illustration of sperm trying to impregnate an egg

The Intersection Of Testosterone Therapy And Fertility

Testosterone Replacement Therapy (TRT), the conventional remedy for low testosterone in males about 40 years old, can significantly diminish fertility and sperm production by disturbing hormonal equilibrium. Additionally, it poses potential hazards such as myocardial infarctions, cerebrovascular accidents, and worsening of pre-existing ailments. Enclomiphene, a viable alternative therapy, enhances testosterone levels without compromising fertility. It operates by the stimulation of endogenous testosterone synthesis and the preservation of sperm count, providing a safer alternative with less severe side effects in comparison to testosterone replacement therapy (TRT). Men who wish to address low testosterone levels while preserving fertility might use enclomiphene as a more favorable choice.

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Around the age of 40, a man’s testosterone levels naturally begin to drop at a rate of one to three percent per year. Testosterone Replacement Therapy (TRT) is the standard treatment for correcting low testosterone (low T) levels, but it can hinder a man’s fertility. However, there is another treatment option that raises testosterone levels without negatively impacting fertility: enclomiphene.

Continue reading to learn more about the effect TRT has on fertility and how enclomiphene can be used to help treat low T levels.

Effects of TRT On Fertility

Testosterone is essential for spermatogenesis (sperm production) mainly because it helps control processes such as meiosis (cell division) and the release of mature sperm. Although testosterone is important for fertility, increasing your testosterone levels can lead to diminished fertility because using exogenous (external) testosterone disrupts your hormone balance and may make your body stop producing sperm.

To better understand the effect of TRT on fertility, it is important to first understand how your brain and body work together to produce sperm and testosterone.

The hypothalamic-pituitary-gonadal axis is responsible for maintaining the normal function of your reproductive system. The hypothalamus region of the brain releases gonadotropin-releasing hormone (GnRH) that causes the pituitary gland area of your brain to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which both support testicular function.

illustration of sperm trying to impregnate an egg

Specifically, FSH develops and maintains Sertoli cells that are vital for sperm production, and LH stimulates testosterone production in the testes. Finally, the testosterone made by your testicles sends a feedback loop to your brain to start or stop producing GnRH, FSH, and LH.

When the testosterone levels in your blood increase because you are taking TRT, your hypothalamus and pituitary gland stop producing the hormones your body needs to produce sperm. TRT can reduce FSH and LH levels to less than half of their original levels. Reduced or stopped sperm production leads to low sperm counts and reduced fertility.

A 2018 article published in the World Journal of Men’s Health classified testosterone as a contraceptive and stated that testosterone should not be given to men who want to preserve their fertility while treating low T.1

In addition to its detrimental effects on sperm production and fertility, TRT is also associated with numerous harmful side effects, including:

  • Increased risk of heart attack or stroke
  • Irritation, itching, or rash
  • Potential worsening of pre-existing benign prostatic hypertrophy (BPH)
  • Potential worsening of pre-existing blood clots due to deep vein thrombosis, polycythemia, or pulmonary embolism
  • Potential worsening of pre-existing congestive heart failure
  • Potential worsening of pre-existing prostate cancer
  • Potential worsening of pre-existing sleep apnea
  • Shrinking of the testicles

How Enclomiphene Can Treat Low T Without Impacting Fertility

Enclomiphene works by preventing estrogen from binding to the estrogen receptors in your brain. This causes your body to believe it is not getting enough estrogen, so it responds by producing more FSH and LH.

In other words, TRT turns off the feedback loop between your brain and your testes and slows down or stops sperm production and fertility, but enclomiphene turns that feedback loop on and increases sperm production and fertility.

Another key difference between TRT and enclomiphene is that TRT increases blood testosterone levels by delivering synthetic testosterone that was created in a lab directly into your body, while enclomiphene stimulates your body’s production of testosterone naturally.

The way you take TRT or enclomiphene will vary. Enclomiphene is available as a tablet that you take by mouth. Testosterone undecanoate (Jatenzo) is the only oral form of TRT available in the United States, but TRT is available in many other forms, including gels, patches, and injections.

doctor with a list consulting with a patient

Enclomiphene is a viable alternative to TRT because enclomiphene raises testosterone levels and preserves or increases fertility and sperm production naturally, and its side effects are less dangerous than TRT side effects.

Potential side effects of enclomiphene may include:2

  • Blurred vision (stop taking enclomiphene and contact your doctor immediately)
  • Hot flush
  • Fatigue
  • Breast tenderness (contact your doctor immediately)
  • Headaches
  • Dizziness
  • Skin issues such as acne
  • Joint pain
  • Stomach issues, including bloating, nausea, and diarrhea


Decreased testosterone levels are a normal part of aging. TRT can restore normal blood testosterone levels with exogenous, synthetic testosterone supplements, but TRT is associated with dangerous side effects and has been found to decrease fertility and sperm production.
Enclomiphene restores testosterone levels by causing your body to produce more testosterone naturally. It also maintains (and in some cases increases) fertility and sperm production, and it is a safer alternative to TRT.

If you have low T and want to preserve your fertility, see if you can correct low testosterone levels with enclomiphene or switch from TRT to enclomiphene. Talk to your doctor to determine what is best for you.

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[1] Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility. Patel AS.

[2] Enclomiphene citrate: A treatment that maintains fertility in men with secondary hypogonadism. Earl JA.

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