Testosterone plays a decisive role in the production of sperm, which occurs in testicles through a process called spermatogenesis. This process is regulated by the axis of the hypothalamus-pituitary gonadal (HPG). When testosterone levels are low, the hypothalamus releases gonadotropin-releasing hormone (GnRH), which signals the pituitary gland to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones stimulate the testes to produce both testosterone and sperm.

When a person is exposed to TRT, exogenous (external) testosterone is introduced into the body. This creates a negative feedback loop and signals the brain that sufficient testosterone is available. Consequently, the hypothalamus reduces the production of GNRG, which leads to a decrease in the level of LH and FSH. Since LH and FSH are necessary for the production of sperm, their suppression can cause a significant decrease in the number of sperm or even finish azoospermia (absence of sperm in semen).

Is the Infertility Caused by TRT Permanent?

For most men, recovery times vary, but infertility caused by TRT is reversible even after treatment stops. Some men can take months up to several years, so that sperm production returns to the normal level, while others may experience long -term or constant effects, especially after prolonged use of TRT. Factors such as age, the duration of therapy and individual health states play a role in recovery.

What to do next to TRT to preserve fertility?

Men who require testosterone therapy but want to maintain fertility at all times have alternative treatment options including:

  • Clomifen citrate (Climid) is a selective modulator of estrogen receptors (SERMs) that stimulate natural body testosterone products without removing sperm.
  • Gonadotrophin in the human chorionic membrane (HCG) is a hormone that mimics LH and stimulates testosterone and sperm test circles.
  • Aromatase Inhibitors (AIS) – These drugs help prevent the transformation of testosterone into estrogen and increase testosterone levels naturally.

Are you considering TRT? Please talk to your clinic first

Before starting TRT, men concerned about fertility should discuss potential risks with their clinic. Medical professionals can recommend sperm storage options, such as sperm banks, before starting TRT. Regular monitoring of hormone levels and sperm counts can also help you assess how your body responds to treatment. Here you can read more about fertility. Do you want to know how TRT works? Read this.