Despite its positive effects on sexual function, testosterone therapy can have a negative impact on fertility. Exogenous testosterone supplementation can disrupt the hypothalamic-pituitary-gonadal axis and inhibit the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). One of the side effects of testosterone treatment is infertility, as it decreases sperm production by reducing FSH levels. In most cases, infertility caused by testosterone therapy is reversible.
Men who have been taking testosterone for a shorter period of time are likely to recover more quickly. However, for a small percentage of men, infertility may not be reversible. It is generally believed that testosterone administered through injections and pellets is more likely to cause infertility than gels, although any form of testosterone supplementation can alter the normal hormonal balance required for sperm production. The bottom line is that if your husband takes testosterone, your concerns about getting pregnant are valid.
Testosterone supplements are likely to affect sperm production and your ability to conceive. But don't despair; the damage is often reversible, and there are plenty of options to safely increase your husband's sperm count and testosterone levels. Testosterone is not a form of birth control; some people mistakenly believe that taking testosterone will prevent pregnancy, but this is not true. In a survey of 41 trans men who became pregnant and gave birth, 61% had used testosterone before becoming pregnant.
Three quarters of these pregnancies were planned, meaning that a quarter were unplanned. This highlights the fact that taking testosterone is not a form of contraception. Trans men and non-binary people in AFAB who have not had a hysterectomy (removal of the uterus) or an oophorectomy (removal of the ovaries) should continue to use contraception if they have sex with the penis in the vagina and want to avoid pregnancy. Testosterone plays only a small role in sperm production; the body needs FSH to produce sperm.
Excessive amounts of testosterone through TRT can reduce FSH production. With excessive testosterone replacement, the body may stop producing testosterone naturally, leading to testicular atrophy or reduced testicle size. In women, testosterone peaks due to TRT can cause irregular periods, polycystic ovary syndrome, and infertility. Health care providers prescribe these treatments frequently, and the number of men using testosterone therapy has increased significantly in recent years. After all, testosterone is the main male hormone, and testosterone supplementation can increase sexual desire and improve erectile functioning.
According to the American Society for Reproductive Medicine (ASRM), testosterone injections and implants may be more likely to affect fertility than testosterone gel. If you are taking testosterone and think you may be pregnant, see your health professional as soon as possible. Men who currently use TRT to increase their testosterone levels will likely need to stop taking it to restore their fertility. This belief has led to an increase in the idea that TRT can help couples conceive. Testosterone is needed for sperm production, but the level in the testicles where sperm is produced is many times higher than in the blood. For some men, medication, along with a healthy diet, a normal BMI and exercise, can increase testosterone levels and improve their chances of getting pregnant.
Many transgender men and people who are non-binary or gender queer AFAB (woman assigned at birth) take testosterone as a form of gender-affirming therapy. If your husband (or male partner) takes testosterone and you're wondering if you can still get pregnant, you're far from alone.