Testosterone Replacement Therapy (TRT) is the most common form of therapy for men with low testosterone levels, but it does come with one potential drawback for some men—it can reduce your sperm count and make having a baby much more difficult.
While some men—especially those who do not want children or more children—aren’t bothered by this, if you’re planning on expanding your family, this side effect can prevent you from doing so.
Luckily, there are ways to reduce TRT’s impact on your sperm count so that you can continue to enjoy the benefits of therapy. It’s also important to note that stopping TRT can usually restore fertility.
Here's what you need to know about TRT's effects on your sperm count, its benefits for your sexual health, and your options for maintaining fertility while treating your low testosterone.
How TRT Affects Your Sperm Production
When you take testosterone, your body responds by shutting down its natural testosterone and sperm production. This happens because TRT suppresses the hormones that stimulate your testicles to produce both testosterone and sperm.
Specifically, your brain reduces the production of two critical hormones:
- Follicle Stimulating Hormone (FSH), which stimulates sperm production
- Luteinizing Hormone (LH), which triggers testosterone production
This hormonal suppression can lead to significantly reduced sperm count or even azoospermia (complete absence of sperm in your semen) within a few months of starting TRT.
However, keep in mind that your sperm count will usually return to normal if you stop TRT—most men return to normal sperm production within 3 months.
How Long It Takes for Your Sperm Count to Drop on TRT
Your sperm count typically begins to decrease within a few months of starting TRT. For most men, sperm production becomes severely impaired within 6–12 months of treatment.
However, this effect is usually reversible when you stop TRT, though recovery can take several months to a year or longer.
The Benefits of TRT for Sexual Health
While TRT can impact fertility, many men find that the symptoms of their low T are so bad that it’s worth starting therapy. Understanding these benefits can help you make an informed decision about whether TRT is right for you.
Improved Erectile Function
Low testosterone often contributes to erectile dysfunction (ED), and TRT can help restore your ability to achieve and maintain erections. When your testosterone levels return to normal through TRT, you may experience stronger and more frequent erections. You might also find that you respond better to ED medications.
One of the most noticeable benefits of TRT is its positive impact on your sex drive. Many men report significant improvements in sexual desire, and many men report that they become much more likely to initiate sex.
Beyond Sexual Health
TRT's benefits extend beyond sexual function. You might also experience:
- Increased muscle mass and strength
- Improved bone density
- Better mood and mental clarity
- Increased energy levels
- Improved body composition
- Better sleep quality
While temporarily losing the ability to have children can be a pain, most men find that the benefits outweigh this drawback.
Planning for Future Fertility When You Start TRT
Starting TRT isn’t the end of your fertility. If you're considering TRT but want to save your ability to have children in the future, several options are available to you.
Sperm Banking
Before starting TRT, you might want to bank your sperm for future use. This provides insurance against potential fertility issues and gives you peace of mind if you're planning to have children later.
Regular Monitoring
Working with your healthcare provider to monitor both your testosterone levels and sperm count can help adjust your treatment as needed (lower amounts of testosterone can have a reduced impact on fertility).
Pausing Therapy
If you decide you want to have children, you can always pause therapy temporarily. However, keep in mind that a small fraction of men may find that their sperm levels are permanently reduced by TRT.
This is why sperm banking—for men who are certain they want children in the future—is a good idea.
Telling Your Healthcare Provider You Plan on Having Children
When considering TRT, it's crucial to discuss your fertility goals with your healthcare provider. They can help you develop a treatment plan that balances your testosterone needs with your fertility preservation goals.
Recovery After TRT
If you've been on TRT and want to restore your fertility, recovery is possible but requires patience. The recovery process typically involves the following:
- Gradually tapering off TRT under medical supervision
- Monitoring hormone levels regularly
- Tracking sperm count recovery
- Making lifestyle modifications to support fertility and low testosterone levels
Keep in mind that, if you pause TRT, you’re likely to see your symptoms come back as your body gradually returns your testosterone levels to what they used to be.
The recovery timeline varies, but most men see improvement within 3 months after stopping TRT, though it may take up to 1 year in some cases. Success rates can vary based on how long you were on TRT, how old you are, and other factors.
Lifestyle Factors That Support Both Testosterone and Fertility
Whether you’re on TRT or not, there are numerous lifestyle modifications that can help you optimize your natural hormone levels and fertility.
First, regular exercise, especially weight training, can help to slightly elevate testosterone levels while fighting against the weight gain that’s common in men with low testosterone.
Working on your sleep hygiene can also make a slight difference in your testosterone levels as adequate sleep (7 to 9 hours) is necessary for proper testosterone production.
Your diet also plays a major role in testosterone production since what you eat provides the building blocks for all your hormones. Focus on lean proteins, whole foods, and leafy vegetables. You’ll also want to eat plenty of healthy fats.
You should also avoid excessive alcohol consumption and quit smoking if applicable.
If You Have Low T but Want to Preserve Your Fertility, We Can Help
Remember that treating low testosterone and maintaining fertility isn't always an either/or situation—there are plenty of ways to allow you to have the family you want to have without suffering from the debilitating symptoms of low T.
If you suspect that you may have a hormone imbalance, your next step is to get your hormone levels tested.
Learn more about TRT here. You can also schedule an appointment with a specialist today to discuss getting your levels tested.