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TRT and Fertility — Important Decisions About the Future

There’s an important connection between testosterone replacement therapy (TRT) and fertility that you’ll want to consider if you’re looking into treatment for clinical low testosterone.

Let’s start off with a question that you and your spouse or partner should answer together before beginning TRT — is fertility important to you, and are you planning to have children in the near future?

The answer to those questions will be important in determining your course of treatment.

trt fertility

TRT and Fertility — The Basic Connection

In men, almost all testosterone is produced in the testes, which are the male sex glands — the same glands responsible for sperm production.

In the brain, your hypothalamus and pituitary gland control the amount of work your testes do.

Your hypothalamus produces gonadotropin-releasing hormone (GnRH) that signals the pituitary gland to generate two key fertility hormones, which are known as luteinizing hormone (LH) and follicular stimulating hormone (FSH).

FSH is responsible for initiating spermatization (the production of sperm), and LH plays a key role in testosterone production.

When exogenous testosterone is introduced into your system in order to bring levels up into the optimum range, your hypothalamus will determine that there is now enough testosterone present.

The hypothalamus doesn’t really concern itself with whether the testosterone in your system came from a TRT injection or was produced naturally — it delivers instructions to your pituitary gland based on the level of testosterone it detects.

The pituitary gland then produces less FSH and LH, which signals the testes to slow both testosterone and sperm production simultaneously.

Simply put, your brain senses sufficient levels of testosterone, so it slows down natural testosterone production. Sperm production will decline at the same time, which means your sperm count will be reduced, which means — you guessed it — your fertility will be reduced.

(It is important to note that TRT should never be mistaken for a form of birth control or contraception.)

TRT and Fertility — What Are My Choices If We Still Want Kids?

If you still hope to have children, if you’re interested in TRT but fertility is still a big concern, you may be faced with a difficult decision.

On the one hand, getting testosterone imbalance under control through TRT treatments can take care of those unpleasant symptoms of low testosterone by restoring energy and sex drive, keeping the body trim, and improving your mood — testosterone replacement therapy can drastically increase your quality of life.

On the other hand, due to a reduced sperm count, the likelihood of having a child will be significantly less — simple statistical probability indicates the chances are low.

There’s a drastic tradeoff happening for men undergoing TRT, but there are some ways to possibly work around this dilemma.

Utilizing a Sperm Bank

Banking sperm is a possible solution for some couples.

Stored sperm that has been frozen can been unfrozen and used, even years later, to have a child.

While some people might consider this option “impersonal,” it offers couples the option to treat symptoms of low testosterone now and pursue a better quality of life while maintaining the possibility of having children down the road.

Delaying Treatment

The other option is to wait on treatment for Low T until after you’ve had a child.

Obviously, there’s no way of predicting conception with any accuracy, so relief for the symptoms of low testosterone may have to be delayed for a significant amount of time — a difficult choice that may not be a practical option for those experiencing severe symptoms.

If having a family in the traditional manner is still a lifetime goal for you, holding off on treatment for a period of time is one option.

(You can read more about these options here.)

There is also a third possibility.

hCG Used in Conjunction With TRT — Fertility May Be Maintained Through the Use of hCG

The use of hCG (human chorionic gonadotropin) injections could help increase fertility during the course of testosterone replacement therapy treatments.

hCG mimics luteinizing hormone (LH). If you remember, production of LH by the pituitary gland was interrupted when the hypothalamus sensed sufficient testosterone levels.

The presence of LH, or what the body believes is LH in the case of using supplementary hCG, can trigger the testes to produce sperm — but it’s not a guaranteed effect.

Some men, particularly younger men, may benefit from forms of TRT which potentially result in an overall increase in the testicular production of testosterone as opposed to replacing the deficiency with exogenous hormone (injections, patches, gels, etc). Again, hCG and other and other medications such as clomiphene can potentially be beneficial in this scenario as they do not result in lower sperm counts. Some of these medications carry different side effect profiles so be sure to discuss this with your healthcare provider.

TRT and Fertility — A Difficult Decision

A man experiencing the symptoms of low testosterone who is still planning to start or expand his family has some decisions to make, along with his spouse or partner.

However, it can be encouraging to know that there are options available to men who need TRT but are still hoping to have children.

If you’d like to find out more about hCG and how this hormone might lessen the effects of TRT on fertility, we have further information available — click the button below to learn more about hCG.

Find Out About hCG



(Bill) William J. White, PA-C

(Bill) William J. White, PA-C brings over 20 years of surgical experience to our practice. He is a decorated veteran of the United States Army where he served for nearly 6 years with duty assignments, both here and abroad.   During his military career, Bill was trained as a Certified Surgical Technologist, and following an Honorable Discharge from the Army, he attended Texas Tech University.   He graduated with a Bachelor of Science in Biology and went on to attend PA School at the University of Texas Southwestern Medical Center at Dallas. He spent the first 10 years of his career in Neurosurgery.

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