Testosterone is a naturally occurring sex hormone that is responsible for the development of male reproductive tissues and secondary sex characteristics. When prescribed medically, testosterone is used as a hormone replacement therapy for individuals with low testosterone levels or gender dysphoria.
While taking testosterone supplements or injections, most individuals will experience some level of reduced fertility and sperm production. This occurs because exogenous testosterone signals the testes to slow or stop producing its own natural testosterone and sperm.
However, the extent to which testosterone impacts fertility can vary significantly between individuals. Some people taking testosterone are able to maintain sperm production and remain fertile, while others experience a major reduction. There are a few key factors that influence one's ability to produce sperm while on testosterone:
- Dosage - The higher the dosage of testosterone, the more it will suppress natural production. Lower doses may allow some continued sperm production.
- Method of administration - Injections or implants that maintain consistently high testosterone levels in the bloodstream tend to have stronger suppressive effects than gels or creams that are absorbed more gradually.
- Individual response - Due to differences in metabolism and physiology, some individuals are more sensitive to the sperm-suppressing effects of testosterone than others. Age and baseline fertility levels also play a role.
- Duration of treatment - The longer someone has been taking testosterone, the more it will accumulate in the body and suppress the hypothalamic-pituitary-gonadal axis that controls natural hormone and sperm production.
Some steps that may help maintain fertility while on testosterone include:
- Talking with your doctor about lowering the testosterone dosage, changing to a gel/cream, or using another method if sperm production is a priority.
- Getting regular sperm analysis tests done to track fertility status.
- Using medications that stimulate sperm production, such as clomiphene citrate, human chorionic gonadotropin (hCG), or gonadotropin injections. These can help counteract testosterone's suppressive effects.
- Banking sperm prior to starting testosterone therapy, which gives the option for later use in surrogacy or in vitro fertilization.
It's important to note that even if sperm production continues, testosterone therapy can impact sperm health and function. Issues like reduced sperm count, motility, and abnormal morphology are common. This may require assisted reproductive techniques to achieve pregnancy.
For those looking to start a family while transitioning, it’s ideal to discuss fertility preservation options with both a hormone therapy specialist and a reproductive endocrinologist. Navigating both gender-affirming hormone treatment and attempting pregnancy require close management by experts.
At Hormone Harmony Clinic, our compassionate medical team specializes in transgender hormone therapy and fertility. We develop customized treatment plans that meet each patient's unique goals, whether that’s starting testosterone, preserving fertility, or anything in between. Our patients appreciate our collaborative approach and expertise in transgender health and assisted reproduction.
In summary, endogenous sperm production while taking testosterone is highly variable between individuals. Maintaining fertility while transitioning is possible, but requires careful monitoring and management of hormone levels, sperm health parameters, and any fertility interventions. Working closely with medical specialists knowledgeable in both hormone therapy and reproduction can help transgender individuals successfully navigate this process.
