Preserving Fertility While Treating Testosterone Deficiency

Written by Dr. Chris Smith, Updated on December 17th, 2023
Reading Time: 3 minutes

For men with Low-T, Bio-Identical Testosterone Therapy can be life-changing. A physician-mediated Testosterone Program can provide immense benefits for patients with a low risk of serious complications. Testosterone Deficiency is a major blow to hormone balance which leads to loss of strength, depression, fatigue, weight gain, and more.

Six months of HRT Treatment with Testosterone can provide widespread and significant benefits, but it's also important to realize what Testosterone Therapy can't do.

Testosterone Replacement Impairs Fertility

The actual mechanism by which Testosterone is naturally produced is somewhat complicated. While the testes and adrenal glands are responsible for Testosterone Production, they cannot produce Testosterone without upstream signaling from the Pituitary and the Hypothalamus.

The Hypothalamus registers a need for Testosterone and sends a signal to the Pituitary Gland. The Pituitary Gland then releases two important hormones—Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH).

These hormones travel to the testes and adrenal glands to initiate the production of testosterone and sperm.

Luteinizing Hormone promotes the production of Testosterone, which works with Follicle-Stimulating Hormone to produce sperm.

FSH also helps keep the testes full and healthy. This delicate interplay falters when a patient receives Hormone Replacement Therapy with Testosterone. Because Testosterone Levels are artificially normalized via injection, cream, or other delivery mechanisms, this causes the Hypothalamus to stop signaling for the production of Luteinizing Hormone and Follicle-Stimulating Hormone.

For men that aren't interested in having children, this isn't a big deal. Testosterone is incredibly important to system-wide physiological function, but LH and FSH are specifically associated with fertility and sex hormone production. Men that are interested in having children or otherwise maintaining fertility have some things to consider.

Options for Men that Have Low-T but Want to Protect Fertility

Go to a Sperm Bank

Sperm banking is an excellent choice for men that may want children but are interested in Testosterone Therapy now. Low-T Treatment with Testosterone will not permanently impair fertility, but semen production will decline, and fertility will practically cease for the duration of treatment. A visit to a sperm bank allows you to cryogenically freeze your genetic material for when you think the time is right to have a child.

Choose an Estrogen Inhibitor that Maintains Fertility

If you're interested in boosting Testosterone but want to maintain your natural ability to reproduce, there are medications available that increase Testosterone without impairing sperm viability.

Two of the most common treatments that function in this way are Aromatase Inhibitors and Selective Estrogen Receptor Modifiers (SERMs). These drugs work by reducing the influence of Estrogen on the brain, which encourages increased natural Testosterone Production. While these treatments have been effective for many people, their clinical use for Low-T is off-label.

Use Gonadotropic Agents That Mimic Pituitary Sex Hormones

There are some medications, such as Menotropins, that mimic the effects of Follicle-Stimulating Hormone and Luteinizing Hormone, thereby encouraging the production of both Testosterone and Sperm.

These treatments are usually combined with Bio-Identical Testosterone to maintain the form and function of the testes during Low-T Treatment. Like SERMs and Aromatase Inhibitors, these medications have been effectively used in clinical settings but are not FDA-approved for this purpose.

Solve Underlying Medical Issues Which May Be Limiting Testosterone Production

Sometimes, Testosterone Deficiency can be resolved by treating other health problems which contribute to Low-T. There are many conditions such as sleep apnea, metabolic syndrome, and prolactinoma, which can suppress Testosterone Production.

Sedentary lifestyle, obesity, diabetes, and obesity all contribute to suppressed Testosterone Levels as well. Losing weight, working out, and finding effective treatments for these conditions can all restore your Testosterone, and they may even improve your fertility!

This isn't effective for all patients, but increasing Testosterone Naturally is always the best option if possible.

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