Knowledge | Low Testosterone and Male Infertility: Replacement Therapy May Affect Fertility



Knowledge | Low Testosterone and Male Infertility: Replacement Therapy May Affect Fertility


Low Testosterone May Affect Fertility, and Replacement Therapy Requires Caution

Low testosterone (Low T) can reduce libido and cause erectile dysfunction (ED). Although testosterone replacement therapy (TRT) is widely used to restore libido, it may impair fertility in men who want children.


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Low Testosterone and Fertility

Testosterone is essential for sperm production. Michael Eisenberg, director of male reproductive medicine and surgery at Stanford Hospital, said TRT has profound effects on male reproductive potential. It has even been studied as contraception because sperm counts fall to nearly zero in 90% of men receiving testosterone.


The Feedback Mechanism

The brain releases gonadotropin-releasing hormone (GnRH), which signals the testes to produce testosterone and maintain a healthy sperm count. External testosterone raises blood levels, causing the brain to interpret that enough is present and stop signaling the testes. Natural testosterone and sperm production are then suppressed, lowering sperm count and making conception more difficult.


Conflict with Fertility Goals

Eisenberg said TRT is unsuitable for men with reproductive goals: “If you have any fertility goals, it is best not to use TRT.” Spyros Mezitis, an endocrinologist at Lenox Hill Hospital in New York, agreed that external testosterone suppresses natural sperm production and is unfavorable for conception.


Fertility Options for Low Testosterone

Men with low testosterone who want to increase sperm count may use gonadotropin injections to stimulate sperm production. When a couple has difficulty conceiving, sperm count is often checked first, followed by testosterone testing if the count is low. Gonadotropins may stimulate natural testosterone production and improve fertility.


“If you have low testosterone and want to improve fertility, consult a reproductive endocrinologist,” Mezitis added.


Benefits of a Healthy Lifestyle

Regular exercise and a balanced diet are also important. Men with obesity or excess weight often have lower testosterone because abdominal fat converts testosterone into estrogen. Weight loss can therefore support fertility.


Eisenberg said weight loss can improve testosterone levels. Although it is not easy, it is a good starting point for highly motivated men.


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