If you stop taking your testosterone, it normally takes around six months for the body to start releasing a mature egg every month. Contrary to popular belief, testosterone is not a form of birth control. Even people who have been taking testosterone for a while and no longer have menstrual periods can get pregnant. 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 reliable form of contraception. Trans men and non-binary people in AFAB who have not had a hysterectomy or an oophorectomy should continue to use contraception if they have sex with the penis in the vagina and want to avoid pregnancy. The good news is that while taking testosterone replacement therapy (TRT) can lower sperm counts, the effects are usually reversible once TRT is stopped. It may take a few months for fertility to recover and you may continue to have a low sperm count after discontinuing TRT due to other contributing factors.
Once a man begins testosterone replacement therapy, the total sperm count takes approximately 2.7 months to decrease. After the cessation of testosterone therapy, it can often be 6 months before the total sperm count returns to normal. Spontaneous recovery of fertility is common after stopping testosterone therapy, but this process can be accelerated. The increase in age and duration of testosterone use significantly reduce the likelihood of sperm recovery in ejaculation, according to the criteria of a CMD of 5 million sperm, at 6 and 12 months. Doctors should be careful when following long-term testosterone therapy, especially in men who still want fertility.
With these findings, doctors can advise men on the likelihood of sperm recovery at 6 and 12 months. While some men will be comfortable not taking testosterone therapy until their partner is pregnant, others will want alternative options to increase testosterone levels in the meantime. This means that trans men can take hormonal contraceptives, even if they are taking testosterone at the same time. If you are taking testosterone and want to become pregnant, it's important to talk to your healthcare provider about the possibility of stopping taking testosterone. Men who are trying to conceive with their partner or who want to have a child in the near future should consider testosterone replacement alternatives that increase testosterone and maintain sperm function. SERMs enhance spermatogenesis by inhibiting negative estrogen feedback, thus raising GnRH and gonadotropin levels and increasing subsequent testosterone production.
Periods can be a source of gender dysphoria for some people, and testosterone doesn't always cause menstruation to stop immediately. Most trans men who previously used testosterone conceived within six months, although 44% did use medical interventions such as fertility drugs and assisted reproductive technologies. Currently, there are no guidelines available that discuss the treatment of men with infertility that is presumed to be associated with the use of testosterone. Many transgender men and people who are non-binary or of the gender queer AFAB (woman assigned at birth) take testosterone as a form of gender-affirming therapy. In addition, five of the six trans men who had previously used testosterone chose to freeze their embryos.
Age more consistently limited sperm recovery, while the duration of testosterone use had less influence at 12 months than at 6 months. 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. In addition, it is not clear how long after the cessation of testosterone administration adequate spermatogenesis should be expected.