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If your husband (or male partner) takes testosterone and you wonder if you can still get pregnant, you are far from alone. Over the past decade, the number of men using testosterone replacement therapy has tripled (Patel, 2019). Yet many men aren’t counseled on how TRT can affect sperm count and their ability to conceive.
The reality is taking TRT can decrease sperm count and make conception difficult (Patel, 2019). But there’s hope. There are options for treating your partner’s testosterone issues without TRT. There are also many alternatives for increasing your husband’s sperm count if his healthcare provider determines his count is low.
Does TRT make you infertile?
Testosterone replacement therapy (TRT) is often used in males who experience low testosterone (hypogonadism). To know for sure that you have low T, you would need to be evaluated by a doctor and get your blood testosterone levels tested. Still, people with low T may have some typical symptoms, such as (Patel, 2019):
- Decreased sex drive
- Low muscle mass
- Erectile dysfunction
- Low mood or depression
When it comes to testosterone treatment, there are a few choices available, including testosterone injections, patches, gels, and implants. Healthcare providers prescribe these treatments often, and the number of men using testosterone therapy has increased significantly in the past few years. Yet sometimes, men are not aware of how testosterone affects fertility.
The truth is that TRT can impact sperm production and decrease sperm count. In fact, testosterone supplementation can have such profound effects on male fertility that it has been considered a form of birth control (Gava, 2019; Kamischke, 2002). This is because synthetic testosterone can decrease a hormone called follicle stimulating hormone (FSH), which is responsible for orchestrating sperm production in the body (Patel, 2019).
It’s common to be confused about how TRT affects fertility. Many people think adding more testosterone to the body will increase sperm production. After all, testosterone is the primary male hormone, and supplementing with testosterone can boost sex drive and enhance erectile functioning. But this isn’t accurate.
It’s also not unusual to believe that having low testosterone is what is causing your infertility. Although there are hormonal causes of male infertility, low T isn’t one, according to the American Society of Reproductive Medicine (ASRM). Indeed, most men with low testosterone can produce adequate sperm (ASRM, 2015).
High testosterone with lower sperm count: what does it mean for fertility?
Tips for getting pregnant with low sperm count
The good news is, although taking TRT can decrease sperm count, the effects are usually reversible once you stop TRT. Still, it may take a few months for your fertility to return, and you may find that you still experience low sperm count after stopping TRT because of other contributing factors (Kolettis, 2015).
If you have trouble conceiving, it’s best to start by seeing a reproductive endocrinologist for an evaluation. When looking at male fertility as a possible issue, the first intervention would be to have a semen analysis done—sometimes more than one. Semen analysis looks at aspects of your semen, such as sperm count and motility. It also evaluates something called morphology, which is the shape and size of your sperm (Choy, 2020).
If it’s determined that you have a low sperm count, there are many options to increase your chances of conceiving. But first, the cause of your low sperm count needs to be uncovered. Besides the side effects of TRT therapy, common causes of low sperm count may include hormonal imbalances, genetic causes, anatomical differences, injuries, use of certain drugs and medications, and obesity (Choy, 2020).
Fertility treatments for low sperm count will depend on the cause and can include medications and surgeries (Sunder, 2021). For many people, making lifestyle modifications can have a substantial impact on sperm production. These modifications may include losing weight if you have obesity and decreasing alcohol and nicotine use (Balawender, 2020).
For couples who still aren’t able to conceive naturally, reproductive assistance, including in vitro fertilization (IVF), may be considered (Sunder, 2021). Using a sperm donor may be an option if this doesn’t work.
How to increase testosterone without affecting fertility
If your partner has low testosterone, but you want to start a family, there are many options available to you. How you tackle this issue will depend on your partner’s health status, so it’s best to consult with a healthcare provider to address this issue.
Men currently using TRT to increase testosterone will likely need to stop taking testosterone to restore their fertility. Your healthcare provider will guide you on the best way to wean off it. Studies have found that most men who stop taking TRT will have normal sperm analyses within 6–9 months of stopping TRT treatment. In rare cases, it may take up to two years for sperm counts to get back to baseline levels (Patel, 2019).
Does testosterone increase sex drive? The relationship explained
Although some men will be comfortable staying off of their testosterone therapy until their partner is pregnant, others will want alternative options for increasing testosterone levels in the meantime.
Thankfully, there are some alternatives to TRT therapy for people with low testosterone that don’t impact sperm count. These include (Patel, 2019):
- Clomiphene citrate (Clomid)
- Enclomiphene citrate
- HCG therapy
Therapies like enclomiphene citrate don’t have FDA approval for use in increasing testosterone, so your healthcare provider may have to prescribe it “off-label” (Patel, 2019). HCG therapy is another way to support testosterone production without affecting sperm count side effects. It’s an appropriate therapy for people specifically experiencing secondary hypogonadism (low testosterone due to pituitary or hypothalamus dysfunction) (Lee, 2018; Patel, 2019).
If stopping TRT or trying an alternative doesn’t feel viable, you might want to talk to your healthcare provider about changing dosages or methods of delivery. According to ASRM, testosterone injections and implants might be more likely to impact fertility than testosterone gel (ASRM, 2015).
10 foods that boost testosterone
The bottom line is that if your husband takes testosterone, your concerns about getting pregnant are valid. Testosterone supplementation will likely impact sperm production and your ability to get pregnant. But don’t despair; the damage is usually reversible, and there are many options to safely increase your husband’s sperm count and testosterone.
- American Society for Reproductive Medicine (ASRM). (2015). Testosterone use and male infertility. Retrieved from https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/testosterone-use-and-male-infertility/
- Balawender, K. & Orkisz, S. (2020). The impact of selected modifiable lifestyle factors on male fertility in the modern world. Central European Journal of Urology, 73(4), 563-568. doi:10.5173/ceju.2020.1975. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848840/
- Choy, J. T. & Amory, J. K. (2020). Nonsurgical management of oligozoospermia. Journal of Clinical Endocrinology & Metabolism, 105(12), e4194–207. doi:10.1210/clinem/dgaa390. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566408/
- Gava, G. & Meriggiola, M. C. (2019). Update on male hormonal contraception. Therapeutic Advances in Endocrinology and Metabolism, 10, 2042018819834846. doi:10.1177/2042018819834846. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419257/
- Kamischke, A., Heuermann, T., Krüger, K., et al. (2002). An effective hormonal male contraceptive using testosterone undecanoate with oral or injectable norethisterone preparations. Journal of Clinical Endocrinology & Metabolism, 87(2), 530–539. doi:10.1210/jcem.87.2.8218. Retrieved from https://academic.oup.com/jcem/article/87/2/530/2846688
- Kolettis, P. N., Purcella, M. L., Parker, W., et al. (2015). Medical testosterone: an iatrogenic cause of male infertility and a growing problem. Urology, 85(5), 1068-1073. doi:10.1016/j.urology.2014.12.052. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25819620/
- Lee, J. A. & Ramasamy, R. (2018). Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men. Translational Andrology and Urology, 7(Suppl 3), S348–S352. doi:10.21037/tau.2018.04.11. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087849/
- Patel, A. S., Leong, J. Y., Ramos, L., et al. (2019). Testosterone is a contraceptive and should not be used in men who desire fertility. World Journal of Men’s Health, 37(1), 45-54. doi:10.5534/wjmh.180036. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6305868/
- Sunder M. & Leslie S. W. (2021). Semen analysis. StatPearls. Retrieved on Oct. 10, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK564369/
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.