Low testosterone · Telehealth for men · Canada & USA
Does testosterone therapy affect fertility, and what are the options?
It often does, and for many men the effect eases after stopping. Testosterone from outside tells your brain to turn down LH and FSH, the signals your testes use to make their own testosterone and sperm, so sperm counts can fall very low while you’re on it. If children are in your plans, there are ways to raise your own testosterone while keeping production going, such as hCG and clomiphene. We help you map them against your labs and timeline.
Part of our low testosterone and andropause guide for men in Canada and the USA.
What testosterone therapy does to sperm production
Your pituitary gland sends two signals to the testes: LH, which drives testosterone production, and FSH, which supports sperm production. When testosterone comes from outside, your brain senses plenty and turns both signals down. With less LH, the testes make less of their own testosterone, including the high level inside the testes that sperm production depends on. The AUA and Canadian Urological Association guidelines both describe this, and the Canadian guideline notes that it is often overlooked.
LH turns down
The signal that tells the testes to make testosterone fades, so your own production slows.
FSH turns down
The signal that supports sperm production fades too.
Testosterone inside the testes falls
Healthy sperm production needs a high local testosterone level, which depends on your own LH signal.
Sperm counts can drop
Counts can fall very low while you’re on treatment, and in some men to none. It varies from man to man.
Where are you on the family question?
Your plans change what a good first step looks like. The Endocrine Society guideline (2018) advises against starting testosterone therapy in men planning fertility in the near term, and the AUA/ASRM guideline (2024) says men interested in current or future fertility should not be prescribed exogenous testosterone.
Trying now or soon
We focus on labs, causes and options that keep your own production working, and on what to do first.
Already on TRT, now planning
Stopping testosterone comes before any attempt to conceive. We build a restart plan with labs and semen analysis along the way.
Maybe someday
The same options apply, since future fertility counts. We map them now so you aren’t forced to choose later.
Done having children
Fertility isn’t a factor, so the focus is your symptoms, your labs and the option that fits your life.
Does sperm production come back after stopping?
For many men it does, but the timing is hard to predict. In male contraceptive trials of testosterone, about two-thirds of men had sperm back in the ejaculate within six months of stopping, and roughly one in ten took until the second year (AUA guideline). In a study of men who stopped therapy and used hCG and/or a SERM, older age and longer treatment predicted a lower chance of recovery at six and twelve months.
Months, not days
Sperm take time to rebuild once your own signals return, so a semen analysis too early can look low.
Length of treatment matters
The longer testosterone has been used, and the older you are, the slower the return tends to be.
Stop before you try
The AUA advises that testosterone stops before any effort to conceive begins.
Not the same for everyone
Some men, especially those who already had fertility problems, may not recover fully. A baseline tells you where you start.
Semen analysis and baseline labs before you start
Blood testosterone doesn’t show how many sperm you’re making. A semen analysis does. The AUA guideline recommends a reproductive health evaluation before treatment for men with low testosterone who are interested in fertility: a testicular exam, FSH and, where indicated, a semen analysis.
Semen analysis
A baseline for sperm count, movement and shape. Counts vary from sample to sample, so a repeat can be useful. Follow the lab’s collection instructions.
LH and FSH
Show whether the signal from the brain is active. High FSH alongside low testosterone typically points to impaired sperm production.
Testosterone, prolactin, estradiol
Put the picture together. See our guide to the labs to ask for.
A safety net
If you want a backup, ask about freezing a sample before starting anything.
Options that keep your own production going
If fertility matters, the aim is to raise your own testosterone or protect sperm production rather than replace testosterone from outside. The AUA lists aromatase inhibitors, hCG, SERMs or a combination as options for men with low testosterone who want to maintain fertility, and the Canadian guideline lists the same classes as off-label alternatives.
hCG
A prescription injection that acts like LH, prompting the testes to make testosterone and keep sperm production going. Of these medicines, only hCG has FDA approval for use in males, per the AUA guideline.
Clomiphene and enclomiphene
Tablets from the SERM family. They block estrogen’s brake on the pituitary so LH and FSH rise and your testes make more testosterone. Clomiphene is used off-label in men. Enclomiphene is its single-isomer form.
Aromatase inhibitors
Reduce the conversion of testosterone into estrogen, which can lift your own LH and FSH. Used in selected men, off-label.
hCG alongside testosterone
In one small study, low-dose hCG given with testosterone preserved sperm production in selected men. The evidence is limited.
Fix the causes first
Excess weight, short sleep, heavy alcohol and some medications can lower testosterone. Weight loss and better sleep can lift it. See TRT or fix the causes first.
Restarting after TRT
After stopping testosterone, men commonly use hCG and/or a SERM to restart production. Age and length of past treatment affect how quickly sperm return.
Canada and the USA: what’s available
The same medicines are discussed on both sides of the border, and rules and stock differ and change. Here is where things stand for the three most-discussed options.
Canada
Health Canada lists chorionic gonadotropin products such as Pregnyl as prescription-only, with a labelled use in selected cases of hypogonadotropic hypogonadism in males. Clomiphene is authorized for women, and its use in men is off-label. Health Canada’s Drug Product Database has no enclomiphene listing.
USA
FDA-approved hCG brands such as Novarel and Pregnyl are on the market. hCG has been regulated as a biologic since March 23, 2020, which ended pharmacy-compounding exemptions for it. Clomiphene is approved for women and used off-label in men. Enclomiphene has not been approved by the FDA, and where it is offered, it is through compounding.
On both sides
Labeling, rules and supply keep changing. As part of your plan, we check what is available to you in your province or state.
How we help you plan around fertility
Odin Health Labs is telehealth for men in Canada and the USA with low testosterone symptoms. Here is how we work with you.
- Step 1
Map your goals and timeline
Do you want children, and when? We start there, because it shapes every other choice.
- Step 2
Review your labs and semen results
We go through testosterone, LH, FSH and any semen analysis with you, and point out what is missing.
- Step 3
Lay out your options
We explain each route, what it aims to do and what to ask about, so you can choose with confidence.
- Step 4
Track progress and adjust
Repeat labs and check-ins keep your plan on track, whether you’re protecting fertility or getting ready to try.
Sources
- Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol 2018;200:423-432 (validity reviewed 2024). doi.org/10.1016/j.juro.2018.03.115
- Brannigan RE, Hermanson L, Kaczmarek J, Kim SK, Kirkby E, Tanrikut C. Updates to Male Infertility: AUA/ASRM Guideline (2024). J Urol 2024. doi.org/10.1097/JU.0000000000004180
- Grober ED, Krakowsky Y, Khera M, et al. Canadian Urological Association guideline on testosterone deficiency in men: Evidence-based Q&A. Can Urol Assoc J 2021;15(5):E234-E243. doi.org/10.5489/cuaj.7252
- Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2018;103(5):1715-1744. doi.org/10.1210/jc.2018-00229
- Kohn TP, Louis MR, Pickett SM, et al. Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy. Fertil Steril 2017;107(2):351-357. doi.org/10.1016/j.fertnstert.2016.10.004
- US Food and Drug Administration. Notice to Compounders: Changes that affect compounding as of March 23, 2020. fda.gov
- Health Canada. Drug Product Database (chorionic gonadotropin, clomiphene citrate) and the Pregnyl product monograph (Organon Canada). health-products.canada.ca
Frequently asked questions
Does testosterone therapy cause infertility?
It can lower fertility while you are on it. Testosterone from outside tells your brain to turn down LH and FSH, the signals your testes need to make sperm, and sperm counts can fall very low, in some men to none. The American Urological Association and Canadian Urological Association guidelines both describe this effect. For many men it eases after stopping, but how quickly varies from man to man. If children are part of your plans, we help you look at options that keep your own production going.
How long does it take for sperm to come back after stopping?
It varies. In male contraceptive trials of testosterone, about two-thirds of men had sperm back in the ejaculate within six months of stopping, and roughly one in ten took until the second year (AUA guideline). In one study of men who stopped therapy and used hCG and/or a SERM, being older and having been on therapy longer were linked to a lower chance of recovery at six and twelve months. Some men do not return to their earlier level. A semen analysis after stopping shows where you stand, and we track it with you.
Can I use hCG, clomiphene or similar options instead of testosterone?
For men with low testosterone who want to keep their fertility, the AUA says aromatase inhibitors, hCG, SERMs such as clomiphene, or a combination may be used, and the Canadian guideline lists the same classes as off-label alternatives. They work by raising your own testosterone rather than replacing it. Each has its own trade-offs, response differs from man to man, and they are prescription medicines. We help you compare them against your labs and your timeline.
Are hCG and enclomiphene available in Canada and the USA?
hCG products are authorized in both countries: Health Canada lists chorionic gonadotropin products such as Pregnyl, and FDA-approved brands include Novarel and Pregnyl. In the USA, hCG has been regulated as a biologic since March 23, 2020, which ended the pharmacy-compounding exemptions for it. Clomiphene is authorized for women in both countries and used off-label in men. Enclomiphene is not an FDA-approved product, and Health Canada’s Drug Product Database has no enclomiphene listing. Rules and stock change, so we check what is available to you where you live.
Do I need a semen analysis before starting treatment?
If you may want children, it is a sensible baseline. The AUA guideline recommends a reproductive health evaluation before treatment for men with low testosterone who are interested in fertility, including a testicular exam, FSH and a semen analysis where indicated. A baseline also makes later results easier to read. We help you arrange the right tests and go through them with you. See our lab guide.
How does Odin Health Labs work with my doctor and fertility specialists?
Odin Health Labs is a telehealth service for men in Canada and the USA with low testosterone (andropause) symptoms. We review your labs and semen results with you, map your options around your fertility goals, build your plan and track your progress. We can share your plan and results with your own doctor or a men’s fertility specialist if you choose. See our low testosterone overview and our Privacy Policy.
Planning a family and managing low T? Let’s map your options.
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