Is Testosterone Therapy Harming Your Chances of Conceiving?
Did you know testosterone is considered a contraceptive and is not advised if you’re TTCing?
Here’s something else that might surprise you: more testosterone doesn't always mean more sperm. In fact, it’s often the opposite. A lot of men assume that boosting testosterone, whether through medication or supplements will improve fertility. But the truth is, when testosterone comes from outside the body, it can actually shut down sperm production completely.
Why? Because sperm needs locally made testosterone - right inside the testicles, to be created. The body’s natural system is finely tuned, and when that balance is disrupted, fertility can take a hit. In this blog, we’re breaking down exactly how this works, why it matters, and what men need to know before starting testosterone therapy while trying to conceive.
Ladies, if you’re deep into your fertility journey, this post might be one to gently share with your partner, or at the very least, read together. There’s something happening that not many people are talking about: more and more men are using testosterone therapy, and while it might help with energy, muscle mass, and mood… it can also quietly sabotage your chances of getting pregnant.
Let’s break it down, because knowledge is power, and this one’s important.
Testosterone Therapy: Why It’s On the Rise
You’ve probably seen the ads. “Low T” clinics are popping up everywhere, and online companies make it almost too easy to get a prescription for testosterone. Men in their 30s and 40s are signing up in record numbers, some with clinical symptoms, and others simply chasing energy, drive, and performance.
In fact, testosterone prescriptions in younger men (ages 18 - 45) quadrupled between 2003 and 2013, and that trend hasn’t slowed down. One recent report found that over a quarter of men on testosterone therapy today are under 45.
But here’s the thing: even though testosterone can help with certain symptoms, it comes with a hidden cost if you're trying to grow your family.
How TRT Impacts Sperm (and Fertility)
Here’s the short version: when you take testosterone from outside the body, it can tell your brain to stop making its own. Sounds simple enough - but the ripple effect is huge.
The brain normally produces signals (via LH and FSH) to keep sperm production running smoothly. When testosterone is added into the mix, the brain thinks, “We’ve got plenty,” and shuts down those signals. That can mean a sharp drop in sperm count - sometimes even zero. One review explains how testosterone therapy suppresses intra-testicular testosterone, leading to decreased spermatogenesis and testicular atrophy (shrinking). It notes that TRT can cause azoospermia in up to 65% of men within 4 months, but sperm production typically recovers after stopping therapy, although it may take up to 2 years in some cases.
Yes - 2 years!
And unfortunately, a lot of men don’t find this out until much later, often when they’ve been trying to conceive for a while and finally get a semen analysis.
Here’s What You Can Do
If your partner is taking or considering TRT and you’re on a fertility journey (or planning to start one), here are three smart steps:
1. Test Before Starting
Ask for a semen analysis before starting any testosterone treatment. This gives you a baseline - so you know what you’re working with. If sperm count is already low, TRT could make it worse. Test at home with Legacy (this is the only at home sperm testing kit that includes DNA. fragmentation too). Use my code TRACYDONEGAN and get 10% off.
Legacy At Home Sperm Test
2. Know There Are Alternatives
Not every low testosterone case needs a prescription. In some situations, there are some medications that can help the body boost testosterone naturally, without shutting down sperm production. (This is a great convo to have with a fertility-savvy doctor.)
3. Keep Testing
Already on TRT? A semen analysis can still give you the clarity you need. If fertility is a priority, it’s never too late to check in and adjust the plan.
If you're already overwhelmed with supplements, protocols, and tracking apps, I get it, this might feel like one more thing to think about. But this is one of those rare situations where a simple test can save you months (even years) of heartbreak and confusion.
So, if you’re working hard to support your fertility, and your partner is too, this is one conversation that could make all the difference.
Before I work with someone in my clinic I’ll always insist on having baseline test results so we can measure the improvements from red light therapy - otherwise we’re just guessing. (Find my top recommended home red light therapy devices here)
4. Red Light Therapy & Sperm Health
There’s no studies on this but given the mechanism of action of PBM it might be worthwhile exploring - especially if you’re using a home device yourself. Research suggests that PBM can stimulate mitochondrial activity, reduce oxidative stress, and improve blood flow to the testes, all of which are critical for healthy sperm production. While PBM won’t reverse the hormonal suppression caused by testosterone therapy on its own, it may help optimize the testicular environment as your partner transitions off TRT under medical supervision. Think of it as a gentle, non-invasive way to support recovery, enhance cellular function, and stack the odds in your favor while you both work to restore natural fertility.
Tracy
Additional Reading
