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Millions of men in the United States use testosterone replacement therapy (TRT) to treat low testosterone (Low T). With the rise in testosterone supplement use, fertility doctors are warning men who would like to have children in the future to reconsider starting TRT.
The pituitary gland produces follicle stimulating hormone (FSH) and luteinizing hormone (LH). LH stimulates the testes to release testosterone. When in balance, testosterone works with follicle stimulating hormone (FSH) to help generate sperm.
Men suffering from low testosterone may experience fatigue and low libido. As a result, TRT has been on the rise, with men of all ages using testosterone supplements. However, fertility doctors are seeing many of these men as their testosterone supplements may be causing azoospermia (no sperm in their ejaculates).
The pituitary gland uses testosterone levels in the blood to determine how much FSH and LH to release for both testosterone and sperm production. When a man is given exogenous testosterone (much like when a woman takes birth control pills), their hypothalamus and pituitary believe the testis is already working and FSH and LH secretion are suppressed, leading to less production of testosterone in their own testes and reduced or failed sperm production (much like a woman does not release eggs while taking birth control pills).
If you wish to have children in the future but are suffering from low testosterone, consider foregoing treatment or alternative treatment options. Low testosterone does not necessarily mean low sperm count. Your fertility doctor can conduct a sperm analysis if you and your partner are having difficulty conceiving.
To treat low testosterone without supplements, you may take an HCG supplement, which will increase your testosterone levels without negatively impacting FSH levels or sperm production. You may also decide to freeze sperm prior to starting TRT to preserve the ability to have biological children.
If you are already taking testosterone supplements and are still wanting biological children, your fertility doctor will likely recommend you cease taking testosterone. Studies have shown that sperm production will increase in most men after discontinuing supplements, although it typically takes 6 months or longer to resolve (up to 12 months has even been reported). Do not stop taking any medication without checking with your doctor first.
While the majority of men do not have permanent effects, a small percentage of men still had low sperm production after stopping testosterone. More studies and tests need to be conducted to determine whether or not testosterone supplements led to permanent sperm production issues.
For men suffering from low testosterone who would like the opportunity to have children, avoid TRT and work with your fertility doctor if you have challenges conceiving.
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