Testosterone therapy (TRT) has helped many men improve energy, mood, strength, and overall quality of life. But one question comes up more than almost any other before starting treatment: Will TRT affect fertility?
It’s an important question—and the answer depends on what you mean by “infertile,” how long you’re on therapy, and whether fertility preservation is part of your plan.
In this article, we’ll explain how testosterone affects fertility, what happens to sperm production on TRT, and what options may be available if you want to maintain fertility while optimizing testosterone.
How Testosterone Can Impact Fertility
Testosterone therapy can reduce fertility by lowering sperm production.
TRT can signal your body to stop producing as much of its own testosterone, which can lead to decreased sperm count and, in some cases, temporary infertility while on treatment.
For many men, fertility can recover after stopping TRT, but recovery time varies and isn’t guaranteed for everyone. If having children is a goal, it’s important to discuss fertility-preserving options with your healthcare provider before starting a TRT plan.
Why Testosterone Therapy Can Affect Fertility
Your body doesn’t just “make testosterone.” It follows a hormone communication pathway between your brain and your testes that controls both testosterone production and sperm production.
When you start TRT, you’re introducing testosterone from an outside source. That can cause your brain to reduce the signals that normally tell your testes to produce testosterone and sperm.
As those signals drop, the testes may produce:
- Less natural testosterone
- Less sperm
That’s why TRT can significantly impact fertility even if it improves symptoms like energy and libido.
Does TRT Always Cause Infertility?
Not necessarily—but it can.
Some men on TRT experience:
- A noticeable drop in sperm count
- Very low sperm count
- No sperm present in semen (in more severe cases)
Others may still produce sperm, but at a reduced level that can make conception more difficult.
The impact can depend on factors like:
- Your baseline fertility before TRT
- Dose and duration of therapy
- Individual hormone response
- Age and overall health
The key point: TRT should be treated as a potential fertility risk unless proven otherwise with testing.
Can You Take Testosterone and Still Have Kids?
In some cases, yes—but it requires the right strategy and medical guidance.
If you want to optimize testosterone while preserving fertility, your provider may discuss options designed to support natural signaling and sperm production. The right approach depends on your goals, timeline, and lab results.
This is one of the most important conversations to have before starting TRT—not after.
Final Thoughts
If you’re considering testosterone therapy but want to protect your ability to have children, we can help you understand your options and make a plan that aligns with your goals.
Our team can review your symptoms, discuss lab work, and help you understand what your results actually mean so you can make informed decisions about your health.
Book a confidential, complimentary consultation with Evolve. Our team is here to answer your questions and support your health journey every step of the way.
Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a licensed healthcare provider before starting, stopping, or adjusting any hormone therapy.
