Testosterone Replacement Therapy (TRT) is a treatment to restore testosterone levels for men with hypogonadism (low testosterone levels). The TRT treatment boosts the testosterone level in men addressing issues such as decreased energy, libido, and muscle mass. Although it helps men both physically and mentally, it has some serious impacts on fertility. Here is a detailed outlook on how TRT affects male fertility.
How does TRT affect male fertility?
TRT’s Impact on Natural Testosterone and Sperm Production
Yes, Testosterone Replacement Therapy (TRT) can potentially affect fertility in men. The addition of external testosterone in the bloodstream, cuts the production of natural testosterone in the body, by signalling the testicles. When natural testosterone production gets cut off, it would stop the production of sperm.
How does TRT suppress the HPG Axis (Hypothalamic-Pituitary-Gonadal Axis)?
Injecting testosterone into the bloodstream will send a signal to the brain to suppress the hypothalamic-pituitary-gonadal (HPG) axis by sending a negative feedback mechanism. The HPG axis plays a major role in controlling development, reproduction and ageing. Suppression of the HPG axis shuts down the production of testosterone and sperm, resulting in low sperm count and even infertility.
Can TRT Cause Temporary or Permanent Infertility?
Men who undergo TRT experience low sperm count in the semen, resulting in temporary infertility. Some studies found that stopping TRT could restore sperm production and fertility, however, it all depends on the recovery time and the ability of testicles to regenerate the natural testosterone and sperm.
Signs of Infertility Due to TRT
Symptoms of Reduced Sperm Count and Hormonal Imbalance
Some of the regular symptoms of reduced sperm and hormonal imbalance caused by Testosterone Replacement Therapy include:
- Sleep Apnea- serious sleep disorder with irregular breathing.
- Acne & other skin allergies.
- Stimulates non-cancerous growth of the prostate & increases existing prostate cancer.
- Enlargement of breasts.
- Shrinking of testicles.
- Low sperm production.
- Production of more Red Blood Cells.
- Internal blood clots.
How to monitor fertility while undergoing TRT?
Men taking TRT can monitor their fertility by regular checkups and semen analysis can help identify the fertility parameters and can treat it accordingly.
A semen analysis will look for the pH value, semen volume, sperm density, morphology, motility, liquefaction, vitality and white blood cells.
Treatment options to maintain or restore fertility while on TRT
Role of hCG and Clomid in preserving sperm production during TRT
Human Chorionic Gonadotropin (hCG)
Human Chorionic Gonadotropin (hCG) has a similar biological activity of Luteinizing Hormone (LH) which preserves or stimulates the testes to produce natural testosterone, which helps in maintaining the testicular function and sperm production.
Clomid
Clomid is a pill that binds the estrogen receptors and increases the release of LH and FSH from the pituitary gland. This stimulates the production of testosterone during the TRT and improves sperm generation, to remain fertile.
Recombinant FSH injections: FSH injections stimulate the seminiferous tubules and leydig cells in testis to produce sperms.
Sperm Banking as a Safeguard Option
Men who choose to undergo TRT can preserve their sperm in the sperm bank or cryopreservation. Where the semen is preserved by freezing the sperm cells to safeguard the fertility for later use.
Alternative Medications That Do Not Affect Fertility
Selective Estrogen Receptor Modulators (SERMs)
SERMs are hormone therapies that help to manage the estrogen levels in the pituitary gland and increase the production of the gonadotropin-releasing hormone and luteinizing hormone release, to stimulate endogenous testosterone production and increase the sperm count. Some examples of SERMS include:
- Clomiphene Citrate
- Tamoxifen
- Enclomiphene
- Raloxifene
How to reduce infertility risks before and during TRT?
Consult with a Healthcare Provider before starting TRT
Men with hypogonadism, before opting for Testosterone Replacement Therapy, discuss with your doctor or healthcare provider about the risks involved. If you are concerned with fertility or other medical concerns, discuss it with the healthcare provider about the treatment options accordingly. Take a couple of tests to measure your testosterone levels before starting the therapy, as T levels change day by day. If you don’t have the medical conditions to undergo TRT, your fertility doctor might recommend some natural ways to boost the T levels.
Adjusting TRT dosages and using adjunct medications to preserve fertility
To preserve fertility during TRT for men with hypogonadism, a semen analysis should be taken before the treatment. If the man plans for a future pregnancy, hCG should be prescribed alongside TRT to prevent testicular atrophy. FSH level and semen analysis should be conducted periodically to avoid negative effects. Adjusting the TRT and medication dosages can help preserve fertility under constant supervision.
Alternative treatments for low testosterone that do not affect fertility
Alternative treatments for low testosterone that do not affect fertility
- Regular exercising and lifting weights.
- Eating foods that are rich in protein, fat and carbs.
- Minimize the stress and hormone cortisol levels.
- Consume more Vitamin-D-rich foods.
- Intake supplements such as ginger, ashwagandha and saw palmetto that are rich in zinc.
- Have plenty of rest and high-quality sleep.
- Avoid chemicals that are rich in estrogen.
- Reduce the amount of alcohol intake.
Hormone-Balancing Therapies
SERMs
SERMs are used to decrease the function of estrogen receptors in the pituitary gland and increase the production of FSH and Leuitinizing Hormone. Some of the commonly used SERMs include:
- Clomiphene
- Tamoxifen
- Enclomiphene
- Raloxifene
Aromatase Inhibitors
Aromatase inhibitors are used to decrease estradiol and thereby increases the FSH production from the pituitary gland. Some of the commonly used Aromatase Inhibitors include:
- Anastrazole
- Letrozole
- Testolactone
- Exemestane
Conclusion
Testosterone Replacement Therapy (TRT) is one of the ways to boost the testosterone levels of men with hypogonadism. However, it negatively affects the fertility for a temporary period of time. Although it affects the fertility of men, treatments such as HCG and Clomid could help remain fertile during the TRT treatment. Although infertility conditions are recoverable, there is no guarantee. It is always advisable to discuss with your doctor or the healthcare provider about the TRT treatment before starting.
Frequently Asked Questions(FAQs)
No, TRT doesn’t usually result in permanent infertility, as certain treatment options are available to restore the infertility conditions during or after the therapy.
After stopping TRT, most of the men restore their fertility within a few months to a year. The recovery time depends on the length of TRT and the body’s ability to produce the natural testosterone.
One can freeze their sperm in the sperm bank and make use of it to have a child. On the other hand, using hCG and Clomid could also help preserve fertility and help have children.
Intaking TRT reduces the sperm count, however, using hCG and clomid medications could help remain fertile during the TRT process.
