Will TRT make me infertile?

Exogenous testosterone suppresses the hypothalamic-pituitary-gonadal (HPG) axis by reducing GnRH and LH secretion, which reduces intratesticular testosterone and stops or dramatically reduces sperm production, making conventional TRT incompatible with fertility goals in most men, with the degree of suppression variable but often significant within weeks of starting therapy (Crosnoe et al., Curr Opin Urol, 2013).

This is the most important information for men under 45 considering TRT for the first time: if you want biological children in the future, exogenous testosterone is the wrong first-line approach. The alternatives that support testosterone physiology without suppressing spermatogenesis: clomiphene citrate (clomid) and enclomiphene, SERMs that increase GnRH and LH from the pituitary, stimulating endogenous testosterone production while preserving HPG axis activity and spermatogenesis. These are first-line options for younger men with low testosterone who want to preserve fertility.

Honesty Scale: Solid (1) for TRT suppressing spermatogenesis. Solid (1) for SERMs (clomiphene, enclomiphene) as fertility-preserving alternatives.

What to do: If you are under 45 and have not completed your family, discuss clomiphene citrate or enclomiphene with your prescribing physician before starting TRT. The fertility discussion is not optional, it must happen before the first testosterone injection.

For the full picture, read The Testosterone/TRT Deep Dive