Men rarely see Thomas J. Weida, MD, for medical tests without prodding from a wife or girlfriend. When they do show up, Weida jokes that he “can see the drag marks on the carpet.”
It’s amusing, of course. But it can quickly turn serious when a man ignores important symptoms. Weida says he knows of men who got away with ignoring chest pain for a couple of weeks. Eventually, though, they died of heart attacks.
But if you want to have children, there's one downside to TRT you should know about. It gives you back your sex life, but it might also reduce your ability to father children as long as you're on it.
"Testosterone replacement therapy has a profound impact on a man's reproductive potential," says urologist Michael Eisenberg, MD. He's director of male reproductive medicine and surgery at Stanford Hospital and Clinics in Palo Alto, Calif.
"In fact," Eisenberg says, "it's been studied as a method of birth control, because 90% of men can drop their sperm counts to zero while on testosterone. By increasing testosterone, you're not going to increase fertility."
Testosterone and Fertility
Testosterone plays an important role in making sperm.
Eisenberg describes the relationship between testosterone and sperm production as part of a "feedback loop." Here's how the system works.
Your brain makes special hormones, called gonadotropin-releasing hormones (GnRH). These hormones signal the testes to make more testosterone, vital for a healthy sperm count.
When you're getting testosterone replacement therapy, testosterone is added into the bloodstream by patches, gels, or other treatment methods.
Your brain interprets this rise in testosterone levels as a sign that you now have enough testosterone. So it stops sending signals to the testes to make more testosterone. But when your testes don't make more testosterone, your sperm production goes down.
A low sperm count makes it harder to conceive a child.
"If you have any kind of reproductive goal, you should not be using TRT," says Eisenberg.
Endocrinologist Spyros Mezitis, MD, PhD, agrees. "You want to increase the patient's own testosterone production in order to get an appropriate sperm sample for pregnancy," says Mezitis, who practices at Lenox Hill Hospital in New York City. "When testosterone comes from the outside, it suppresses the body's production of sperm."