Your future family should be part of your testosterone care from the start. TRT can suppress sperm production, so anyone considering treatment who wants children needs a plan that takes both hormone health and fertility into account.
Heracles brings together expertise in urology, andrology and male reproductive health. Our Clinical Lead, Peter Grice, coauthored a published review of hypogonadism treatment in men seeking to preserve fertility. Meet the team behind Heracles.
Yes. Testosterone supplied as a medicine reduces the hormonal signals that tell the testes to make testosterone and sperm. Sperm production can fall substantially or stop, even while the testosterone level in your bloodstream improves. This applies to prescribed testosterone, including gels and injections.
That is why fertility plans are discussed before a prescription. The Endocrine Society recommends against starting TRT when fertility is planned in the near term. Having low testosterone does not automatically mean testosterone replacement is the right treatment when you are trying to conceive.
It is possible: the degree of sperm suppression varies. Do not assume TRT makes you infertile or use it as contraception. Equally, a normal testosterone result, normal erections or normal-looking semen does not establish that sperm production is normal.
A semen analysis examines sperm, while a testosterone blood test assesses hormone levels. They answer different questions. NICE recommends a repeat semen test when the first result is abnormal; the wider assessment may include examination and hormone testing. Your partner’s reproductive health matters too.
Tell your clinician before starting treatment, even if having children is several years away. Explain whether you are trying now, have a future plan or are unsure. The decision needs to consider the cause of low testosterone, your symptoms and your reproductive goals together.
Ask whether a semen analysis or a fertility specialist assessment would be useful before treatment. A discussion may also include sperm freezing: the HFEA describes it as an option for people facing treatment that may affect fertility. Frozen sperm can be stored for future fertility treatment, although freezing does not guarantee a future pregnancy.
Read the HFEA explanation of sperm freezing for how the process works.
Arrange a review with your prescriber and explain that your fertility plans have changed. Share your current prescription, how long you have used it, previous hormone results and any semen tests. This gives the clinician the information needed to plan the next investigation or referral.
Sperm production often recovers after testosterone is stopped, but recovery can take months and sometimes longer. Some men do not fully recover their previous sperm production. The AUA/ASRM male infertility guideline explains why the timing cannot be promised for an individual.
Agree any change with your prescriber. Do not stop, change doses or add an online “post-cycle therapy” programme on your own.
It is not a guarantee. Treatment depends on why sperm production or testosterone is low. Gonadotrophins, including hCG, have a role in selected patients, particularly when the brain’s hormonal signals to the testes are deficient. That is a specific diagnosis called hypogonadotropic hypogonadism.
NICE recommends gonadotrophin treatment for that condition, while restricting gonadotrophin or anti-oestrogen therapy for impaired semen parameters without that diagnosis to clinical trials. Testosterone itself should not be used to treat semen abnormalities. A specialist decides which options fit the diagnosis; adding a medicine to a TRT plan does not by itself establish that fertility is preserved.
Heracles was co-founded by Professor Suks Minhas and Professor Tet Yap. Their expertise in urology, andrology and male reproductive health sits alongside Peter Grice’s published work on testosterone deficiency and fertility preservation.
Understand the people behind your care, then raise your fertility plans with the clinician responsible for your treatment. Explore the Heracles clinical team. For the broader treatment picture, read our UK TRT guide or our guide to male infertility treatment.
