Testosterone use and male infertility
Revised 2015
What is testosterone?
Testosterone (also referred to as “T”) is a hormone produced in men by the testes (testicles). It is involved in muscle and bone development, hair growth, and development of sex organs such as the penis and prostate. It contributes to a man’s sense of overall well-being and sexual function. Testosterone is also required for sperm production.What is low testosterone?
This medical condition is also called hypogonadism. A low T level is one that is below the normal range, which can vary widely. It is measured with a blood test. Some signs or symptoms of low testosterone are problems with erections or decreased sex drive. Testosterone levels should be checked early in the morning, and an abnormal test should be repeated. Testosterone levels vary throughout the day, and a man’s T level will vary from one test to the next.Can low testosterone be treated?
Men with low T levels and symptoms of low T can consider treatment. Men with low T can be treated with medicine through shots, gels, patches, or implantable pellets. There are advantages and disadvantages to each type of treatment. Recently, the number of men receiving T treatment in the United States has increased significantly. Medications for low testosterone are now marketed directly to patients in the media.Does low testosterone cause infertility?
Low testosterone does not cause infertility. Sperm production is actually stimulated by hormones other than testosterone. Testosterone is required for sperm production, but the level in the testes where sperm are produced is many times higher than in the blood. Even men with low or borderline T levels may have sufficient T levels for sperm production.How does testosterone treatment cause infertility?
One side effect of testosterone treatment is infertility. Testosterone treatment decreases sperm production by decreasing levels of another hormone, follicelstimulating hormone (FSH), which is important for stimulating sperm production. In most cases, the infertility caused by testosterone treatment is reversible. Men who have received testosterone for a shorter period of time probably recover more quickly. For a small percentage of men, the infertility is not reversible. It is generally believed that testosterone given by shots and pellets are more likely to cause infertility than gels, although any form of testosterone supplementation can disrupt the normal hormonal balance required for sperm production.If a man is taking testosterone and wants to have children, what are his options?
He should consult with a male reproductive specialist. Men should avoid testosterone treatment until they are done trying to have their own biological children. If a man has a pituitary disorder that is causing the low testosterone, then he can be treated with a pituitary hormone (hCG) that will increase his T level without disrupting sperm production. When he is done having children, he can take testosterone to treat his low T level directly.If a man is infertile and taking testosterone, what are his options?
A man should see a male reproductive specialist who will perform a complete history and physical examination for him. He will need to have hormone testing, at least two semen analyses, and possible additional testing performed. He will need to stop taking testosterone and have hormone tests and semen analyses checked periodically as it could be months before his sperm count returns to baseline.How else can low testosterone be treated?
There are other medicines, such as clomiphene citrate, letrozole, and fertility injections of pituitary hormones that men can take to raise testosterone levels. This is considered off-label use of these medications. Hormone levels and semen analyses should be monitored as these medications can cause hormone abnormalities and occasionally decrease sperm counts. A man should see a reproductive specialist for additional evaluation and counseling about his condition.My doctor suggested putting me on testosterone. I may want to have children in the future. What should I do?
Patients and providers should be aware that testosterone treatment causes lowered sperm counts and hormone alterations. Men of reproductive age should avoid testosterone treatment if they want to have biological children or consider freezing sperm for use later.Are there other risks to taking testosterone?
The long-term safety and effectiveness of testosterone supplementation are not known. Men considering treatment should discuss these risks and possible benefits with their health-care provider.Find a Health Professional
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Male Fertility/Andrology
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Stress and infertility
It is not clear how exactly stress impacts fertility. Read the Fact Sheet
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The most common test of a man’s fertility is a semen analysis. View the fact sheet
Spinal cord injury sperm retrieval
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Infertility: an Overview (booklet)
Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. View the booklet
Optimizing Natural Fertility
Before attempting pregnancy, a woman should make sure she is healthy enough for pregnancy by adopting a healthier lifestyle and taking prenatal vitamins. If she has a medical or genetic condition or risk of one, she should seek advice from a medical professional before conceiving (becoming pregnant) View the fact sheet
Optimizing Male Fertility
About 20% of infertility cases are due to a male factor alone. Another 30% involves both male and female factors. View the fact sheet
Male Fertility and Infertility - a patient education video
Male Factor Infertility is responsible for about 30% of infertility cases and can contribute infertility to an additional 20% of cases. Watch Video
Infertility
Infertility is the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery. Watch Video
Basic Infertility Evaluation
Dr. Roger Lobo of the American Society for Reproductive Medicine discusses the various methods to evaluate infertility. Watch Video
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Infertility Treatments
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Understanding Fertility
In this video series, Dr. Roger Lobo explains the basics of infertility, including causes, treatments and coping methods. Watch Video
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The experience of infertility is a rollercoaster of hope and disappointment. Treatment presents an opportunity for hope as well as a new set of challenges. Watch Video
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Endometriosis
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Causes of Female Infertility
Dr. Roger Lobo, of the American Society for Reproductive Medicine explains the causes of female infertility. Watch Video
Causes of Male Infertility
Dr. Roger Lobo, of the American Society for Reproductive Medicine explains the causes of male infertility. Watch Video
Diagnostic Testing for Male Factor Infertility
When a couple has trouble having a baby, there's about a 50-50 chance that the man has a problem contributing to the pregnancy.View the Fact Sheet
FAQ About Infertility
Infertility is not an inconvenience; it's a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction. Learn the facts
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Infertility often creates one of the most distressing life crises that a couple has ever experienced together. Learn the facts
Mary Dolan's Story
I was diagnosed with diminished ovarian reserve/premature ovarian failure at 28 years old.
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Infertility Infographics
ASRM has prepared infographics to illustrate the subject of Infertility better. View the infographicsFact Sheets/Booklets
View more fact sheets and booklets written by the ASRM Patient Education Committee.
Assisted Reproductive Technologies (booklet)
This booklet will help you understand in vitro fertilization (IVF) and other assisted reproductive technology (ART) that have become accepted medical treatments for infertility.
Hormonal Contraception
Hormonal contraceptives contain a progestin (progesterone medicine) with or without an estrogen.
What do I need to know about Zika virus and trying to have a baby?
Common symptoms include fever, rash, joint pain, conjunctivitis (red eyes), muscle pain, and headache.
Third-Party Reproduction
The phrase “third-party reproduction” refers to involving someone other than the individual or couple that plans to raise the child (intended parent[s]) in the process of reproduction.Resources For You
The American Society for Reproductive Medicine (ASRM) is committed to providing patients with the highest quality information about reproductive care.
