Taking Testosterone: Does It Affect Your Fertility?

Testosterone is known for being the dominant male sex hormone, playing a central role in things like mood, muscle mass, bone health, and of course, libido and sexual function. 

Low testosterone can cause issues such as low energy and erectile dysfunction. And while some men are able to get things back in order by adjusting certain lifestyle habits, others may opt for medical intervention in the form of testosterone replacement therapy (TRT), which may be delivered through injection, topical gels, or pellets inserted under your skin.

Everything comes with potential risks, including hormone therapy — but does TRT make you infertile? Unfortunately, there is a connection between TRT and male infertility, though there are some nuances to know.

Keep reading to understand the effects of treatments like testosterone injections on male fertility, plus common indications for TRT and possible alternatives.

Let’s face it: When your testosterone levels dip, life can feel like it’s in low gear. Because testosterone helps keep you feeling strong and energized, when levels drop, it can feel like your body’s trying to retire early.

Here are some common symptoms of low testosterone:

• Low energy: If you feel like taking a nap after walking up a flight of stairs, your testosterone might be hitting the snooze button. That "get-up-and-go" feeling? It got up and left.

• Decreased libido: Let’s just say your sex drive might feel more like a Sunday stroll than a race car these days.

• Problems with erections: Low T doesn’t just slow things down — it can make certain things stop altogether. Case in point: erectile dysfunction.

• Mood swings: If you’re feeling crankier than normal, you might need to blame your hormones. 

• Loss of muscle mass: Notice your favorite shirt fits a little looser in the arms? It’s not your laundry routine — it’s your muscles taking a hiatus.

• Increased body fat: Low T can invite extra padding to the party, especially around the waistline (called visceral fat).

• Brain fog: Can’t remember where you put your keys? Or your phone? Or what you walked into the room for? Low T might be to blame.

Testosterone is just one of dozens of hormones in the body, but it affects many different aspects of a man’s life. Fatigue, brain fog, low libido, and loss of muscle mass aren’t exactly winning ingredients for living your best life. So when levels are low — that is, below 300 nanograms per deciliter (ng/dL), according to the American Urological Association (AUA), testosterone replacement therapy can make a big difference in how someone looks and feels.

The AUA notes that a diagnosis of testosterone deficiency is made when low testosterone levels are combined with symptoms, like those we mentioned above. If low T is caused by a medical condition or its treatment, and not just the normal aging process, that’s typically when a healthcare provider may consider TRT as a treatment option.

Some medical conditions or treatments that can cause low testosterone include:

• Certain medications, especially those that affect the hypothalamus or pituitary gland, like opioids 

• Chemotherapy and radiation therapy for cancer

• Genetic conditions that impair testosterone production, such as Klinefelter or Kallmann syndromes

• HIV/AIDS

• Hypogonadism 

• Infections like mumps

• Metabolic disorders such as hemochromatosis, where too much iron builds up in the body

• Obesity 

• Pituitary gland disorders

• Testicular injuries

While testosterone replacement therapy can work wonders for energy, mood, and libido, it’s not all smooth sailing. Like any medical treatment, it comes with risks — one of the biggest ones being its possible effects on fertility. 

Does testosterone affect sperm? Yes. Testosterone might make you feel invincible, but it has a sneaky way of putting the brakes on sperm production. By disrupting the body’s hormone balance, TRT can lead to temporary infertility. 

It has such an effect on fertility that testosterone has been called a male contraceptive. This is because it suppresses follicle-stimulating hormone (FSH), which is responsible for triggering sperm production.

The Hormonal Chain Reaction

Your body’s natural testosterone production is like a well-tuned orchestra, with the hypothalamic-pituitary-gonadal (HPG) axis as its conductor. 

When you take testosterone from an outside source (like injections), it’s as if you hand the conductor a ticket to an all-expenses-paid vacation.

Without the HPG axis directing the show, your body stops producing its own testosterone — and with it, sperm production tends to nosedive.

Low Sperm Count

Taking testosterone injections essentially signals to your brain that it has plenty of hormone on tap and doesn’t need to make more. 

This means your testicles, which are responsible for sperm production, go on break. The result? A sharp decline — or complete halt — in sperm production.

Dose Matters

The more testosterone you take, the stronger the signal to shut down your natural production. 

While some men may still produce sperm at low levels, high doses of testosterone can lead to significant suppression, making it difficult (if not impossible) to conceive naturally while on TRT.

Temporary, but How Temporary?

The good news is that for many men, fertility suppression is reversible once testosterone use is stopped. The bad news? It can take several months — or even longer — for sperm production to return to normal (sometimes up to a year).

Recovery times vary depending on factors like age, overall health, and how long you’ve been on testosterone treatment.

(Rare) Permanent Effects

In rare cases, long-term use of testosterone injections can cause permanent suppression of sperm production. This is why it’s crucial to approach TRT with a clear understanding of the risks, especially if you’re planning to start or expand your family.

Even if you’re not concerned about infertility from testosterone injections, before diving headfirst into the process, here are some other potential downsides to consider:

• Skin rebellion: If you thought breakouts were a thing of your teenage years, think again. TRT can sometimes bring back acne, especially if you’re using a gel.

• Fluid retention: Testosterone can cause the body to hold onto extra fluid, leaving you feeling a bit bloated and puffy. It’s not dangerous for most, but it can be uncomfortable.

• Increased blood clot risk: TRT can raise red blood cell counts, which sounds great (more oxygen), until it increases the risk of blood clots. This is why regular blood tests are key to staying safe.

• Aggression: While TRT may improve mood, taking too much testosterone may lead to irritability or mood swings. Balance is everything.

• Prostate health concerns: Although the research is still mixed, there’s been debate about whether TRT might accelerate the growth of existing prostate cancer or increase prostate size in some men. This makes regular checkups with your healthcare provider non-negotiable.

• Heart health risks: TRT may carry a small risk of cardiovascular issues, such as heart attacks or strokes, especially in older men or those with preexisting conditions or with prolonged use. This is why TRT should always be carefully monitored by a doctor.

• Gynecomastia (breast tissue enlargement): Hormonal imbalances caused by TRT can sometimes lead to the development of breast tissue, a side effect nobody asks for.

Note that many of these risks can be managed or minimized with proper medical supervision. TRT isn’t one-size-fits-all, and its safety depends on your personal health, dosage, and monitoring. 

Testosterone replacement therapy is a popular option for managing low testosterone, but it’s not the only game in town. Read on to learn about other options, especially if your wife is wondering, If my husband takes testosterone injections, can I still get pregnant?

For men looking to avoid the potential side effects of TRT — like fertility suppression — there are alternative treatments that can help boost testosterone levels and address symptoms, while maintaining and sometimes even improving sperm production. Here’s a look at some options:

• Clomiphene citrate (Clomid): Clomid helps stimulate the body’s natural testosterone production by signaling the brain to boost hormone production. It may be an option for men who want to maintain their fertility while addressing low testosterone.

• Human chorionic gonadotropin (hCG): hCG mimics a hormone that signals the testes to produce testosterone. It can be used alone or alongside TRT to preserve fertility, making it a flexible treatment option.

• Lifestyle changes: Reaching a healthy weight, exercising, sleeping better, and eating a balanced diet can naturally boost testosterone levels. These changes benefit overall health, but they require a consistent effort to see results.

• Sperm banking: Sperm banking involves storing sperm before starting treatments like TRT that may suppress fertility. It’s a proactive step toward future family planning that uses cryopreservation to freeze sperm until they’re needed.

Testosterone injections can be a powerful tool for improving symptoms of low testosterone, but they come with potential risks — especially when it comes to fertility. For men considering TRT, here are the key takeaways:

• Understand the potential impact on fertility. Testosterone therapy can suppress sperm production, but in most cases, this effect is reversible after stopping treatment.

• Explore alternative options. Treatments like clomiphene citrate, hCG, lifestyle changes, and supplements may help boost testosterone levels without compromising fertility.

• Plan ahead. If fertility is a priority, consider sperm banking or discuss fertility-preserving options with a fertility specialist (and your significant other, of course) before starting testosterone therapy.

If you’re dealing with low testosterone, you’re not alone — many men are in your shoes. 

Rather than trying to navigate what to do by yourself, consult a healthcare provider to weigh the benefits, risks, and alternative treatments that align with your health and family goals.