Testosterone Deficiency Treatment & Fertility


Hi, I’m Dr. Caplan from Helios Telemedicine for Men.  Our topic today is, Testosterone Deficiency Treatment and Fertility

You’ve been diagnosed with symptomatic testosterone deficiency (male hypogonadism) and want to feel better, but you’ve heard that testosterone replacement therapy can cause fertility issues and you want kids in the future.  Great.  Remember that the testes Sertoli cells make sperm based, in-part, on their stimulation by Follicle Stimulating Hormone (FSH) in conjunction with testosterone stimulated by Luteinizing Hormone (LH) from the pituitary gland, and that testosterone replacement therapy essentially turns off the hypothalamic stimulation of the pituitary gland, cutting of the flow of LH and FSH.  So what’s a guy to do?

What Are Your Options?

If you’ve been watching my prior videos, you know that you could have secondary hypogonadism or a milder case of the primary form.  If this is the case, assuming you don’t have infertility for other reasons, your clinician may recommend trying to stimulate the hypothalamic-pituitary-testes axis to see if we can relieve your symptoms without inhibiting the pituitary’s release of FSH and LH and avoiding the risk of therapy induced infertility.  You could also try taking a hormone called human chorionic gonadotropin.  Human chorionic gonadotropin is a hormone produced by the placenta to support the uterus during pregnancy.  When it is injected in men, it simulates LH and FSH, and could stimulate enough testosterone production to relieve symptoms of testosterone deficiency without causing the sperm count to fall.  

What If You Have To Go To Testosterone Replacement Therapy?

Some physicians recommend getting a semen analysis and, potentially, freezing your sperm prior to starting testosterone replacement therapy if you are concerned about having children.  While that seems drastic and is expensive, it gives you the best chance of parenthood if you do develop a lower sperm count or make sperm of lower in vitality while on testosterone.  The sperm count or quality doesn’t go down on testosterone in everyone and it may recover on its own if the therapy is stopped, but it may not.  

OK, what can we do to prevent the sperm count from falling in the first place while on testosterone?  We can administer Menopur and similar medications that contain LH and FSH, FSH preparations, a hormone called Human Menopausal Hormone (HMG) that simulates FSH, or a hormone called HCG to simulate LH and FSH.  Even if it couldn’t correct the low testosterone levels, it may still work on the Sertoli cells and preserve fertility.  The hypothalamus is inhibited from releasing GNRF ab estradiol, which binds to receptors in the hypothalamus.  This means less stimulation on the pituitary gland and less sex hormone release.  We can also use a medication called Clomiphene (Clomid) and/or supplements to block the estrogen receptors and stimulate LH and FSH production and release by the pituitary.  We could also try using aromatase inhibitors like Anastrozole (Arimadex) or DIM to block the aromatase enzymes in the fat cells from converting of testosterone to estradiol in the first place.  

If you find you cannot conceive or if an analysis shows that your sperm count did go down while on medically supervised testosterone replacement therapy, it is likely to improve if we stop the testosterone.  It may take as long as six months, but it does improve in the majority of men.  If it doesn’t, you will most likely be referred to a fertility specialist who may try larger doses of Clomid and/or Anastrozole than typically given out in men’s health clinics.  They usually have success with establishing a pregnancy; whether it is through the natural way or through a procedural process.  It’s the self-medicators, those who get their anabolic steroids from a friend, on line, or at the gym who they have the lowest success rate with.  


In the meantime, you can get started with our complementary self-assessment.  You can watch all of our videos and posts on Facebook and Instagram.  Thanks for your time and attention.


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