Testosterone and Fertility


My husband’s doctor started him on Testosterone supplements and I want to have a baby. Is that a problem?
With few exceptions the answer is yes. Most men who take testosterone see dramatic reductions in their sperm counts and it is very common for us to see azoospermia (no sperm in the ejaculate) when guys are on testosterone or similar supplements even for short periods of time. It is impossible to conceive without sperm, and even with very low sperm counts, and so conception is likely to be much more difficult.

Why would testosterone be bad for sperm?  I thought that male hormones that improve his performance would also help his sperm.
Most hormones in the body are controlled by what is called a feedback system. A gland’s job is to produce one or more hormones. High levels of that particular hormone sends a message back to the master gland that stimulates it (usually the pituitary gland and the brain) that the gland in question is working too hard, and the gland then stops producing that stimulating hormone. In this case, the high testosterone levels from his supplements are telling the pituitary gland and the brain that the testes do not need to be stimulated, and the hormones necessary to enable to sperm to develop in the testes are no longer being released. When this happens, sperm production comes to a halt.

My husband feels awful when his off the testosterone. If there any way for him to still take testosterone without harming his fertility?
Some doctors and clinics will prescribe a hormone called hCG (the same one we use to trigger ovulation) to replace some of those hormones that go missing while a man takes testosterone supplements. Sometimes it is effective in keeping a normal sperm count, and other times it does not work. The only way to determine this is to check a semen analysis and see. Do not make any assumptions that taking the will just be OK.

My husband is on testosterone and we are trying to have a baby. What do I do next?
First of all, get him off the testosterone and schedule him for a semen analysis. If there is no sperm or the count is low, you will need to see a Reproductive Medicine specialist (a fertility doctor), not your regular OBGYN or midwife. They will discuss your options and most importantly get him referred to the appropriate doctor (a reproductive urologist) who can prescribe the medications he will need for his sperm to recover. This recovery process may take many months, and many couples chose to begin treatment such as IVF or IUI before full sperm recovery is complete.

He takes a bunch of work out supplements recommended by his friends at the gym. Should I be concerned?
It depends. There are a variety of supplements that are used to make workouts more effective. Many of these contain male steroid hormones that are similar to testosterone, while other are just protein supplements or metabolism boosters. While we cannot vouch for the safety or effectiveness of any of these supplements, we do know that if there are hormone-like chemicals in there, it could potentially be a problem.  Have your doctor schedule a semen analysis to see if there is a problem.