Testosterone Replacement Therapy (TRT) Effect on Men’s Fertility

Testosterone Replacement Therapy (TRT) Effect on Men’s Fertility

men fertility sperm

Testosterone replacement therapy suppresses spermatogenesis (sperm production) by reducing intratesticular testosterone and decreasing FSH through suppression of the hypothalamic-pituitary-gonadal axis (HPGA). Conflicting evidence exists for the long-term risk to fertility in men on TRT. Data abstracted from trials which sought to utilize TRT as a contraceptive found that sperm concentrations were suppressed to less than 1 x 106 ml-1 within 3.5 months. After discontinuation of testosterone, projected time to recovery (20 x 106 ml-1) was 67%, 90%, 96%, and 100% at 6, 12, 16, and 24 months respectively.

A recent publication evaluating men who presented to an infertility clinic with a history of TRT use found that only 70% of men achieved sperm recovery (total motile count >5 x 106) and that increased age and duration of TRT use were negative predictors of a patient’s ability to return to fertility. This data is likely overestimates the long-term detrimental effect of TRT on fertility as no information regarding the patients’ ability to produce sperm before TRT is available. While a subset of these men was likely infertile prior to TRT therapy, this data serves as a caution to men and practitioners considering TRT within their reproductive years. While the absolute percentage of men who experience irreversible fertility loss after undergoing TRT is not known, there is a significant concern for this side effect in young men who may ultimately desire to father a child.

Reference

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