TRT can affect the body’s own sperm production because hormone levels are being regulated externally. For this reason, particular care should be taken when considering TRT in patients who currently wish to have children or are planning to start a family.

The effects can vary depending on the form of treatment: oral bioidentical testosterone therapy offers flexible control and can, where appropriate, be incorporated into individualized treatment plans for patients wishing to preserve fertility, as it generally does not impair fertility. Gel therapy and, in particular, testosterone injections can have a significant effect on the hormonal axis due to their systemic and depot-like effects, which means a substantial reduction in sperm production should be expected.