for men who are considering biological children. Fertility specialists can provide the necessary support and options so men can still manage low testosterone.

Shutting down sperm production

The body’s hormone system operates through consistent feedback loops. When introducing external testosterone, the brain can shut down the hormone signals needed for sperm production. The pituitary gland, for instance, stops releasing luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which stimulate sperm production. Without the signals from the brain, the testicles stop producing both testosterone and sperm. These changes can occur within weeks of starting TRT. Over time, some men experience oligospermia or more severe azoospermia. The sperm production on TRT can be too low for natural conception.

Attempting conception on TRT

Once men are on TRT, achieving pregnancy becomes challenging but not impossible. Stopping TRT allows natural hormone production to resume, though the process is unpredictable and often slow. Some fertility specialists recommend hormone medication to improve outcomes. Adding hormone chorionic gonadotropin (hCG) to the TRT protocol can restart sperm production while maintaining testosterone levels. For men who cannot or prefer not to stop TRT, fertility medications can sometimes stimulate sperm production. Additional support, such as follicle-stimulating hormone (FSH) injections, stimulates the testicles, potentially restoring sperm production. These protocols are complex, requiring close attention, but can provide hope for men on TRT.

Fertility preservation options

There are several amazing benefits of TRT, yet men who intend to start or grow a family must consider long-term fertility. Some may consider fertility preservation. Sperm banking, which consists of cryopreservation of healthy sperm, allows men on TRT to preserve sperm for future use. Sperm can be used to perform intrauterine insemination (IUI) or in vitro fertilization (IVF) with a partner. Depending on the length of time on TRT, some men can try the hormone therapies mentioned. Along with FSH and hCG, using clomiphene citrate can block estrogen receptors. This reignites the body’s ability to produce natural testosterone.

A critical link to pregnancy

Testosterone use has a direct link to male fertility. While men can enjoy the many benefits in the short term, long-term, natural conception is increasingly difficult. For many men, critically low testosterone warrants TRT, which can improve quality of life. At the same time, these men can lose the ability to produce high amounts of sperm altogether. Before starting TRT, have an important conversation about future family planning goals. Understand that fertility suppression is not a rare side effect, but an expectation. Natural conception becomes challenging, leading to an infertility diagnosis. Weigh the pros and cons, then consider fertility preservation before starting TRT.