Does TRT affect fertility?
Yes. Exogenous testosterone suppresses LH and FSH and reduces spermatogenesis. Fertility-prioritized candidates are typically routed to enclomiphene rather than TRT. Fertility is a required input in the assessment, not an afterthought.
Full answer
Exogenous testosterone suppresses pituitary release of LH and FSH and downregulates endogenous testicular function, including spermatogenesis. This is reversible in most men after discontinuation but the timeline is variable. Fertility-prioritized candidates — men actively trying to conceive or planning to in the near term — are typically routed to enclomiphene, which raises endogenous testosterone by stimulating the HPG axis rather than replacing it. Fertility status is a required input in the oMeds assessment. The pathway recommendation is shaped by candidacy, not the other way around.
Educational. Not a substitute for individualized provider review.
- Enclomiphene pathway — Primary source · oMeds
- Reviewed by Dr. Laura Purdy, MD, MBA · Clinical Director, oMeds · Last reviewed 2026-05-29