Testosterone and male fertility are closely connected, but the relationship can be confusing. Testosterone plays an important role in male reproductive health and is necessary for normal sperm production. However, testosterone replacement therapy can actually lower or stop sperm production in some men.
This is especially important for men with low testosterone who are trying to have a child. If you are experiencing symptoms of low testosterone while trying to conceive, talk with a fertility specialist before starting testosterone replacement therapy.
Is Testosterone Important for Sperm Production?
Yes. Testosterone is essential for normal sperm production, but having a normal testosterone level in your bloodstream does not necessarily mean that sperm production is normal.
Sperm production is controlled by a complex hormonal system involving the brain, pituitary gland and testicles. The pituitary gland produces hormones called luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which signal the testicles to produce testosterone and sperm.
The testicles need a much higher concentration of testosterone than what is typically measured in the bloodstream to support sperm production. This means that both testosterone and the hormones that stimulate the testicles are important for fertility.
Can Low Testosterone Cause Infertility?
Low testosterone and infertility can occur together, but low testosterone does not automatically mean that a man is infertile.
Certain hormonal conditions can affect both testosterone levels and sperm production. Problems involving the brain or pituitary gland, for example, can interfere with the signals that tell the testicles to produce testosterone and sperm.
Male infertility also has many other possible causes. A fertility evaluation may include a semen analysis, hormone testing, a physical examination and a review of your medical and reproductive history.
Can Testosterone Replacement Therapy Cause Infertility?
Yes. Testosterone replacement therapy can significantly reduce sperm production and, in some men, cause sperm production to stop altogether.
This includes testosterone injections, pellets, gels and oral testosterone pills. Some over-the-counter supplements marketed for testosterone enhancement may also contain hormones or other ingredients that can negatively affect sperm production.
The key difference is between testosterone produced naturally by the testicles and testosterone taken from an outside source.
When testosterone is taken as a medication, the brain senses the increased testosterone and can reduce the hormonal signals that stimulate the testicles. As LH and FSH levels decrease, the testicles receive less stimulation. Testosterone levels inside the testicles can then fall, even though the amount of testosterone in the bloodstream increases.
This can cause sperm production to decrease significantly or stop completely. When no sperm are present in the semen, the condition is called azoospermia.
Can I Take Testosterone If I Am Trying to Have a Baby?
If you are trying to conceive, or may want children in the future, tell your doctor before starting testosterone therapy.
Men with low testosterone and fertility concerns may have other treatment options.Certain medications can help the body produce more of its own testosterone without the same risk of reducing sperm production as testosterone replacement therapy. These may include:
- Clomid (clomiphene citrate): A commonly prescribed medication called a selective estrogen receptor modulator (SERM) that helps stimulate the testicles to produce more testosterone and sperm.
- Human chorionic gonadotropin (hCG): A medication that works like one of the body’s natural hormones to help the testicles produce more testosterone while supporting sperm production.
- Anastrozole: A medication called an aromatase inhibitor that helps increase testosterone levels by reducing the amount of testosterone the body converts into estrogen.
Unlike traditional testosterone replacement therapy, these medications typically do not suppress sperm production and may help men maintain their fertility while addressing low testosterone.
However, not every treatment is right for every patient. A fertility specialist can evaluate your hormone levels, sperm production and family planning goals to help determine the best approach for you.
What If I Am Already Taking Testosterone and Want to Have Children?
If you are already taking testosterone replacement therapy and want to have children, talk with a doctor who specializes in male fertility before making changes to your treatment.
Sperm production may return after testosterone is stopped, but recovery is not always immediate. Some men may see sperm production return within several months, while others may need additional treatment or more time.
A fertility specialist can evaluate your hormone levels and semen analysis and help determine what may be affecting your sperm production.
How Are Testosterone and Fertility Evaluated?
If you are concerned about both testosterone and fertility, your doctor will look at more than your testosterone level.
Your evaluation may include:
- Semen analysis to evaluate sperm count and other characteristics
- Testosterone testing to determine whether your testosterone levels are consistently low
- FSH and LH testing to evaluate the hormones involved in sperm production
- Medical and reproductive history
- Physical examination
- Additional testing when needed
The goal is to determine why your testosterone may be low and whether it is affecting sperm production. This information can help your doctor recommend treatment that aligns with your fertility goals.
What Should I Do If I Have Low Testosterone and Want Children?
If you have symptoms of low testosterone and are trying to have a baby, don’t start testosterone replacement therapy without first discussing your fertility plans with a doctor.
Symptoms such as decreased sex drive, fatigue, reduced muscle mass and erectile difficulties can have several possible causes. Likewise, difficulty conceiving can result from many different factors.
A comprehensive evaluation can help identify the cause and determine which treatment options may support both your health and fertility goals.
Expert Male Fertility Care in Memphis
At Conrad Pearson Clinic, Dr. Michael Granieri is an expert in male fertility and the only fellowship-trained specialist in male reproductive medicine in the Memphis region. His advanced training and focused expertise allow him to provide highly specialized evaluation and treatment for men facing infertility, low testosterone and other complex reproductive health concerns.
If you are concerned about testosterone levels and fertility, a specialized evaluation can help identify the underlying cause and determine treatment options that align with your fertility goals.
