Trying to Conceive While on Testosterone Therapy? Risks, Alternatives, and Expert Advice

Introduction

Testosterone therapy is now more common than ever before. It is used to treat low testosterone levels in cisgender men, a condition known as hypogonadism. It is also an essential part of hormone therapy for many transgender and gender-diverse individuals. Since many people begin testosterone treatment during their twenties or thirties, which are often considered peak years for starting a family, questions about how testosterone affects fertility are becoming more frequent. These questions are important for individuals who may want to have children either now or in the future.

There are several ways testosterone can be given. Some people use weekly or bi-weekly injections, while others may use daily gels, skin patches, small pellets placed under the skin, or oral pills. All of these methods work to increase testosterone levels in the body. This rise in testosterone can help improve symptoms such as tiredness, low sex drive, reduced muscle mass, and weak bones. It can also have a positive effect on mood and overall energy levels. For transgender men, testosterone helps bring about physical changes such as a deeper voice, more facial and body hair, and a shift in body shape to a more masculine appearance. These benefits explain why more people are turning to testosterone therapy today.

Despite these positive effects, testosterone therapy can interfere with fertility. When the body receives testosterone from an outside source, the brain senses that hormone levels are already high. This leads to a drop in the brain’s release of two important hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones are responsible for signaling the testes to make sperm. When LH and FSH levels fall, sperm production can slow down significantly or even stop. Research shows that many men who begin testosterone therapy will have very low sperm counts or no sperm at all within just a few months of treatment. In transgender men, testosterone also affects the ovaries. It can lead to irregular or absent menstrual cycles and can stop the release of eggs, making it difficult or impossible to conceive.

These changes often happen without obvious symptoms. Many people do not realize their fertility has been affected until they try to conceive. That is why understanding the effects of testosterone on fertility is so important, especially for people who are still considering having biological children. This is especially true for younger individuals. Transgender men often begin hormone therapy in their teenage years or early twenties, and men with low testosterone levels that develop in adulthood often start therapy in their thirties or forties. People in these age groups are still commonly planning to start families. Some individuals in their fifties may also want to have children, either naturally or through fertility treatments.

Because of the impact testosterone can have on sperm and egg production, experts now recommend that fertility be discussed before starting therapy. Talking to a doctor early on can help make a plan that fits a person’s reproductive goals. This might include storing sperm or eggs before starting treatment or using other medications to protect fertility.

This article looks at the most common questions people ask about trying to conceive while using testosterone therapy. It explains whether pregnancy is possible while on testosterone, whether fertility problems caused by testosterone are permanent, how long it might take to recover fertility after stopping therapy, and how someone might recognize if their fertility has been affected. It also explores whether trying to conceive while still on therapy is safe, what medical treatments can help support fertility, how sperm and egg freezing work, and what transgender men need to know about preserving their options for having children. The article also covers what doctors and specialists usually recommend for people who want to protect or restore their fertility while managing hormone needs.

Each of these topics is explained in clear and simple terms. The information is based on trusted medical research and expert advice from professionals in endocrinology and reproductive medicine. No personal stories are used, and the goal is to give accurate, easy-to-understand facts to help people make informed choices about their health and future family plans.

Can You Get Someone Pregnant While on Testosterone Therapy?

Testosterone therapy is a medical treatment used to raise testosterone levels in people who have low amounts of this hormone. It is often used by men with a condition called hypogonadism, where the body does not make enough testosterone. It is also used by some transgender men as part of gender-affirming care. Testosterone therapy can be given in several forms, including:

• Injections

• Gels

• Skin patches

• Pellets placed under the skin

Testosterone helps improve energy, mood, sex drive, and muscle mass. However, while it helps in these areas, it can also make it harder or even impossible to have children naturally.

How Sperm Is Made in the Body

To understand why testosterone affects fertility, it helps to know how the body makes sperm. Sperm production happens in the testicles and is controlled by signals from the brain. This system is called the hypothalamic-pituitary-gonadal axis (HPG axis). It includes three parts:

1. The hypothalamus – a part of the brain that releases a hormone called GnRH (gonadotropin-releasing hormone).

2. The pituitary gland – a small gland under the brain that responds to GnRH by making two important hormones: LH (luteinizing hormone) and FSH (follicle-stimulating hormone).

3. The testicles – which use LH to make testosterone and FSH to make sperm.

This system works like a loop. If testosterone levels drop, the brain tells the body to make more. If levels are too high, the brain tells the body to make less.

How Testosterone Therapy Affects Sperm Production

When testosterone is taken from outside the body (like with injections or gels), it increases testosterone levels in the blood. The brain sees this increase and thinks the body has made enough. As a result, the brain stops sending GnRH. Without GnRH, the pituitary gland stops making LH and FSH. When LH and FSH go down, the testicles stop making sperm.

This leads to a drop in spermatogenesis — the process by which sperm are made. After a few months on testosterone therapy, many people have very low sperm counts. Some have oligospermia (very few sperm), and many develop azoospermia (no sperm at all in the semen).

This means that most people on testosterone therapy cannot get someone pregnant during treatment.

How Common Is Fertility Loss on Testosterone?

Research shows that more than 90% of people on testosterone therapy experience a major drop in sperm production. This usually starts within 3 to 6 months after starting therapy. The longer testosterone is used, the more likely sperm production will completely stop.

Even people who use testosterone for non-medical reasons, such as athletes or bodybuilders, have similar results. These users also often notice smaller testicles and reduced fertility over time.

Does Testosterone Increase Fertility or Sex Drive?

Some may think that higher testosterone will improve their chance of having a child because it increases sex drive or muscle strength. This is not true. Testosterone therapy may increase sexual desire or improve erections, but it almost always reduces or stops sperm production.

So, even though someone on testosterone therapy may feel more interested in sex, they are much less likely to make someone pregnant.

What Doctors Recommend

Medical experts do not recommend trying to conceive while on testosterone therapy. Because of its strong effect on the body’s sperm-making process, it is not considered a safe or reliable time for trying to have a child.

Doctors usually suggest stopping testosterone therapy if a person wants to try to have children. In some cases, other medicines can be used to help the body start making sperm again. These include hormones that replace the signals that testosterone shuts down.

Testosterone therapy makes it very difficult or even impossible to get someone pregnant. It works by stopping the brain from telling the testicles to make sperm. Over time, most people on testosterone will have low or no sperm in their semen. Although it may help with sex drive and mood, it does not help with fertility. Anyone planning to have children should talk to a doctor before starting or continuing testosterone therapy.

Does Testosterone Therapy Permanently Affect Fertility?

Testosterone therapy can cause temporary infertility, but in most cases, it does not cause permanent damage to fertility. Many people are able to recover sperm production after stopping testosterone. However, how long it takes and how complete the recovery is can depend on several factors, including how long the therapy was used, the person's age, and their overall health.

How Testosterone Therapy Affects Fertility

When testosterone is taken from an outside source, it tells the body to stop making its own testosterone. This happens because of the way hormones work together in the body. Normally, the brain sends signals through two hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones tell the testicles to make testosterone and sperm. But when testosterone is added from outside, the brain stops sending these signals. As a result, the testicles stop producing both testosterone and sperm.

This can lead to a condition called azoospermia, which means there is no sperm in the semen. Azoospermia makes it impossible to cause a pregnancy naturally. Some people may have very low sperm counts instead, which also makes it difficult to conceive.

Is This Effect Permanent?

Most of the time, the effect on sperm production is not permanent. Once testosterone therapy is stopped, the brain can begin sending signals again, and the testicles may slowly start producing sperm. This process is called recovery of spermatogenesis.

Several studies have shown that sperm production can return in many men after stopping testosterone. In one study, more than 65% of men had some sperm in their semen within six months after stopping therapy. Within one year, this number increased even more.

However, recovery does not always mean a full return to the person’s sperm count before starting therapy. In some cases, sperm count remains lower than normal, but it may still be enough to cause a pregnancy.

What Affects Recovery?

The chance of full recovery depends on a few key factors:

• Duration of Therapy: The longer someone has been using testosterone, the longer it may take for their body to recover. People who used testosterone for just a few months often recover faster than those who used it for several years.

• Age: Younger people tend to recover better than older individuals. This is because sperm production naturally slows down with age, even without hormone therapy. Recovery in people over 40 may take longer or may not return fully.

• Baseline Fertility: If sperm count or fertility was low before starting testosterone, it may be harder to recover normal levels after stopping. A fertility evaluation before starting testosterone can help understand the baseline.

• Type of Testosterone Used: Different forms of testosterone (injections, gels, patches) may have different effects on hormone levels. Injections may suppress the brain’s hormone signals more strongly, which can delay recovery.

• Other Health Conditions: Conditions such as obesity, diabetes, or testicular injury can also impact how well sperm production recovers. These conditions may reduce natural testosterone production even after stopping therapy.

Can Anything Help with Recovery?

In some cases, doctors may prescribe medications to help restart sperm production. These include:

• hCG (human chorionic gonadotropin): This hormone acts like LH and can stimulate the testicles to start working again.

• Clomiphene citrate: This pill helps increase LH and FSH levels by blocking estrogen’s feedback to the brain.

• Aromatase inhibitors: These lower estrogen levels, which can help increase the body’s natural testosterone and sperm production.

These medications are often used under the care of a fertility specialist or an endocrinologist.

Testosterone therapy can stop sperm production, but in most cases, this effect is temporary. After stopping treatment, the body can slowly begin to make sperm again. Recovery time varies and depends on age, how long the therapy was used, and a person’s overall health. With time, and in some cases medical support, many people can regain their fertility. For those thinking about having children in the future, it is important to talk with a doctor before starting or continuing testosterone therapy.

How Long After Stopping Testosterone Can Sperm Production Return?

Testosterone therapy can strongly affect how the body makes sperm. When testosterone is taken from outside the body (called exogenous testosterone), the natural hormone system slows down. This leads to reduced sperm production. For people who want to have children, this can cause worry. Many ask how long it takes for sperm to return after stopping testosterone. The answer depends on several factors, but most people can recover fertility over time with the right steps and support.

Why Sperm Production Stops During Testosterone Therapy

To understand recovery, it is important to know why sperm production stops in the first place. The brain controls hormone signals through the hypothalamic-pituitary-gonadal (HPG) axis. The brain sends signals to the pituitary gland to release hormones called luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These two hormones travel to the testes and help with testosterone production and sperm creation.

When someone takes testosterone from outside the body, the brain senses high hormone levels and slows down or stops the release of LH and FSH. Without these hormones, the testes stop making their own testosterone and stop making sperm. This can lead to a condition called azoospermia, which means there is no sperm in the semen. Azoospermia is common among people who use testosterone therapy, especially for long periods.

Average Time for Sperm to Return

Once testosterone therapy is stopped, the brain and testes need time to begin working normally again. Most studies show that sperm production can return in 3 to 18 months. Some people see early signs of recovery after just 3 to 6 months, but full return of normal sperm counts often takes 1 year or longer.

In one study published in the Journal of Urology, about 67% of men had sperm return to the semen within 6 months of stopping testosterone. Over 90% recovered within 24 months. However, these numbers vary based on age, how long testosterone was used, and whether the person had normal fertility before starting therapy.

Factors That Affect Recovery Time

Several factors play a role in how quickly sperm production returns:

• Length of Time on Testosterone: The longer someone uses testosterone, the longer recovery may take. Short-term use often allows for faster return of sperm. Long-term use (more than 12–24 months) can delay or reduce the chance of full recovery.

• Type and Dose of Testosterone: Injections, gels, and pellets all affect the body differently. High doses suppress the brain’s signals more strongly, which may slow down recovery.

• Age and Baseline Fertility: Younger people and those with healthy hormone levels before starting therapy tend to recover faster. Older individuals or those with existing hormone issues may need more time.

• Use of Fertility-Preserving Medications: Some people use medications like hCG or clomiphene citrate to help restart hormone signals. These medications can help improve sperm production during and after testosterone therapy.

How Recovery Is Measured

Doctors often check sperm levels through a semen analysis. This test looks at the number, shape, and movement of sperm in the semen. It is usually done every few months after stopping testosterone. Some people may also need hormone blood tests to track LH, FSH, and testosterone levels. A rise in LH and FSH after stopping therapy is a good sign that the brain is signaling the testes again.

When Sperm Does Not Return

In rare cases, sperm production may not return even after many months. This may happen if testosterone therapy was used for a long time, if the person had fertility problems before treatment, or if there is damage to the testes. In such cases, doctors may suggest medications to help restart sperm production or talk about using frozen sperm (if available) or assisted reproductive techniques.

Stopping testosterone therapy often leads to the return of sperm production, but it takes time. Most people see recovery within 3 to 18 months. Recovery depends on personal factors such as age, duration of therapy, and overall hormone health. Regular testing and medical support can help guide the process and improve the chances of having children in the future.

What Are the Signs That Testosterone Has Affected Fertility?

Testosterone therapy can affect the ability to have biological children. This happens because testosterone treatment changes how the body makes sperm. There are signs and symptoms that may show fertility has been affected. These signs are not always easy to notice right away. Some people may not know something is wrong until they try to conceive. Understanding these signs early can help in getting proper care and support.

Testicular Atrophy (Shrinking Testicles)

One of the most common signs that testosterone therapy is affecting fertility is testicular atrophy. This means the testicles become smaller. The testicles are where sperm is made. When someone takes testosterone from outside the body (called exogenous testosterone), the brain thinks the body is making enough. As a result, the brain stops sending signals (through hormones called luteinizing hormone or LH and follicle-stimulating hormone or FSH) that tell the testicles to make both testosterone and sperm. Without these signals, the testicles can shrink.

Shrinking testicles often go unnoticed at first. It may not cause pain, and there may be no change in how the body feels. But smaller testicles usually mean a drop in sperm production. A person may also notice their scrotum (the skin around the testicles) feels less full than before.

Low Semen Volume

Another sign of fertility problems is a decrease in semen volume. Semen is the fluid released during ejaculation. It carries sperm from the testicles through the penis. When sperm production is reduced or stops, the semen may look thinner or there may be less of it. This can be a clue that testosterone therapy is affecting the sperm-making process.

It is important to know that semen and sperm are not the same. Semen is the fluid, and sperm are the cells inside it that can fertilize an egg. A person can have normal-looking semen but still have low or no sperm. So semen volume changes are only one part of the picture.

Decreased Libido or Sexual Drive

Changes in sex drive may also occur. Sometimes testosterone therapy improves libido, but in some cases, a person may notice a drop. This can happen if hormone levels become unbalanced. Low FSH and LH can cause problems with the way the body produces not only sperm but also other sex hormones. A lower sex drive can be a sign that the hormone system is not working properly.

Problems with Erections or Ejaculation

Some people may notice trouble getting or keeping an erection. Others may have changes in ejaculation, such as less force or a different feeling during orgasm. These problems are not always caused by fertility issues, but when they happen during testosterone therapy, they should be checked. They can be signs of low sperm count or other hormone problems.

Emotional and Physical Changes

Testosterone affects mood, energy, and general well-being. When fertility is affected, the body may also show other changes. These may include tiredness, sadness, or mood swings. Sometimes people feel frustrated or stressed, especially when they are trying to have children and are not succeeding. While these feelings do not directly mean sperm levels are low, they are common in people dealing with fertility issues.

Medical Testing to Confirm Fertility Problems

Many of these signs are not clear proof that fertility is affected. The only way to be sure is with medical tests. A semen analysis checks how many sperm are present, how they move, and how healthy they are. This is often the first test done when checking for fertility problems. Blood tests can also help. They measure hormone levels like testosterone, LH, and FSH. Low LH and FSH are strong signs that the body is not making sperm properly.

Doctors may also check testicle size during a physical exam. An ultrasound may be used to look for other issues in the reproductive system.

When to Get Help

Anyone who notices changes in semen, testicle size, or sexual function while on testosterone therapy should speak with a healthcare provider. People who plan to have children in the future should ask for a fertility check before or during treatment. Early testing can help find problems before they become serious or harder to fix.

Recognizing the signs of fertility changes early can help protect future chances of having biological children. Medical testing and expert care can guide the next steps, whether stopping testosterone therapy, switching treatments, or taking medicine to help the body make sperm again.

Is It Safe to Try to Conceive While on Testosterone Therapy?

Testosterone therapy, often called TT, is used to treat low testosterone levels in men and transmasculine individuals. While it can improve energy, mood, muscle mass, and sex drive, it also affects the body’s natural hormone system. One major concern for those on testosterone is how it impacts fertility.

Trying to conceive while using testosterone therapy is not recommended. This is because testosterone treatment can reduce or stop sperm production, making it very hard or even impossible to cause a pregnancy during the time the therapy is being used.

How Testosterone Affects Fertility

The body produces testosterone naturally through a system called the hypothalamic-pituitary-gonadal (HPG) axis. When testosterone is taken from outside the body, such as in the form of injections, gels, or patches, the brain gets the signal that there is enough testosterone in the body. As a result, the brain reduces the release of hormones called luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones are very important because they help the testicles make sperm.

When LH and FSH levels fall, the testicles stop making as much sperm. In many cases, sperm production can drop so low that there is no sperm in the semen at all. This condition is called azoospermia. In other cases, sperm counts may be very low, a condition called oligospermia. Both conditions make it difficult or impossible to cause a pregnancy through natural methods.

Conceiving While on Testosterone: What the Research Shows

Studies have found that up to 90% or more of people using testosterone therapy may develop azoospermia after just a few months of use. The risk is higher when higher doses are used or when treatment lasts for a long time. Because of this, doctors strongly advise against trying to conceive while continuing testosterone therapy.

Even though some people may still have small amounts of sperm in their semen while on testosterone, the chances of causing a pregnancy are very low. In rare cases where sperm is still present, the quality may also be poor, which further reduces the chance of success.

It is important to note that sperm quality does not only affect whether a pregnancy can happen, but also the health of that pregnancy. Poor sperm quality has been linked to a higher risk of miscarriage and certain birth problems, although these risks are still being studied in more detail.

Can Testosterone Harm a Partner or Baby?

There is no strong evidence that testosterone in semen directly harms a partner or unborn child. However, in some situations, especially if a partner is pregnant or trying to become pregnant, it is important to avoid skin contact with testosterone gels or creams. These forms of testosterone can be absorbed through the skin and may affect hormone levels in the partner. Because of this risk, care should be taken to wash hands and cover application sites properly if these products are used.

For transgender men, there is also a separate concern. If a transmasculine person becomes pregnant while still using testosterone, the hormone could affect the development of the fetus, especially in the early stages. Testosterone can be harmful to a developing baby, which is why doctors recommend stopping testosterone before trying to conceive and during pregnancy.

Medical Guidance on Conception and Testosterone Use

Medical experts, including endocrinologists and fertility doctors, agree that testosterone should not be used by anyone actively trying to conceive. Instead, a plan should be made with a healthcare provider to stop testosterone and allow the body time to start making sperm again. This process can take several months or longer.

In many cases, stopping testosterone is not enough, and other medicines may be needed to help the body restart sperm production. These include medications like hCG and clomiphene citrate, which support the brain and testicles in making sperm naturally.

Trying to conceive while using testosterone therapy is not considered safe or effective. Testosterone lowers the body’s ability to make sperm and may take months to reverse. There are also risks if a partner is pregnant or if pregnancy occurs while on testosterone. Anyone who wants to preserve fertility or start a family in the future should speak with a healthcare provider about stopping testosterone and exploring safe options to support fertility.

What Are the Alternatives to Testosterone for Preserving Fertility?

Testosterone therapy (TT) can reduce or stop sperm production in many people. This happens because the body thinks it is making enough testosterone and slows down its natural hormone signals. As a result, the testicles may stop making sperm. For those who want to maintain or restore fertility, there are safe and effective alternatives to traditional testosterone therapy.

Gonadotropins

Gonadotropins are hormones that can help the body make its own testosterone and produce sperm. These hormones include human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG), or recombinant follicle-stimulating hormone (FSH).

• hCG acts like luteinizing hormone (LH), which tells the testicles to produce testosterone. This helps raise testosterone levels in a natural way.

• hMG or FSH supports the growth of sperm cells. Together with hCG, it can improve sperm production over time.

Many studies show that using gonadotropins can restart sperm production in people whose fertility was affected by testosterone therapy. Treatment usually takes several months, and semen analysis is used to track progress. While it takes time, this method is often successful in helping people conceive.

Clomiphene Citrate (a SERM)

Clomiphene citrate is a selective estrogen receptor modulator (SERM). It works by blocking estrogen signals in the brain. This causes the brain to release more LH and FSH, which stimulate the testicles to make both testosterone and sperm.

Clomiphene is taken as a pill, usually several times a week. It has been used for decades in men with low testosterone who also want to keep their fertility. It raises natural testosterone levels without shutting down sperm production. In many cases, it even improves sperm count.

Clomiphene is generally well-tolerated, and side effects are usually mild. Some people may feel mood changes, vision problems, or headaches, but most do not have serious problems.

Aromatase Inhibitors (AIs)

Another option for preserving fertility is aromatase inhibitors, such as anastrozole or letrozole. These medications block the enzyme called aromatase, which turns testosterone into estrogen. By lowering estrogen levels, the body is encouraged to produce more LH and FSH. This results in increased natural testosterone production and support for sperm development.

Aromatase inhibitors are less commonly used than clomiphene or gonadotropins, but they can be helpful in specific cases. For example, people who have a high estrogen-to-testosterone ratio or who are overweight may benefit from these medications.

Side effects can include joint pain, decreased bone density, and changes in mood, but these are usually not severe when taken at the proper dose under medical supervision.

When Are These Alternatives Used?

These alternatives are usually considered in the following situations:

• A person is currently on testosterone therapy but wants to start a family.

• A person has low testosterone and wants treatment without affecting sperm production.

• A person has stopped testosterone therapy and wants to recover fertility faster.

Doctors who specialize in hormones or fertility will usually perform blood tests and semen analysis before starting treatment. These tests help find the best approach for each individual. Treatment plans are often adjusted based on results and goals.

Key Benefits of Fertility-Friendly Alternatives

Unlike testosterone therapy, these options:

• Support sperm production instead of stopping it.

• Boost the body’s own testosterone without shutting down natural hormone signals.

• Allow for family planning while still treating symptoms of low testosterone.

Using these medications gives people a chance to maintain or restore fertility without losing the benefits of hormone support. While not every option works for everyone, most people find one or more of these choices helpful when guided by a trained healthcare provider.

There are several safe and effective alternatives to testosterone therapy for people who want to preserve or regain their fertility. Gonadotropins, clomiphene citrate, and aromatase inhibitors all work differently, but they share a common goal: helping the body make its own testosterone while keeping sperm production going. These treatments are best used under the care of an experienced doctor who can monitor progress and adjust the plan as needed. With the right support, many people can improve both their hormone levels and their chances of starting a family.

Can You Bank Sperm Before Starting Testosterone Therapy?

Testosterone therapy can greatly reduce or even stop sperm production. This can make it hard or impossible to father a child while on treatment. Because of this, sperm banking is often recommended before starting testosterone therapy. Sperm banking is a safe and proven way to preserve fertility.

What Is Sperm Banking?

Sperm banking is the process of collecting, freezing, and storing sperm for future use. The frozen sperm can later be used for assisted reproductive techniques such as intrauterine insemination (IUI) or in vitro fertilization (IVF). The goal is to have healthy sperm available in case natural conception becomes difficult or impossible later.

The sperm is frozen using a process called cryopreservation. This process keeps sperm cells alive for many years. Frozen sperm can be stored for decades and still be usable. Many people have had healthy children using sperm that was frozen years earlier.

Why Bank Sperm Before Starting Testosterone?

Testosterone therapy can shut down the body’s natural hormone signals that tell the testicles to make sperm. This can cause sperm count to drop to very low levels, or even to zero. This effect may take just a few weeks or months to happen after starting testosterone. Once sperm production stops, it often takes many months to return after stopping therapy — and in some cases, it may not fully come back.

Banking sperm before starting testosterone ensures that there is a backup plan for having biological children later. It gives peace of mind to those who may want children someday, even if they are not planning to start a family right away.

For transgender men and people with hypogonadism (low testosterone levels), sperm banking can be especially helpful. Testosterone therapy is often a long-term or lifelong treatment. Having stored sperm before starting helps preserve the option for future fertility, without the need to stop treatment later.

How Is Sperm Collected for Banking?

Sperm is usually collected through masturbation into a sterile cup at a sperm bank or fertility clinic. The clinic then checks the sample for sperm count, motility (movement), and shape. In most cases, several samples are collected over a few days or weeks to get a good number of high-quality sperm for freezing.

Some people may feel nervous or uncomfortable with the process. Clinics are used to this and work hard to make people feel safe and respected. In certain situations, if masturbation is not possible, other options such as sperm retrieval procedures may be used. These are done under medical care and are more invasive.

It is helpful to avoid ejaculation for two to five days before collecting a sample. This gives the best chance of getting a high sperm count.

How Much Does Sperm Banking Cost?

The cost of sperm banking includes both the initial collection and long-term storage fees. The collection and testing process usually costs a few hundred dollars. Storage can cost about $300 to $600 per year, depending on the clinic and location.

Some health insurance plans may cover part of the cost, especially when fertility may be affected by medical treatment. It is important to check with both the clinic and the insurance provider before beginning.

How Successful Is Sperm Banking?

Frozen sperm works well for future pregnancy, especially when frozen before testosterone affects fertility. The success of using frozen sperm depends on several things, including the age and health of both partners and the method of fertility treatment.

Sperm frozen before testosterone therapy usually has good quality. Pregnancy using frozen sperm is common and safe. Many couples use IUI or IVF, depending on the sperm count and the health of the female partner or gestational carrier.

Even if natural fertility returns after stopping testosterone, there is no way to know how long that will take or how strong the sperm will be. That’s why many doctors recommend sperm banking early, before starting treatment.

When Should Sperm Be Banked?

The best time to bank sperm is before the first dose of testosterone is taken. Once hormone treatment begins, sperm production may begin to shut down quickly. It is safest to collect samples while the body is still producing healthy sperm.

People who are thinking about starting testosterone should talk to their doctor or a fertility specialist as early as possible. This helps ensure that sperm can be banked at the right time, without rushing or missing the window.

Sperm banking is a reliable way to protect fertility before starting testosterone therapy. It allows people to preserve the chance to have biological children in the future. The process is safe, widely used, and supported by doctors and fertility experts. Planning ahead can make a big difference later, especially when fertility is affected by long-term hormone treatment.

What Should Transgender Men Know About Fertility and Testosterone?

Testosterone therapy is an important part of gender-affirming care for many transgender men. It helps with physical changes like deeper voice, facial hair, and muscle growth. But testosterone also affects the reproductive system, including fertility. For those who may want biological children, it’s important to understand how testosterone changes the body and what options are available for having kids.

How Testosterone Affects Fertility

Testosterone is not a form of birth control, but it often stops periods and ovulation. Ovulation is the release of an egg from the ovaries. Without ovulation, it becomes very hard to get pregnant. In most cases, taking testosterone causes the ovaries to stop working normally.

Even though testosterone usually prevents pregnancy, there are rare cases where ovulation still happens. Because of this, pregnancy is still possible, even when someone is on testosterone and not having periods.

Long-term testosterone use can also shrink the ovaries and change the uterus. Some research suggests this may lower egg quality or reduce fertility over time. However, more studies are needed to fully understand these changes.

Is Fertility Loss Permanent?

Fertility changes caused by testosterone are often temporary. Many transgender men who stop testosterone therapy see their periods return in a few months. Ovulation may also return, which means natural pregnancy is sometimes possible.

However, the longer someone stays on testosterone, the harder it may be to recover normal fertility. Some people regain full fertility, while others may have more difficulty. Age, health, and how long someone has been on hormones all play a role.

Egg Freezing Before Starting Testosterone

Freezing eggs before starting testosterone is the best way to preserve future fertility. This process is called oocyte cryopreservation. To freeze eggs, a person takes hormone injections for 10 to 14 days to help the ovaries release multiple eggs. Then, a doctor collects the eggs in a short medical procedure. The eggs are frozen and stored until they are ready to be used.

This process can be physically and emotionally hard. It often requires stopping testosterone during the preparation, which may lead to gender dysphoria. However, it gives the best chance for future biological children.

Embryo Freezing as Another Option

Embryo freezing is similar to egg freezing. The main difference is that the eggs are fertilized with sperm before freezing. This may be a good choice for someone who has a partner or sperm donor. Embryos often survive freezing and thawing better than eggs alone, so success rates can be slightly higher.

Like egg freezing, embryo freezing requires stopping testosterone for a short time and going through the same preparation process with hormone shots.

Ovarian Tissue Freezing for Special Cases

Ovarian tissue freezing is a newer and less common option. In this method, small pieces of the ovary are removed and frozen for future use. Later, the tissue can be placed back into the body to help restore hormone function and possibly fertility.

This method is still being studied. It is usually used for young people or for those who cannot go through the full egg stimulation process. It is not widely available and may not work for everyone.

Can Transgender Men Get Pregnant After Stopping Testosterone?

Yes, pregnancy is possible after stopping testosterone. In most cases, periods return within a few months. Once ovulation starts again, natural pregnancy may be possible.

Some transgender men choose to carry a pregnancy themselves. This can be safe for both the parent and the baby, but it may bring emotional challenges. Stopping testosterone may cause distress, especially if unwanted changes like breast growth or mood changes return.

Support from medical providers, therapists, and support groups can help during this time.

Other Ways to Have Children Without Pregnancy

Not all transgender men want to carry a pregnancy. Some may choose to use a gestational carrier. A gestational carrier is someone else who carries the pregnancy using eggs or embryos from the transgender parent.

For example, if eggs were frozen before starting testosterone, those eggs can be fertilized and placed in a gestational carrier later. This option allows someone to have a biological child without stopping hormones long-term or going through pregnancy themselves.

When to Talk to a Fertility Specialist

The best time to talk to a fertility doctor is before starting testosterone. A specialist can explain what options are available based on age, health, and personal goals. They can also help make a plan for preserving fertility.

It’s also important to have a doctor who understands transgender health. Working with a supportive medical team can make the process easier and more comfortable.

Planning for the Future

Starting testosterone does not always mean giving up the chance to have children. With early planning and the right care, many transgender men are able to build families later on. Whether someone wants to carry a pregnancy, use a gestational carrier, or freeze eggs or embryos, there are options available.

Making informed choices before starting hormone therapy helps keep more doors open in the future. Talking with experienced medical providers can make a big difference in reaching both gender and family goals.

What Do Endocrinologists and Fertility Specialists Recommend?

Doctors who treat hormone problems and fertility issues often work together to help people who want to conceive while on testosterone therapy. These experts include endocrinologists, who manage hormone levels, and fertility specialists, such as reproductive endocrinologists and reproductive urologists, who help with sperm or egg health and fertility treatments. Their advice depends on the reason someone is taking testosterone, how long they’ve been on it, and what their goals are for having children.

Why Expert Guidance Is Important

Testosterone therapy (TT) can lower the brain’s signal to the testicles or ovaries. When this happens, the body often stops producing sperm or releasing eggs. Because of this, it can be harder—or even impossible—to conceive while taking testosterone. Many people do not know this before starting treatment. Doctors recommend talking to a fertility specialist or hormone doctor before starting testosterone if there is any chance of wanting children in the future.

Fertility doctors use blood tests and imaging to check how well the body is still producing sperm or eggs. These tests include hormone levels such as luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol, as well as semen analysis or ultrasound of the ovaries, depending on the person’s sex assigned at birth. These tests give doctors a better idea of how the body is reacting to testosterone and whether fertility is still possible.

What the Endocrine Society Recommends

The Endocrine Society is a leading group that creates medical guidelines for hormone care. Their recommendations say that testosterone should not be used as a form of birth control, but that people on testosterone often become infertile. They also stress that anyone thinking about having children in the future should be warned that testosterone may lower or stop fertility, sometimes for a long time.

If someone wants to become pregnant or father a child, the Endocrine Society advises stopping testosterone therapy under the care of a doctor. They also recommend offering options like sperm banking or egg freezing before starting testosterone if the person may want to have children later.

What Fertility Specialists Recommend

Fertility specialists use different treatments to help restore fertility in people who have taken testosterone. For people assigned male at birth who want to produce sperm again, doctors may stop testosterone and use medicines like:

• hCG (human chorionic gonadotropin) – a hormone that tells the body to make more testosterone naturally, inside the testicles.

• FSH (follicle-stimulating hormone) – often given with hCG to restart sperm production.

• Clomiphene citrate – a pill that increases the brain’s signals to make natural testosterone.

• Anastrozole or letrozole – pills that lower estrogen, which helps balance hormones and protect sperm production.

These medicines can take 3 to 12 months or more to work. In many cases, sperm return slowly, and regular semen testing is needed to track progress. Some people may not fully recover sperm production, especially if they have been on testosterone for many years without a break.

For people assigned female at birth who are taking testosterone as part of gender-affirming therapy, fertility specialists recommend stopping testosterone at least 3 to 6 months before trying to become pregnant. Ovulation (the release of eggs) may return during this time, but doctors may also use medications to help the ovaries work again. If fertility does not return, options like in vitro fertilization (IVF) using previously frozen eggs or embryos may be offered.

The Role of a Team Approach

Doctors agree that a team approach works best. A reproductive endocrinologist can help with egg or sperm health and offer fertility treatments. A reproductive urologist focuses on sperm recovery for people with male anatomy. An endocrinologist can safely manage hormone levels during the fertility process. Mental health support may also be helpful, especially for transgender individuals who may feel distress when stopping testosterone.

By working together, these experts can create a plan that matches each person’s medical needs, gender identity, and goals for having children. The care plan may include stopping testosterone, using fertility medicines, storing sperm or eggs, or using assisted reproductive technologies.

Planning Ahead Makes a Difference

Doctors strongly encourage early planning. Even if someone is not ready to have children now, thinking about the future is key. Many fertility options work best before testosterone therapy begins or in the early stages of treatment. Having open, honest talks with doctors helps ensure that the right steps are taken, and fertility is protected as much as possible.

Overall, expert care can make a big difference. With the right support and treatment, many people who have taken testosterone can still have biological children.

Conclusion

Testosterone therapy can be a helpful treatment for people who have low testosterone levels. It can improve mood, energy, and sexual health. But when someone is trying to have a child, testosterone therapy can make it harder to conceive. This is because taking testosterone from outside the body tells the brain to stop sending signals to make sperm. When this happens, sperm production in the testicles can slow down or stop completely.

This effect on fertility is usually not permanent, but it can take time to reverse. In many cases, sperm production starts again after stopping testosterone therapy. The amount of time it takes can be different for each person. For some, it may take a few months. For others, it could take over a year. Age, how long testosterone has been used, and overall health can affect how quickly sperm comes back. That is why it's important to plan ahead when thinking about having children.

There are signs that may show fertility is being affected. These include smaller testicles, lower semen volume, and changes in sexual desire. Testing hormone levels and doing a semen analysis can help find out if fertility is reduced. These tests can also guide doctors in making a plan to help bring back sperm production.

Trying to conceive while still using testosterone therapy is not usually advised. Most people on testosterone will have very low sperm counts, sometimes even zero. This makes it very hard to get pregnant naturally. Also, testosterone therapy does not help with sperm production—it does the opposite. It is a form of birth control for many people. Because of this, medical experts usually recommend stopping testosterone when trying to start a family.

There are ways to support fertility while managing low testosterone. Doctors may use medicines that help the body make its own testosterone instead of giving testosterone from outside. These medicines include hCG (human chorionic gonadotropin) and SERMs like clomiphene citrate. These treatments tell the brain to keep making the hormones that help produce sperm. They may not work for everyone, but they are often a good first step for people who want to stay fertile.

Some people choose to freeze their sperm before starting testosterone therapy. This is called sperm banking. It can be a smart way to protect future fertility. The sperm can be used later for fertility treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF). Freezing sperm is safe and can be done at most fertility clinics.

For transgender men, fertility planning is also very important. Long-term testosterone therapy can stop ovulation and affect egg quality. However, fertility may return after stopping testosterone. Some transgender men are able to become pregnant naturally or through assisted methods. Others choose to freeze eggs or embryos before starting hormone therapy. These decisions can be personal and complex. Speaking with a fertility doctor can help make the best choice.

Doctors who specialize in hormones and fertility offer helpful guidance. Endocrinologists understand how testosterone therapy affects the body. Fertility specialists can give options for protecting or restoring the ability to have children. Some people need a team of doctors working together to create a plan that supports both hormone needs and family goals. Starting this planning early makes it easier to make informed decisions.

Fertility and hormone health do not have to be at odds. With the right support, many people are able to stop testosterone, recover sperm or egg function, and go on to have children. The most important step is to talk to a healthcare provider before starting or continuing testosterone therapy, especially if having children in the future is important. Medical advice and careful planning give the best chance of reaching both health and family goals.