Q&A: TRT and Fertility

Our team sat down and talked to one of our fertility doctors, Dr. Joseph Bird III, to discuss TRT Therapy and fertility. Watch the video below to see the full interview or read our transcript to learn more.

What is TRT Therapy?

TRT therapy is testosterone replacement, for those that have excessive fatigue that are associated with some form of hypogonadism. It usually is managed by some sort of injectable testosterone. Although, there are a couple other therapies that particular places use to sort of naturally support the testosterone level.

What are the side effects of using testosterone? Does it affect fertility?

We know that in a select few patient populations, and we have a very difficult time predicting who these will be, that if you give yourself testosterone as an injection, it can shut off the pituitary gland that’s responsible for stimulating sperm production and the natural local levels of testosterone in the testes and can affect fertility.

There are some that will be heavily impacted, some that will be minorly impacted, and there are a few that will not be impacted at all. But in those that are experiencing infertility with TRT therapy, it’s very important that we know that in advance.

Are there treatments to raise testosterone and help fertility?

The recommendation if we do a semen analysis and realize that your sperm levels are impacted by that testosterone therapy. Our recommendation is that we either reduce that therapy and add something or stop that therapy entirely.

Some things that we can do very similar to the female side of it is Clomid is a medicine that can try and boost natural testosterone production at the level of the testes while also protecting sperm production and development. If for some reason that doesn’t work, there is an injectable form of medicine called HCG that stimulates the testes to produce more sperm if they’re responsive to it. And we can try either one of those therapies to try and produce sperm again after testosterone therapy.

How long does it take for natural testosterone production to return?

Testosterone production, if there is any native production that was happening, should return pretty quickly after stopping testosterone therapy. Probably within four to six weeks from the time that you stop it, the body will start producing again. We do know that the life cycle of sperm production and maturation is about, six to eight weeks, around that time as well. And so if we take you off of a therapy and start you on another therapy with the goal of trying to produce more sperm, we do know that it will take a little bit of time for the body to recover.

What can a man to do help improve his fertility?

Probably the best thing that we have to promote overall fertility in men is taking a look at sort of the big three areas of lifestyle, primarily tobacco or nicotine consumption, caffeine consumption is another one. The current recommendation is no more than about a cup of coffee a day. As well as alcohol consumption. Trying to limit that as much as possible, maybe one or two drinks a week at most. Although, if we can cut it out entirely, we do know that that can improve things.

The other thing that we don’t utilize as much is our diet. Reducing ultra-processed foods, trying to shop on the outside of the aisles, whole foods, whether that be the whole vegetable, the whole fruit, whether meats that you cook on your own, versus the ultra-processed foods. And then the other sort of antioxidant access that we don’t utilize as much is exercise. Thirty to forty-five minutes of moderate-intensity exercise is associated with overall health improvement, and as much as we can improve our health, we can also improve our reproductive health.

How is male fertility tested?

Semen analysis is probably the best way to get a look into a male’s contribution to fertility.

Our best specimens are with anywhere from two to four days of abstinence, and we need to evaluate that specimen within an hour of collection. There’s sort of four major criteria of any semen analysis that we are interested in. The first one is seminal volume. How much seminal fluid do we have? The next one is considered count or concentration. It goes by two different names. And we’re looking at how many million sperm per milliliter of that fluid is present.

The other things that we look at is motility. How many of them are moving as a reflection of their vitality and their likelihood of making it to the location that they need to achieve pregnancy. And the final one, which is a more specialized test, but we believe is a reflection of fertilization and potentially the genetic material inside the sperm. We call that strict criteria morphology. It’s a reflection of the shape of the sperm head as a reflection of the things that I mentioned earlier. And we use all four of these things to determine, are there any significant inefficiencies in the male side from a fertility perspective?