Quick Answer
Can testosterone therapy affect fertility? Yes. Testosterone therapy can lower sperm production, sometimes to very low levels, because it signals the brain to reduce the hormones the testicles need to make sperm. The effect is often reversible after stopping, but recovery can take months and is not guaranteed. Men who want children now or in the future should discuss fertility before starting treatment.
Who this is for: men who are considering testosterone therapy, already using it, or planning to have children in the future.
How Testosterone Therapy Affects Sperm Production
Sperm production depends on a hormone feedback system between the brain and the testicles. The pituitary gland releases two hormones, LH and FSH. LH signals the testicles to make testosterone, and FSH, together with testosterone made inside the testicles, supports sperm production.
When testosterone is given from outside the body, as an injection, gel, pellet or patch, the brain senses that testosterone levels are high and reduces its release of LH and FSH. Blood testosterone levels may look good, but testosterone levels inside the testicles drop, and sperm production slows. In some men, sperm counts fall to very low levels or to zero.[1][2]
For this reason, testosterone therapy is not a form of birth control, but it is also not recommended for men who are actively trying to conceive.[2]
Outside testosterone can signal the brain to reduce the hormones that support sperm production.
Is the Effect Reversible?
For many men, sperm production recovers after testosterone therapy is stopped. Recovery often takes several months and can take longer than a year, and the timeline varies from person to person. Factors such as age, how long testosterone was used, the dose and baseline fertility can all affect recovery. In some men, sperm production may not fully return.
Because recovery is not guaranteed, it is important to talk about family plans before starting testosterone, rather than after.
Options for Men Who Want to Preserve Fertility
If you have symptoms of low testosterone and want to keep your fertility, there are options to discuss with your provider:[2]
- Medications that support your own production. Some medications can encourage the body to make more of its own testosterone without shutting down sperm production. These are prescribed off-label for this purpose and are not right for everyone.
- Sperm banking. Freezing sperm before starting testosterone can provide an option for the future.
- Semen analysis. Checking sperm count before or during treatment can help guide decisions.
- Referral to a fertility specialist. A urologist or reproductive specialist can help if you are planning a pregnancy soon or have concerns about your fertility.
What to Discuss Before Starting Testosterone
Before starting therapy, it helps to talk through:
- Whether you want children, and when
- Your current fertility, including any past fertility concerns
- Whether your low testosterone has been confirmed with repeated morning testing
- Other possible causes of your symptoms, such as sleep, weight, thyroid or medications
- How treatment will be monitored over time
These conversations help make sure the treatment fits your health and your life plans.
How We Discuss Fertility and Testosterone at Lake Forest Regenesis
Family planning is part of every testosterone conversation with Allana. Before treatment is considered, she confirms low testosterone with appropriate labs, reviews your symptoms and history, and asks about your plans for children. If preserving fertility matters to you, she will discuss options that may protect it and coordinate with or refer to a urologist or fertility specialist when that is the right next step.
When to See a Provider
Talk with a provider before starting testosterone if you might want children. If you are already on testosterone and you and your partner are trying to conceive, do not stop or change medication on your own; schedule a visit to plan next steps. Seek care promptly for testicular pain or a lump, breast swelling, or signs of a blood clot such as leg swelling and pain or sudden shortness of breath.
Considering testosterone and may want children? Talk through your family plans and options with Allana before starting treatment.
Frequently Asked Questions
Can I use testosterone therapy as birth control?
No. Testosterone can lower sperm counts, but it does not reliably prevent pregnancy and should not be used as contraception.
How long after stopping testosterone does fertility return?
It varies. Many men see recovery within several months to a year, but some take longer, and recovery is not guaranteed for everyone.
Does testosterone therapy shrink the testicles?
It can. Because testosterone therapy reduces the signals that stimulate the testicles, some men notice a decrease in testicle size during treatment.
Should I freeze sperm before starting testosterone?
If there is any chance you will want children in the future, sperm banking is worth considering and discussing with your provider.
References
- American Urological Association. Evaluation and management of testosterone deficiency: AUA guideline (2018, amended 2024). Read the guideline
- Bhasin S, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. Read the guideline
This article is for general education and is not a substitute for individual medical advice. See our medical disclaimer.
