Testosterone is widely viewed as the biochemical essence behind male strength, vigor, and virility. When any one of these are lacking, it is a frequent assumption that it must be due to a lack of circulating testosterone; that one need only replace it and then it will fix the distressing issue. While it may boost energy, increase libido, and help build muscle mass, testosterone therapy can, and usually does, exact a huge price.

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The problem with testosterone replacement therapy

We’re all familiar with the term “you can’t have it all”; testosterone replacement therapy (TRT) fits that phrase to the ‘T’ (no pun intended). TRT can invigorate a chronically fatigued man and help him gain extra lean muscle; but, especially with repeated exposure, can lead to low and even absent sperm counts.

This then begs the question of why does such an effect happen? Simply put, the body is full of regulatory hormone loops; one hormone stimulates the production of a second hormone, then the second hormone decreases the amount of the first. This is a negative feedback loop and these loops balance many hormones in our body. Hormones from the pituitary gland near the brain stimulates cells in the testicles to make testosterone. These hormones from the pituitary also are crucial signals which encourage sperm development. However, when testosterone is put into the body, this will automatically suppress these sperm development-supporting hormones via the already-mentioned negative feedback loop.

Hence, like the unicorn blood from Harry Potter, testosterone will exact a terrible price. According to one study, 75% of men taking testosterone replacement therapy will experience azoospermia or the complete absence of sperm on a semen analysis within 6 months. To allow for the recovery of the sperm count, all TRT must be stopped immediately. Even then it usually takes several months for the sperm count to recover. Nonetheless, an unfortunate minority of the men taking TRT will have persistently low sperm counts or may remain azoospermic.

Can treatment for TRT help?

Treatments for TRT-induced low sperm counts include either taking a medication like Clomiphene to boost pituitary hormones or taking in those hormones directly. While effective, these therapies cannot lessen the panic and stress over their diminished sperm count which TRT led to.

In short, before considering TRT, men must understand the destructive effect it can and will have on their ability to reproduce. Starting TRT must be a shared decision between the patient, their doctor, and whomever the patient may start or expand a family with.