Does Testosterone Replacement Therapy Affect Fertility?
Medically reviewed by Linda Girgis | MD, Girgis Family Medicine on August 21st, 2026.
Yes, testosterone replacement therapy typically reduces male fertility by suppressing natural sperm production. TRT shuts down the body's natural testosterone production through negative feedback on the hypothalamic-pituitary-gonadal axis, which can decrease sperm count by up to 90% within months. Studies show that 65-70% of men on TRT experience significant drops in sperm concentration and motility. The effect is usually reversible, with fertility potentially recovering 3-6 months after discontinuing treatment, though some men may require additional interventions like HCG or clomiphene citrate to restore normal sperm production.
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