Does Taking Testosterone Make You Infertile?

Testosterone is often linked with muscle growth, athletic performance, and male health. It’s a hormone that plays a critical role in a variety of bodily functions, but there’s a common question that many people ask: Does taking testosterone make you infertile? Whether you’re using testosterone for a medical condition, to improve athletic performance, or as part of a gender-affirming treatment, understanding how this hormone affects fertility is important. Let’s break it down.

What Is Testosterone?

Testosterone is the primary male sex hormone, but women also produce it, albeit in smaller amounts. In men, testosterone is responsible for the development of male physical traits, such as muscle mass, deep voice, and facial hair. It also regulates sexual function, bone density, and red blood cell production.

In women, testosterone helps with mood regulation, sexual drive, and bone health. Though the body’s production of testosterone differs between the sexes, the hormone is essential for both genders in different ways.

How Does Testosterone Affect Fertility?

Testosterone is important for sperm production, but too much of it—especially from external sources like supplements or injections—can interfere with natural hormone regulation. This is where things get tricky.

1. Sperm Production and the Hypothalamus-Pituitary-Gonadal Axis

The body’s hormone production system is finely tuned. The hypothalamus and pituitary gland control the release of hormones like luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which trigger the production of sperm in men. When external testosterone is introduced into the body, it can disrupt this delicate system. “Taking testosterone can lower your body’s natural production of LH and FSH,” explains Dr. Emily Stone, a reproductive endocrinologist. “This essentially signals to the body that it doesn’t need to make as much testosterone or sperm.”

Because testosterone from external sources raises the body’s testosterone levels, the pituitary gland might stop releasing LH and FSH. As a result, sperm production slows down or stops altogether, leading to infertility. This is why men who take testosterone, especially in high doses or for prolonged periods, might experience a temporary drop in sperm count or even complete azoospermia (the absence of sperm in semen).

2. Testosterone and the Shrinking of Testicles

Excessive testosterone use can also lead to a reduction in the size of the testicles. This happens because the body starts relying on the external testosterone instead of producing it naturally. “When the testes sense that the body has plenty of testosterone, they shrink because they’re no longer needed to make more of the hormone,” says Dr. Michael Lawson, a urologist. The shrinking of the testicles can sometimes cause a decline in sperm production, further contributing to infertility.

3. Temporary vs. Permanent Effects

One of the biggest concerns people have is whether the infertility caused by testosterone is permanent. The good news is that, in many cases, the effects are reversible. When someone stops taking testosterone, sperm production often returns over time. However, the recovery process can take months or even years. Some individuals may require medical treatments like human chorionic gonadotropin (hCG) therapy, which stimulates the testes to begin producing sperm again. “The majority of men who stop testosterone treatment will see their sperm count recover,” notes Dr. Stone. “But in some cases, it can take a long time for fertility to return, and in rare cases, the effects can be permanent.”

Who Should Be Concerned About Testosterone and Fertility?

1. Men Using Testosterone for Low T (Testosterone Therapy)

Testosterone replacement therapy is common for men diagnosed with low testosterone (Low T). While testosterone therapy can help with symptoms like low libido, fatigue, and muscle loss, men who wish to have children should consider the potential effects on fertility. Before starting testosterone therapy, it’s important to have a discussion with your doctor about your fertility goals.

2. Athletes and Bodybuilders Using Testosterone Supplements

Athletes and bodybuilders often use testosterone or anabolic steroids to enhance performance and muscle growth. These substances can raise testosterone levels well above normal, which increases the risk of infertility. If you’re planning on using testosterone for performance reasons, it’s important to weigh the potential long-term consequences on fertility.

3. Transgender Men Undergoing Hormone Therapy

For transgender men who are undergoing hormone replacement therapy (HRT), testosterone is a key part of the process. While testosterone therapy can induce the development of male characteristics such as a deeper voice and facial hair, it can also reduce the chances of pregnancy. However, many transgender men can still conceive if they haven’t been on testosterone for long or if they choose to stop therapy temporarily. This is an important discussion to have with a knowledgeable healthcare provider.

What Are the Treatment Options for Testosterone-Induced Infertility?

If you have been using testosterone and are concerned about your fertility, there are options available for you:

1. Stopping Testosterone: The most straightforward way to restore fertility is to stop taking testosterone. Once you stop, your body may begin producing sperm again. However, this may take time, and you should work closely with a fertility expert to monitor progress.
2. Sperm Banking: If you’re planning to take testosterone but still want to preserve your fertility, sperm banking is a proactive option. By freezing sperm before starting testosterone therapy, you ensure that you have viable sperm available for future use, whether through artificial insemination or in vitro fertilization (IVF).
3. Fertility Treatments: For men who have used testosterone and are struggling with infertility, treatments such as hCG therapy, which stimulates the testes to produce sperm, may help. In some cases, assisted reproductive technologies like IVF with sperm retrieval can be used.
4. Monitoring: If you’re on testosterone therapy but want to have children later, your doctor might suggest regular sperm tests to monitor your sperm count. This way, you can make informed decisions about your fertility.

Key Takeaways

Taking testosterone can affect your fertility by lowering sperm production and, in some cases, causing testicular shrinkage. This happens because testosterone therapy disrupts the natural hormonal balance that regulates sperm production. While the effects are often temporary, they can be serious enough to delay or prevent pregnancy.

Before starting testosterone therapy, talk with your doctor about your fertility goals. If you’re already using testosterone and are concerned about your fertility, there are steps you can take to preserve or restore it, such as stopping testosterone use, banking sperm, or pursuing fertility treatments.

Ultimately, it’s important to make informed choices. “Men should think carefully about their fertility and their future family plans before starting testosterone treatment,” advises Dr. Lawson. Understanding how testosterone impacts your body is the first step toward managing your health and making the best decisions for your reproductive future.