The Fertility Paradox: How TRT Can Help Some Men Make Babies (and Stop Others)

When it comes to testosterone replacement therapy (TRT) and fertility, the internet is full of half-truths and horror stories. You’ve probably heard one version:

“TRT will ruin your chances of having kids.”
Or the opposite:
“TRT boosts testosterone, so it must help with fertility, right?”

The truth? It’s both more complicated—and more fascinating—than either side admits.

Let’s dig into the fertility paradox and why TRT can actually help some men start a family… while it can make it harder for others.

Why Testosterone and Sperm Production Don’t Always Agree

Here’s the short biology lesson:
Your body’s natural testosterone production is closely tied to sperm production. In the brain, the pituitary gland sends signals (LH and FSH) to the testes, telling them to make both testosterone and sperm.

When you start TRT, you’re introducing testosterone from an outside source. The body notices it has “enough” and slows—or stops—its own production. Unfortunately, that same switch can turn down sperm production too.

This is why many men see their sperm count drop while on TRT.

But Wait—How Can TRT Increase Fertility?

Here’s where the plot twist comes in. Not all low-testosterone cases are the same. For some men, low testosterone is actually part of what’s preventing them from conceiving in the first place.

If your testosterone levels are too low, your libido, sexual function, and even the ability to produce healthy sperm can all take a hit. In these situations, the right medical approach—which can include TRT, sometimes in combination with fertility-supporting medications—can boost both your testosterone and your ability to conceive.

The Role of Fertility-Preserving Medications

Doctors who specialize in men’s health often have a few tricks up their sleeves.
By combining TRT with medications like hCG (human chorionic gonadotropin) or clomiphene citrate, it’s possible to stimulate the testes to keep producing sperm while reaping the benefits of higher testosterone.

Think of it as giving your body the fuel it needs and keeping the factory running.

Questions Every Man Should Ask Before Starting TRT

If you’re thinking about TRT and also planning to have kids (now or someday), here are some conversation starters for your next doctor visit:

• “Will TRT affect my sperm count?” (And how do we monitor it?)
• “Are there alternatives to TRT that might preserve fertility?”
• “Can we combine TRT with hCG or other medications to protect sperm production?”
• “If I stop TRT, will my fertility return?”

Bottom Line

TRT’s impact on fertility isn’t black and white—it’s a spectrum. For some, it’s a fertility killer; for others, it’s the missing link that helps them finally become a dad.

The key is working with a provider who understands both hormone therapy and male fertility. At AlphaMD, we know there’s more to testosterone than just a number, and we’re here to help you make informed decisions for your health, your family, and your future.

AlphaMD.org — Better Information. Better Health. Better You.