Testosterone Therapy and Your Fertility

Testosterone supplementation decreases sperm counts significantly and it can take months for levels to return to normal when a patient stops using supplemental testosterone.

The reason is a feedback loop. Your brain keeps track of the testosterone in your blood. When testosterone comes from outside the body, the brain reads the level as high enough and turns down the two signals, LH and FSH, that tell the testicles to work. Sperm production depends on those signals, and on testosterone made inside the testicle, which those signals drive. So a prescription can raise the level in your blood while the testicles make less testosterone of their own, and fewer sperm.

The AUA guideline is unambiguous: exogenous testosterone therapy should not be prescribed to men who are currently trying to conceive, and men with testosterone deficiency who are interested in fertility should have a reproductive health evaluation before treatment.

You are reading a page written and reviewed by David Robbins, MD, a board-certified urologist (Diplomate, American Board of Urology) who has practiced in Miami since 2009 at a practice serving South Florida for more than four decades.

Source: American Urological Association, Evaluation and Management of Testosterone Deficiency (2018; validity confirmed 2024).

If you may want children later, there are two ways to keep that door open before testosterone is started.

Bank sperm first. A semen analysis, then freezing (cryopreservation) of samples at a fertility laboratory, before the first dose. We can direct you to a fertility laboratory.

Choose a treatment that does not switch sperm production off. Some medicines raise the testosterone your own body makes instead of replacing it. They are described in the next section.

A urologist can also evaluate fertility itself — the semen analysis and the causes of male infertility are covered on our men’s health page.

Do not stop or change anything on your own. Make an appointment and bring what you are taking — including anything bought online or from a clinic — so we know exactly what it is and how long you have been on it.

A semen analysis and a hormone panel come first; how testosterone testing works is explained on the symptoms page. The usual path is stopping testosterone and, where appropriate, one of the treatments above. How and when that happens is something we plan with you, not a set of instructions on a web page. What is checked along the way is on the safety and follow-up page.