Testosterone replacement therapy (TRT) is sometimes prescribed for those with low testosterone levels. However, like most medications and treatments, there are some things to consider before starting.
Read on to learn more about TRT, how it affects your body, and how it can affect your fertility.
What is Testosterone Replacement Therapy (TRT)?
Testosterone replacement therapy is a treatment for low testosterone, also known as male hypogonadism.
Testosterone is a sex hormone that is present in both men and women. Testosterone is produced in the testicles in men and in the ovaries in women. Men typically have more testosterone than women.
In men, testosterone is important for sexual function, including sperm production, fertility, libido, and more. It is also important for other bodily processes, like healthy bone and muscle mass and normal mood and cognition.
TRT increases the levels of testosterone in your blood using upplemental testosterone. Raising testosterone levels in the blood can help to bring levels within a normal range, which can help alleviate symptoms of low testosterone and improve quality of life.
How is TRT Administered?
There are several different ways to take testosterone. Each has benefits and drawbacks that you can weigh according to your own personal preferences. Dosage can affect the outcome and side effects of each method, and dosage will vary by person.
- Injection: The benefit of testosterone injections is that they can be given every few weeks or months, so you don’t have to think about them daily. Injections are also usually cheaper than other forms of TRT. However, the downside is that testosterone injections have a higher chance of side effects. In addition, it is a bit more complicated to change the dose of testosterone administered by injection, since it is only given once every few months.
- Patch: The benefit of a testosterone patch is that it is painless and delivers testosterone continuously for 24 hours. However, it does need to be applied daily and can cause some skin irritation.
- Implant: Testosterone implants involve implanting very small testosterone pellets under the skin. The benefit of testosterone implants is that the implanted pellets last for 3-6 months, so you don’t have to think about them daily. However, the process of implanting testosterone pellets under the skin is unappealing to some, and comes with a very slight chance of infection. In addition, like an injection, it is a bit more complicated to change the dose of testosterone administered by implant, since it is only given once every few months.
- Gel: Testosterone gel is applied daily to the body, typically on the shoulders, stomach, or upper arm. The benefits are that it is easy to apply by yourself, easy to change dosage, and less likely to cause skin irritation than when using a patch. However, it is important to be careful that the gel doesn’t come in contact with other people or animals, as the gel can rub from skin to skin when not fully absorbed.
- Nasal gel: Nasal gel is a newer form of TRT that involves squirting a gel into your nostrils a few times per day. The benefit is that it can be self administered and the dose can be easily changed, but it can be messy and hard to remember to take multiple times per day.
- Buccal system: For this type of TRT, a patch containing testosterone is placed between your gums and cheek. The patch will stick to the inside of your gum and your body will slowly absorb the testosterone. This method may support better absorption, but it can be difficult to manage since it requires keeping a tablet in your mouth all day.
- Oral tablet or capsule: Certain oral testosterone was approved by the FDA in 2019 for men with low testosterone specifically related to certain medical conditions. Oral testosterone comes with the risk of liver damage, so the other methods of TRT listed here are recommended for most men.
The Effects of TRT on Male Reproductive Health
TRT can treat and alleviate symptoms of low testosterone levels, such as fatigue and decreased libido. It can improve the quality of life for many men.
However, TRT doesn’t come without a cost. TRT can have negative effects on male reproductive health, affecting sperm production and quality, which in turn can impact fertility.
How TRT Affects Sperm Count and Quality
Research has explored the impact of TRT on sperm count and quality. While some studies have found no significant changes in these parameters, others have reported decreased sperm count and quality in men undergoing TRT.
It is believed that testosterone replacement therapy can negatively affect the hypothalamic-pituitary gonadal axis and inhibit the production of follicle stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH are commonly associated with female fertility, but they are also important for sperm production in men.
How TRT Impacts on Testicular Function
TRT may cause testicular atrophy, a shrinking of the testes due to decreased gonadotropin hormone production. One study measured the effect of testicular atrophy and found that testicular volume decreased over time, from a mean of 16.5 ml before treatment to 13.7 ml after 24 months of treatment. In the study, testicular atrophy became significant beginning at 6 months of TRT.
Is the Effect of TRT on Male Fertility Reversible?
The effect on sperm count and quality from TRT varies by dosage and duration. TRT is not likely to permanently affect fertility. Research shows that sperm production typically recovered within one to two years after TRT was discontinued. Another study found that older age and longer testosterone use significantly reduced the likelihood of recovery of sperm in the ejaculate within 12 months.
Return to normal fertility isn’t guaranteed, so it is important to know the potential risks to fertility that come with TRT.
Tips for Getting Pregnant after TRT
We know that taking TRT can decrease sperm count, but for most otherwise healthy men, the effects can be reversed after one to two years of discontinuing TRT.
During and after TRT, you can work to preserve fertility by maintaining a healthy lifestyle. This includes maintaining a healthy diet, avoiding or limiting alcohol and caffeine, avoiding tobacco or other drugs, exercising regularly, managing stress, and limiting toxins. Targeted supplementation can also support sperm quality.
If you have been off of TRT for one to two years and still having trouble conceiving, it is worth working with a reproductive endocrinologist for an evaluation of both you and your partner.
