Can i get my wife pregnant on trt
For many, having children is the adventure of a lifetime. According to the U. Couples are considered to be dealing with infertility if they have had unprotected intercourse at least two to three times a week for a year and are not pregnant. For couples in which the female is 35 or older, an infertility work-up should be done after six months of unsuccessful attempts to conceive. Most of the time, there is an explanation with one of the partners. An irregular or absent period can be a sign that a woman is not ovulating.
SEE VIDEO BY TOPIC: Clomid for Men - Clomid for TRT - Clomid for Low Testosterone - Clomid for Men's FertilityContent:
- TRT and Fertility – how to get the best of both worlds - part 1
- Low Testosterone & Fertility
- Would-be dads should think twice before trying low-testosterone therapies, experts say
- Hypogonadism -- Male - has anyone concieved while on low T therapy?
- Blogs by Shona Murray, MD
- Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility
- Testosterone Replacement Therapy and Fertility
- Testosterone Effect on Sperm
- Testosterone Replacement and Your Sperm Count: What’s the deal?
- Can testosterone replacement therapy (TRT) make a man infertile?
TRT and Fertility – how to get the best of both worlds - part 1
Testosterone has a variety of functions and is commonly used in older men to treat symptoms of hypogonadism, such as decreased libido, decreased mood and erectile dysfunction.
Despite its positive effects on sexual function, it has a negative effect on fertility. Exogenous testosterone therapy can negatively affect the hypothalamic-pituitary gonadal axis and inhibit the production of follicle stimulating hormone and luteinizing hormone. The purpose of this review is to discuss the contraceptive properties of testosterone therapy and to discuss strategies to increase testosterone in men with the desire to preserve fertility.
Testosterone is a pleiotropic hormone that plays various physiological roles in the development of male genitalia in utero and during puberty. Classically, testosterone is a hormone associated with masculinity. Testosterone is used as treatment for males with late onset hypogonadism, a condition in men who experience symptoms caused by a decrease in serum testosterone.
The use of testosterone replacement therapy TRT among men over the age of 40 years has increased more than 3-fold over the last decade [ 1 ]. Exogenous testosterone comes in various preparations and each form carries various risks. Along with an increase in hematocrit, a major adverse effect of TRT is the diminished sperm production because of the decreased intra-testicular concentration of testosterone and suppression of the hypothalamic-pituitary-gonadal HPG axis [ 2 , 3 , 4 ].
Suppression of follicle stimulating hormone FSH release from the pituitary gland impairs sperm production and suppression of luteinizing hormone LH release inhibits intra-testicular testosterone production. The purpose of this review is to evaluate the contraceptive effect of testosterone, discuss how the use of exogenous testosterone can negatively impact a man's fecundity and identify the importance of family planning in men who are planning to receive TRT. In healthy adult men, testosterone production is precisely regulated by the HPG axis.
Higher cortical centers in the brain signal the hypothalamus to secrete gonadotropin-releasing hormone GnRH in a pulsatile fashion. GnRH in turn stimulates the release of LH and FSH from the anterior pituitary which modulates testosterone production from the Leydig cells and spermatogenesis by the Sertoli cells, respectively.
As testosterone levels increase, negative feedback suppression is exerted on the androgen receptors in the hypothalamic neurons and pituitary gland, thereby inhibiting the release of GnRH, FSH and LH [ 5 ]. The Endocrine Society and American Urological Association AUA recommends treating symptomatic men with low testosterone documented on two morning fasting serum total testosterone concentrations.
Both organizations recommend against the use of testosterone for treatment of hypogonadism in men who desire fertility in the next 6 to 12 months [ 3 , 4 ]. The exogenous administration of testosterone suppresses the release of gonadotropins FSH and LH to levels below that required for spermatogenesis. Spermatogenesis is largely dependent on the action of FSH on Sertoli cells coupled with high intra-testicular testosterone concentrations.
Within the seminiferous tubules, only Sertoli cells possess receptors for both FSH and testosterone. It acts synergistically with testosterone to increase fertility and the efficiency of spermatogenesis [ 6 ]. The inhibition of LH release by exogenous testosterone leads to the suppression of endogenous testosterone production by the Leydig cells. The decreased intra-testicular testosterone combined with the suppression of FSH leads to decreased germ cell survival and maturation Fig. Intra-testicular testosterone is required in spermatogenesis for the formation of the blood-testis barrier BTB.
The BTB is a series of tight and adherens junctions between the Sertoli cells that separates postmeiotic germ cells in the adluminal compartment of the seminiferous tubules from the basal compartment containing the blood supply.
During spermatogenesis, the BTB is disrupted and reformed as preleptotene spermatocytes pass through this barrier. In the absence of testosterone stimulation, spermatogenesis can only proceed as far as the prophase 1-leptotene stage of meiosis [ 7 ]. Testosterone is also required in maintaining connections between Sertoli cells and the haploid spermatid germ cells.
Round spermatids are initially connected to Sertoli cells via desmosomes. As the spermatids mature and elongate, the desmosomes are replaced with stronger, specialized adherens junctions called ectoplasmic specializations, which are maintained until the release of mature sperm.
Testosterone aids in this process and increases the efficiency of germ cell attachment to Sertoli cells. Testosterone is also essential for the release of mature spermatozoa from Sertoli cells. It has been shown that in the absence of testosterone stimulation, sperm are not released but are instead phagocytized by Sertoli cells [ 7 ].
Ultimately, the low intra-testicular testosterone results in decreased proliferation of spermatogonia, defects in spermiation of mature spermatozoa by Sertoli cells and accelerated apoptosis of spermatozoa [ 8 , 9 , 10 , 11 ]. All men in these studies recovered to baseline levels after cessation of therapy; however, it took up to 2 years for some men to recover. These studies were performed in a controlled setting for a clinical trial, with a limited duration of testosterone use.
In actual practice, recovery may not be as pronounced. Kohn et al [ 16 ] studied spermatogenesis recovery with human chorionic gonadotropin hCG and selective estrogen receptor modulators SERM in men with infertility associated with testosterone use. Thirty percent of the 66 men were not able to achieve a total motile sperm count of more than 5 million after 12 months in the study.
They found that the failure of recovery is associated with older patients and longer TRT duration. If fertility is affected because of TRT, couples may require the use of in vitro fertilization or intra-cytoplasmic sperm injection for future conception.
These assistive reproductive technologies are expensive and are not always successful [ 17 , 18 ]. In summary, despite the androgenic effects of testosterone on sexual function, libido and mood; its effect on gonadotropins leads to the inhibition of sperm production [ 13 ]. This effect may diminish with the cessation of testosterone intake, but the extent of recovery is not clear for chronic users [ 16 , 19 ]. Compared to the long list of contraceptive options available to women, men are limited to vasectomy and condoms.
As it is a user-dependent method, many couples seek easier to use options like female oral contraceptive pills or intrauterine devices [ 22 ]. However, there is a demand for alternatives.
In , a newly available oral testosterone preparation known as testosterone undecanoate TU was investigated as a possible form for male contraception. The study found that regular testosterone use for 10 to 12 weeks causes suppression of sperm production, and even azoospermia, albeit inconsistently [ 24 ]. Ever since that study, testosterone has undergone extensive clinical trials as a hormonal method of male contraception and many have found testosterone to be efficacious, reversible and safe with minimal short-term side effects [ 23 ].
Unfortunately, the contraceptive effect of testosterone is not reliable. The different rates of azoospermia can be explained by the variable criteria and by ethnic differences in testosterone response [ 26 , 27 ].
These studies confirm the effectiveness of testosterone as a contraceptive, and provides evidence that men who desire fertility should not be prescribed TRT.
More recent advancements were shown in the Endocrine Society meeting, with dimethandrolone undecanoate shown to effectively decrease sperm counts without adverse effects in a double-blind study in 2 academic sites.
More extensive research on the safety of testosterone as a contraceptive needs to be done before testosterone can be used as a safe and reliable contraceptive [ 29 ]. To date, many different testosterone formulations are available, each with their own side effect profiles.
The selection of the preparation of testosterone requires a comprehensive discussion with the patient about the route of administration, cost and side effects of the individual formulations. Oral methyltestosterone is the only form of oral testosterone approved for use in the USA.
It is strongly associated with hepatotoxicity and the AUA recommends against using the formulation [ 2 , 3 ]. TU is approved for use in some countries but is not approved for use in the USA [ 4 ]. Topical options of TRT include gels and patches. They are relatively easy to administer and doses are able to be quickly altered when needed [ 30 ].
Their adverse effects include skin irritation seen with testosterone patches. Topical testosterone gels also run the risk of transference to others; but this can be avoided by using a clothing barrier [ 31 , 32 ]. It is seen to be advantageous over topical gels because of ease of use and the decreased risk of transference [ 33 ].
With regards to fertility, Conners et al [ 34 ] found that 4. Its short half-life results in a return of serum testosterone to near baseline levels between doses. It is theorized that this decreases its effect on the pulsatile release of GnRH by the hypothalamus [ 35 ].
A phase IV clinical trial is currently evaluating its impact on semen analysis parameters, and it would be the first study to do so [ 36 ]. Based on what is found by future studies, NTGs may have the potential to be a suitable TRT option in men desiring fertility. Intramuscular testosterone injections are another form of TRT. These include testosterone cypionate and enanthate, which are self-administered once every 1 to 2 weeks.
Their starting dose is mg weekly or mg every two weeks before titrating in response to lab results on follow-up visits [ 3 ]. While the patients using these formulations will be able to avoid frequent trips to the clinic once the dose has been adjusted, it does require proper patient education to ensure compliance to the dose set by the healthcare provider. They also have a greater risk of side effects than other preparations [ 30 , 37 ].
TU is another preparation of intramuscular testosterone that is longer acting than the other formulations. It needs to be administered with an initial dose of mg, followed 4 weeks later by another mg dose. This is then followed by an intramuscular injection once every 10 weeks. A disadvantage is that this preparation needs to be administered in the office as a slow injection over 2 minutes and patients need to be monitored for 30 to 45 minutes after administration due to the risk of developing pulmonary-oil micro embolism [ 4 , 40 ].
Beyond gels, patches and injections, another option for TRT are the subdermal implants. They are administered in a to minute procedure in the office every three to six months depending on follow-up laboratory results. This is a popular option among patients because they do not have to self-inject or apply gels repeatedly [ 30 ]. The disadvantages of subdermal implants include the need for regular office visits, pain and bruising at the site of insertion, as well as the minimal risk of infection and pellet extrusion [ 30 ].
In terms of the contraceptive effect of the different formulations of testosterone, most research has shown that transdermal and intramuscular testosterone seem to be the strongest contraceptive formulations. The topical formulations of testosterone have variable contraceptive effects. The testosterone patch was shown to be an ineffective contraceptive [ 41 ] while the gel had mixed results [ 42 , 43 ]. However, the sample size for most of these studies are not large enough to truly assess the extent to which fecundity is affected.
More research needs to be done to evaluate the contraceptive effect of the various formulations of testosterone. A list of the available testosterone formulations with its side effect profiles and effect on fertility can be found in Table 1 [ 3 , 14 , 15 , 25 , 28 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. Dosages are based on the American Urological Association Guidelines [ 3 ]. Considering that there is abundant evidence demonstrating that TRT significantly decreases sperm production, it is important that clinicians consider the evidenced risks of male infertility before starting patients on TRT.
It can be surprising to patients that testosterone can suppress fertility, in contrary to its stimulatory effects on libido and erectile function. The patient's desire for fertility must be discussed in depth and established prior to initiating testosterone. The discussion must also include future thoughts on fertility. This will allow the physician to manage the timing of hypogonadism treatment, essentially balancing the alleviation of hypogonadal symptoms with the patient's desires for fertility.
This could also open discussion about cryopreservation of sperm as an option for the patient to preserve fertility further down the line. Physicians should also educate men already on TRT. Some of these men may not know about its effects on fertility and may not have discussed it with their prescribing physician.
Low Testosterone & Fertility
With the rise in testosterone supplement use, fertility doctors are warning men who would like to have children in the future to reconsider starting TRT. LH stimulates the testes to release testosterone. When in balance, testosterone works with follicle stimulating hormone FSH to help generate sperm. Men suffering from low testosterone may experience fatigue and low libido. As a result, TRT has been on the rise, with men of all ages using testosterone supplements.
Testosterone replacement therapy can lead to a decline in sperm production for some men, making it more difficult for them to father children. The problem lies with the pituitary gland and the makeup of synthetic testosterone, which is used for TRT. Testosterone, produced in the testes, plays an important role in sperm production. When the body needs to make more testosterone, the pituitary gland sends hormones to the testes to start the process. These hormones help stimulate the production of sperm.
Would-be dads should think twice before trying low-testosterone therapies, experts say
You may be thinking about starting TRT, but perhaps you want to have a family sometime in the near future? And if so, what can I do about it? Men with naturally low levels of testosterone have lower sperm counts and quality then men with normal or high testosterone. So you would think that increasing your testosterone levels with TRT would improve fertility, right? Unfortunately it is not that simple. Whilst the level of testosterone present in the testes is important for sperm levels this testosterone is produced by the body, and not replaceable by TRT. Although TRT will likely reduce your sperm count it does not automatically make you infertile.
Hypogonadism -- Male - has anyone concieved while on low T therapy?
Testosterone replacement therapy in theory has a negative effect on sperm counts in reproductive men. As a result men who still want to have kids have to look for alternative treatments to taking testosterone. The current regimen for men who want to have kids is to use HCG units daily subcutaneous injection. Background: Testosterone is produced primarily in the testicles in men.
Mulligan, T. Int J Clin Pract, Trinick, T.
Blogs by Shona Murray, MD
However, what is a normal testosterone level can differ for individual men. Low testosterone is also known as hypogonadism, which can be present during fetal development or become apparent in childhood. Hypogonadism can cause a variety of problems. In adults, it can alter physical characteristics, such as decreased hair growth, and hamper normal reproduction.
Testosterone is a very important hormone in males. It is important for pubertal changes such as muscle and bone growth, hair growth and development of the sex organs. It plays a very important role in libido and sexual function. So when testosterone levels are low, especially when this is interfering with sex drive, sexual functioning and energy level, supplements are often prescribed. This may be as an injection, gel, patch or injectable pellets.
Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility
Is there any chance of pregnancy while on the testosterone hormone? Be sure to use all your usual birth control practices unless you both are trying to conceive. Speak with his doctor about your concerns if you have any doubt that he's fertile. Don't assume. As an ex lab tech in a Federal hospital, there is no correlation between testosterone therapy and infertility or "birth control" like symptoms in men. In my opinion it would have the opposite result as testosterone is notorious for raising a man's libido, thus your chances would increase if sexual activity increased accordingly. If you do NOT want to get pregnant take all precautions as he is firing "live" bullets
See the latest Coronavirus Information including testing sites, visitation restrictions, appointments and scheduling, and more. Fertility Blog. Puneet Masson.
Testosterone Replacement Therapy and Fertility
Testosterone improves libido and sexual function. But in large doses, it also can suppress the body's ability to produce sperm, spelling trouble for couples trying to get pregnant. Treatment for low testosterone in men -- the condition is also called hypogonadism -- has been around for decades.
Testosterone Effect on Sperm
Testosterone Replacement and Your Sperm Count: What’s the deal?
Can testosterone replacement therapy (TRT) make a man infertile?