Sexual Health Q&A

Can testosterone replacement therapy (TRT) make a man infertile?

Testosterone replacement therapy can lead to a decline in sperm production for some men, making it more difficult for them to father children.

The problem lies with the pituitary gland and the makeup of synthetic testosterone, which is used for TRT.

Testosterone, produced in the testes, plays an important role in sperm production. When the body needs to make more testosterone, the pituitary gland sends hormones to the testes to start the process. These hormones help stimulate the production of sperm.

But when synthetic testosterone is in the body, the pituitary gland doesn’t “know” it’s not the real thing. So the hormones needed for sperm production aren’t released. As a result, the testes produce less sperm or none at all.

Some men find that their sperm counts improve after stopping testosterone replacement therapy. However, this does not happen for every man.

Men who would like to father children should discuss fertility implications with their doctors before starting testosterone replacement therapy. They may also consider banking sperm before therapy begins.