Testosterone Therapy and Fertility: What You Need to Know Before You Start

Testosterone therapy is everywhere right now. Ads promise more energy, better focus, stronger workouts, and a revived sense of self. And for some men, medically appropriate testosterone treatment can be life-changing.

But there’s an important piece of the conversation that often gets left out:

Supplemental testosterone can significantly impact fertility.

If whole-body health matters to you, reproductive health has to be part of that picture.

TL;DR

Taking supplemental testosterone can suppress sperm production and, in some cases, lead to low or absent sperm counts. If you’re considering testosterone therapy and may want children now or in the future, it’s essential to talk with a fertility-trained specialist first. Whole-body health includes reproductive health, and there are ways to support hormones without compromising fertility.

How Testosterone Therapy Affects Fertility

Your body already produces testosterone through a finely tuned feedback loop between the brain and the testicles. When you introduce external testosterone, your brain senses there’s “enough” hormone and sends a signal to shut down its own production. That shutdown includes the signals required to make sperm.

As a result, men taking supplemental testosterone may experience:

• Reduced sperm count
• Poor sperm quality
• Complete absence of sperm (azoospermia)
• Testicular shrinkage
• Difficulty conceiving, even if libido and energy improve

This can happen whether testosterone is taken as injections, gels, pellets, or patches.

Why This Often Comes as a Surprise

Many men are prescribed testosterone without a full discussion about fertility implications. Others start therapy through wellness clinics or online services that focus on symptoms, not long-term reproductive goals. The problem isn’t testosterone itself, the problem is treating hormones in isolation.

Your reproductive system is not separate from the rest of your health. It’s deeply connected to metabolism, sleep, stress, inflammation, and overall vitality.

Fertility-Aware Alternatives May Be Available

If testosterone levels are low and symptoms are affecting quality of life, there may be options that support hormone balance while preserving sperm production, depending on your diagnosis and goals. This is where seeing a fertility-trained urologist matters.

A specialist can help determine:

• Whether testosterone therapy is appropriate
• What the underlying cause of low testosterone may be
• Whether fertility-preserving treatments could be an option
• How to safely transition off testosterone if fertility is a priority

Whole-Body Health Must Include Reproductive Health

Feeling better shouldn’t come at the cost of future family-building options. True whole-body health considers:

• Hormones
• Energy and mood
• Sexual health
• Fertility and reproductive potential
• Long-term goals, not just short-term symptom relief

When reproductive health is included in the conversation, patients are empowered to make informed decisions instead of reactive ones.

FAQs About Testosterone and Fertility

Can testosterone therapy cause infertility?

Yes. Supplemental testosterone commonly suppresses sperm production and can lead to temporary or prolonged infertility.

Is the fertility impact reversible?

In many cases, sperm production can recover after stopping testosterone, but recovery is not guaranteed and can take months to over a year. Individual outcomes vary.

Does this happen with all forms of testosterone?

Yes. Injections, gels, pellets, and patches can all suppress the body’s natural sperm-producing signals.

What if I want to feel better but still have children?

That’s exactly the conversation to have with a fertility-trained urologist. There may be treatment paths that support hormones while protecting fertility, depending on your situation.

Should I get a semen analysis before starting testosterone?

If future fertility matters to you, yes. Baseline testing provides critical information before any hormone therapy begins.

When to See a Specialist

If you are:

• Considering testosterone therapy
• Currently on testosterone and thinking about fertility
• Experiencing low energy, libido, or mood changes
• Planning for future family building

…it’s time for a deeper, more informed conversation.

Take the Next Step

At Reproductive Partners Medical Group, we believe whole-body health includes reproductive health. Our fellowship-trained urologist, Dr. James Weinberger, specializes in male fertility and hormone health, helping patients balance how they feel today with what they may want tomorrow.

Book an appointment to discuss your hormone health, fertility goals, and personalized care options.

Your health is not one-dimensional. Your care shouldn’t be either.