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Do Testosterone Shots Cause Infertility?

Do testosterone shots cause infertility? This question is the focus of this blog article.  We are going to discuss some of the signaling involved with testosterone injections and how that relates to fertility. There are three different categories of people or three scenarios we will discuss as it relates to testosterone injections and fertility.  These three scenarios are more and likely pertinent to your situation and questions you might have.

We have a lot of experience treating males with testosterone deficiency, some of which are having fertility issues as well.  I know a lot of people have questions about this because I get these questions a lot. This article will give you more information and context about what to do if you are on testosterone injections or considering testosterone in any form, but also want to have a child.

Testosterone Injections and Intertility Signaling

So the main question we will answer is; do testosterone injections or testosterone shots cause infertility? The short answer is yes they can. The longer answer is, no it doesn't necessarily have to.  To help you understand the details we will discuss  the signaling involved with production of spermatozoa.  This is specifically related to fertility. We will also discuss different segments of the population that may be more susceptible or less susceptible to getting infertility from taking testosterone shots. 

First, we will discuss the signaling. The cells in your testes are where the spermatozoa and testosterone are produced. The cells that make the spermatozoa are called the Sertoli cells and the cells that make the  testosterone are called Leydig cell.  Those cells are triggered to produce these products from signals that come from the brain.  The Sertoli cells are stimulated to produce spermatozoa through a hormone called Follicle Stimulating Hormone (FSH).  The Leydig cells are stimulated through Luteinizing Hormone (LH). When the brain detects higher amounts of testosterone around (through receptors), it will then decrease the production of these two signaling hormones.  As a result, you get less output of testosterone and spermatozoa from the testes. Typically your body produces both testosterone and spermatozoa in a pulsatile fashion based on the levels of testosterone detected. As testosterone goes down throughout the day and through the evening the brain starts to produce more FSH and LH in the early morning time.  As a result, more testosterone and spermatozoa are produced following this surge. 

When you're taking testosterone injections and your overall, serum levels of testosterone stay high, the drop is not detected by the brain, so there is less FSH and LH produced . As a result, you will have a decreased production of spermatozoa, when the testosterone remains high. If you are doing weekly dosing, as the testosterone levels come down there is an increase in FSH and LH and more spermatozoa will be produced. colin-maynard-23136-unsplash

Now, that doesn't necessarily mean that it's completely shut off even when the levels are higher.  This isn't a light switch type of mechanism.  It's more like a dimmer switch. It can down regulate and up regulate even within a given week.  Also it’s not like once you go on testosterone injections you're never going to produce any sperm at all, ever again.  However the higher your levels and longer they are high, the less testosterone and spermatozoa produced. 

Not sure if you really need testosterone anyway?

Who Should Consider Testosterone Replacement Therapy 


Now let's discuss the 3 scenarios to better understand what you need to do if you are on testosterone injections and have concerns about fertility. 



1. Currently Taking Testosterone and Stopping

The first scenario is for someone that is currently taking testosterone and stopping.  Once you stop the testosterone, you should consider helping your body re-initiate production of testosterone and spermatozoa (with HCG or something similar). How much support you need is hard to say. Some people will not need any and it will just rebound on it's own.  Eventually it will rebound on it's own anyway but may take several months.  The amount of time it takes is multifactorial.  It depends how long you were on it, where you sperm production was at prior, and some other factors.  

If you were on testosterone injections for a year, the rebound should come back fairly quickly.  The FSH and LH will start to kick in once the brain detects the lower testosterone.  It should rebound to where it was prior to the injections.  Now, there is little hard data on exactly how much your spermatozoa and testosterone will come back. It might be 100%, 90%, 50% but for sure it is not 0%. I can tell you that for sure because I've tested many patients testosterone both on and then going off testosterone.  And we have had several successful pregnancies in people that were on testosterone and stopped.  In some of these cases, they don't even adjust their testosterone. 


2. Testosterone Replacement Therapy + Fertility Concerns

In the instance that you really are concerned about fertility, but you still feel like you need to take the testosterone injections, you will need some support to Sertoli cells.  In this case you probably want to take some HCG or clomid depending on where you're at on the spectrum of desire for pregnancy.

 If you already know you have fertility issues like low sperm count etc., you might want to go with the clomid. If you're unsure and you just want to have some reassurance to keep the cells stimulated, then may want to do some HCG.  Both HCG and Climid should not be used continually on a regular basis.  You should take pauses from it because even these cells (Leydig and Sertoli) can get desensitized to the hormone stimulus. 


3. Testosterone Naive + Fertility Concerns

If you really are having concerns about fertility and you are considering testosterone injections, get tested before you start get tested.  Not everyone has this opportunity, but it is helpful to look at where you're starting at with your sperm count and some of the other parameters before you go on testosterone.  These tests are not that expensive and you will know if the testosterone is having a negative effect. If the testosterone is having a negative affect, you can deploy some of these other mechanisms.  These will keep the spermatozoa at the same level or at least at a sufficient level to allow for a pregnancy to occur.


So if you are on testosterone injections and have fertility concerns, remember it's not a hard on / off switch.  If you have specific question about the content above, ask in the comment section below.  For a customized treatment for your testosterone deficiency and fertility, click on the link below to get started. 


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