Testosterone replacement therapy, or TRT, negatively impacts fertility in men
Many of our male fertility patients take testosterone replacement therapy, or TRT, to help them feel better. However, many are surprised to learn that TRT can actually decrease their chances of becoming a father. It does seem counterintuitive, right? Wouldn’t more testosterone make a man more fertile? That seems logical, but in actuality the male body does the exact opposite.
Why do men take TRT?
Testosterone is a primary reproductive hormone produced naturally by the biological male body. Produced by the testes and adrenal cortex, testosterone plays a role in a long list of processes in the male body, including the development of reproductive organs, maintaining libido, sustaining muscle mass, and helping produce sperm. During puberty, the surge in testosterone is what drives the growth of pubic hair, deepens the voice and enhances growth in boys.
As men age, testosterone production levels off and then often begins to decline. This is called hypogonadism. Research shows that after age 30 or so, many men begin to lose about 1% of their testosterone per year. Men who normally felt strong with normal energy and sexual desire may begin to notice changes. These changes might include reduced sexual desire, fewer spontaneous erections, increased body fat, reduced muscle mass and strength, and sometimes even depression.
Testosterone replacement therapy, in the form of injections, pellets, patches or gels, is commonly used in men to treat symptoms of hypogonadism. Regularly taking TRT can make many many feel better by enhancing libido, increasing muscle mass and strength, helping with erectile dysfunction and generally increasing mood.
Negative effects of TRT on fertility
However, despite its positive effects on sexual function, TRT has a negative effect on fertility. It is not uncommon for our physicians to see azoospermia (no sperm in the ejaculate) when guys are on testosterone or similar supplements even for short periods of time. This is because TRT can disrupt the body’s hormonal balance, which can interfere with sperm production and development. When TRT is administered, the brain interprets the increase in testosterone levels as a sign that enough testosterone is present, and stops sending signals to the testes to produce more. This can lead to a decrease in sperm production, as well as a decrease in the follicle-stimulating hormone (FSH), which is responsible for stimulating sperm production.
Because of these potential adverse effects, TRT is contraindicated for infertile couples attempting to conceive. In other words, our male patients are required to stop taking TRT if they want to become a dad. The good news is that the negative effects of testosterone replacement therapy are typically temporary and reversible with time. Most men regain the ability to produce sperm after stopping TRT. It generally takes about 3 months for new sperm cells to develop in the testes and about two-thirds of men see sperm return within 6 months. However, 10% might not see recovery until the second year. The recovery time varies, and some men may never fully recover spermatogenesis.
Safely taking TRT
Besides having negative effects on fertility, men should know the other risks of taking TRT. Because it can disrupt a man’s hormonal balance, some of the side effects of TRT include sleep apnea, acne, noncancerous growth of the prostate or the growth of existing prostate cancer, enlarged breasts, and increased risk of blood clots. Our physicians recommend consulting with a reputable male hormonal specialist, such as our reproductive urology partners at Posterity Health to safely take TRT.
Still have questions about TRT? Contact us to schedule a convenient telehealth appointment with our reproductive urology partner Posterity Health.
