Does TRT Help Or Hurt Your Fertility?

For some couples trying to conceive, infertility could be a challenge. The conversation is often centered around women, but men struggle with fertility too. The causes of infertility are numerous and well documented. There’s a common perception that low testosterone causes infertility. This belief has caused a rise in thinking that testosterone replacement therapy (TRT) can help a couple conceive. Studies show that TRT can do more harm than good.


Understanding low T

Testosterone is one of the building blocks of male development. The hormone is produced in the testes and helps with development during puberty. Over time, testosterone governs bone mass, muscle mass, energy levels, hair growth, and sex drive. Testosterone is also needed to produce sperm. For men over 30, low testosterone is a genuine concern since the hormone decreases by 1% every year. A condition called hypogonadism occurs when a man produces less than 300ng/dL of testosterone. This condition is commonly referred to as low T. Over time, decreased testosterone levels significantly reduce the quality of life.

TRT may not be beneficial for fertility

Testosterone replacement comes in a gel, patch, or injection to restore to healthy levels. TRT is helpful for men with low energy levels, poor focus, low sex drive, and a host of other issues. Studies show that TRT decreases the chances of conceiving. This is identified frequently in men that have been taking the medication over long periods.

Women can benefit too

Having healthy testosterone levels isn’t just for men. Women also benefit from healthy androgen levels. Some women suffer from low libido, reduced bone mass, and lower energy levels. With a consistent TRT regimen, there is often a significant improvement in these symptoms. There is a need for a delicate balance since there is a dependence on other hormones for reproduction. For fertility, abnormally high testosterone levels can create an opposite effect.

It hurts your chances of conceiving

Testosterone plays only a small role in sperm production. The body requires follicle stimulating hormones (FSH) for sperm production. Excessive amounts of testosterone through TRT can reduce the production of FSH. With too much testosterone replacement, the body may stop creating testosterone naturally, making some men depend on TRT. This dependency can develop a condition called testicular atrophy or shrink in the size of the testes. For women, spikes in testosterone due to TRT cause irregular periods, PCOS, and infertility.

Here are your options

Couples trying to conceive will need other options besides TRT. For men on TRT therapy already, stopping the treatment altogether is a great start. Over several months, the body should resume natural testosterone production. If testosterone levels are still a challenge, a doctor can suggest other treatments. These include clomiphene citrate and aromatase inhibitors. These can help with balancing the hormones needed for sperm production. For some men, medication coupled with a healthy diet, normal BMI and exercise can increase testosterone and pregnancy chances.

Turning to IVF

Unfortunately, TRT can cause irreparable damage for some men and women. When this happens, a reproductive endocrinologist will suggest IVF. In vitro fertilization is a process that creates an embryo outside of the body. A fertility clinic takes a sperm sample, extracts an egg, creates an embryo, then implants the cells in the hopeful mother’s womb. Due to insufficient sperm production, the fertility clinic will use ICSI, where a single healthy sperm creates the embryo. IVF has high success rates, but there are some risks. Make sure to speak with a doctor to explore all options.

Get the right treatment

Testosterone plays an active role in fertility and sperm production. Consult a reproductive specialist before starting TRT for men with low T who want to start a family. Men with low testosterone can still get pregnant without TRT. Having the correct information can help doctors make the right choice to improve the chances of pregnancy.


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