I am often seeing men with symptoms of low testosterone levels who are still planning to have children. These men need to know that the standard treatment of hormone replacement may not apply to those men who are still interested in having children. This blog will discuss the management of men with low T and who wish to continue to have children.
Testosterone replacement therapy (TRT) can bring your testosterone levels back to normal and restore your sex drive.
But if you want to have children, there’s one downside to TRT you should know about. It gives you back your sex life, but it might also reduce your ability to father children as long as you’re on it.
Testosterone replacement therapy has a profound impact on a man’s reproductive potential.
Approximately 90% of men can drop their sperm counts to zero while on testosterone. By increasing testosterone, you’re not going to increase fertility.
Testosterone, the hormone produced in the testicles, plays an important role in making sperm. Your brain makes special hormones, called gonadotropin-releasing hormones (GnRH). These hormones signal the testes to make more testosterone, vital for a healthy sperm count. When you’re getting testosterone replacement therapy, testosterone is added into the bloodstream by patches, gels, or other treatment methods such as pellets placed under the skin. Your brain interprets this rise in testosterone levels as a sign that you now have enough testosterone. So it stops sending signals to the testes to make more testosterone. But when your testes don’t make more testosterone, your sperm production goes down.
Therefore, a low sperm count makes it harder to conceive a child. My advice is that if you have any kind of reproductive goal, you should not be using TRT.
If you have low testosterone, one way to improve sperm count is with gonadotropin injections. This stimulates the production of sperm. It may be considered as a way to increase a man’s fertility when your partner are having trouble conceiving a child.
It’s standard practice to check a man’s sperm count when a couple has difficulty getting pregnant. If your sperm count is low, the next step is to measure your testosterone. If it’s below normal, we can then inject the signal to produce more testosterone by giving a gonadotropin.
You should also make sure to follow a lifestyle of regular exercise and a healthy diet if you want to father a child. Overweight and obese men tend to have lower testosterone levels because excess belly fat converts testosterone to estrogen, another hormone that can impact sperm production. Shedding those extra pounds will likely have a positive effect on your fertility. Losing weight can definitely increase testosterone.
Bottom Line: If you have symptoms of low testosterone levels or if you have an abnormal sperm count, hormone replacement with testosterone is not the treatment of choice. You should consider gonadotropin injections as a solution.