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Testosterone Replacement and Preserving Fertility

Updated: Apr 4, 2023

The number of men who are seeking treatment for low testosterone is on the rise. Today, there is a greater awareness of low testosterone symptoms and the associated health risks, leading more and more men to request their physicians check testosterone levels. There are several potential causes of low testosterone, so when found, it should always be worked-up prior to starting treatment. A good number of low testosterone cases are considered idiopathic secondary hypogonadism, a fancy medical term for “we don’t know why your brain is not telling your testes to produce adequate testosterone”. But HOLD ON! Don’t start testosterone replacement yet! When treating low testosterone in a younger man, or any man wanting to preserve fertility, you need a knowledgeable physician in your back pocket.

Do I Need to Preserve Fertility?

Let’s get down to the nitty gritty science. When taking testosterone replacement, the brain will sense a (now) appropriate amount of hormone in the body and thus, will tell the testes to further decrease its natural production of testosterone (no need to make extra testosterone when I’m already getting enough elsewhere). For most men this is not big deal. But for men who still wish to have their own biological children, this poses a real problem. Without enough testosterone being produced inside the testicles, sperm production halts. No sperm = No baby. So for these gentlemen, a different treatment approach needs to be taken.

Should I Use Testosterone or Other Medication?

The currently FDA approved non-testosterone medication for low testosterone is human chorionic gonadotropin (hCG). Another medication often used off-label is called clomiphene citrate (Clomid). Although these medications work differently, they both work on the brain, increasing communication to the testes to produce more intratesticular testosterone. This increases testosterone level while also supporting sperm production. Win! For men who have not yet started testosterone replacement, these medications can be (and really should be) used alone to increase testosterone level. Research has shown they alone can produce significant increases in testosterone, particularly in younger men. For men already on testosterone replacement, or who choose to initiate testosterone replacement aware of the fertility risk, augmenting with these medications may be helpful in preserving fertility. Although no treatment guidelines have been established, studies have suggested protocols that may involve adding one or both medications onto testosterone replacement, or completely cycling off testosterone for a short period and onto one or both alternative medications. In all scenarios, frequent semen analysis can be performed to monitor fertility.

In sum, I commend all the men who are being proactive with their health and checking testosterone levels! But for those who wish to preserve fertility, before beginning testosterone replacement, talk with your doctor about alternative treatment options. Make sure you feel fully educated and comfortable with your chosen treatment.

If you are interested in getting your testosterone levels checked and discussing your health concerns, schedule an initial consultation with me at Twin Cities Integrative Medicine in Maple Grove, MN. I look forward to helping you on your journey to health and wellness.

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