When exogenous testosterone enters the body, the brain perceives adequate circulating androgens and shuts down the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary gland.
Because FSH and intratesticular testosterone driven by LH are essential for spermatogenesis, TRT typically causes a marked drop in sperm count, often leading to azoospermia (absence of sperm) within several months.
For men with hypogonadal symptoms who wish to preserve fertility, alternative approaches—such as human chorionic gonadotropin (hCG), selective estrogen receptor modulators (like clomiphene), or lifestyle optimization—are commonly evaluated instead.
Risks and limitations
- While spermatogenesis often recovers after stopping TRT, recovery is not guaranteed and can take several months to over a year.
- Testosterone therapy should never be used as a male contraceptive, despite its suppressive effect on sperm production.