By Masaya Jimbo, RMA Philadelphia
The opinions in this blog do not necessarily reflect the values, opinions, or stances of Men’s Health Network.
Testosterone talk has taken over men’s health media. Once a topic confined to medical clinics and bodybuilding gyms, the promise of testosterone supplementation or replacement therapy, including increased muscle mass, improved energy and mood, and improved sexual desire and performance, is now everywhere. From magazines and medical publications to media, podcasts, YouTube, TikTok and Instagram, they are all pushing the same message: more testosterone means a better you.
While testosterone use can certainly produce positive results, it can also cause undesirable side effects such as acne, hair loss, sleep disorders like obstructive sleep apnea, and heart disease. The least understood and possibly most devastating consequence testosterone can cause is testicle shrinkage and infertility in men.
The rise in testosterone supplementation may be a serious obstacle to reversing declining birth rates and may be creating a fertility crisis for many young men.
It’s time to clear up the most common myths around testosterone therapy and fertility.
Myth 1 – Testosterone therapy enhances fertility.
No, it doesn’t. Testosterone is a critical hormone responsible for several important bodily functions. At healthy levels, it can increase motivation, reduce pain perception and, as the neuroscientist and podcaster Andrew Huberman said, “make effort feel good.” For all its potential benefits, however, testosterone therapy does not enhance fertility, and in fact can severely hurt it.
Once a man starts taking exogenous testosterone, the brain and testicles sense high levels of testosterone in the body and simply stop working normally. The brain stops producing key reproductive hormones, which in turn causes the testicles to shrink and stop making testosterone.
For sperm production, testosterone level within the testicles is critical. Since men on exogenous testosterone have very low intratesticular testosterone, sperm production also declines. Severe infertility can develop quickly and within three to four months of starting testosterone, about 2/3 individuals end up with no sperm in their semen, a condition known as azoospermia.
Myth 2 – After stopping testosterone use, your natural testosterone and sperm production will recover quickly.
Generally, it takes three to six months for men to recover testosterone and sperm production. Depending on the person and how long they have been on testosterone and at what doses, recovery can take longer, even up to three years! In general, longer duration of testosterone use, higher doses of testosterone, and use by older individuals are associated with slower and less complete recovery. In a minority of people, sperm counts may never recover to normal values, necessitating infertility treatments or donor sperm to build a family.
Myth 3 – Testosterone is safe to use without doctor supervision.
Using testosterone without supervision at inappropriate doses can lead to a variety of complications aside from infertility, such as heart attack, heart failure, blood clots, and sudden death.
Obtaining a testosterone prescription under the guidance of a qualified medical provider, such as a urologist, may provide appropriate counseling on the reproductive consequences of its use. Unfortunately, many reproductive-age men obtain their testosterone through non-medical channels and don’t get any medical counseling. This is why men should be skeptical of the countless offers on social media that promise quick and easy access.
Myth 4 – Testosterone use only affects one fertility timeline.
While it’s true that most individuals do recover sperm production, many of these men may also have a female partner who is experiencing an age-related decline in fertility. Female reproduction affects family-building equally to men, so any additional delays are consequential within the family-building partnership. Female fertility begins to decline at 35 and especially at 37. If the female partner is already 35 and wants multiple children, they don’t have the luxury of waiting months or years for sperm counts to recover to levels typically needed for natural conception. Men who have previously taken testosterone and didn’t recover quickly enough may need to proceed with fertility treatments such as IVF.
Some young men may require testosterone therapy for legitimate medical reasons, such as those with certain genetic conditions or a history of cancer treatment. Men who are interested in having biological children in the future (even if they are unsure) should avoid taking testosterone products. The impact on long-term health and fertility can be serious, and in some cases, irreversible.
The good news is that there are proven, natural ways to support healthy testosterone levels. Strength training, maintaining a healthy body weight, reducing stress, getting high quality sleep, limiting alcohol intake, and eating a balanced diet rich in nutrients can all make a measurable difference.
Even for young men who have been diagnosed with low testosterone levels and need treatment, there are different types of medications available that can help stimulate the body’s own production of testosterone, helping to restore hormonal balance and preserve fertility.
About the Author:
Masaya Jimbo, MD, Ph.D. – He completed his Urology residency at the Mayo Clinic and his subspecialty fellowship in men’s health, male infertility, and microsurgery at the University of Utah in Salt Lake City. He was drawn to Urology because it allows him to own his patients carefully—from the workup and medical management to necessary surgeries. 15% of couples are infertile, and in 50% of the cases, there is a male-related issue. His motivation is knowing he can help so many men overcome this hurdle.