What fertility steps should men consider before starting TRT?
Exogenous testosterone suppresses LH/FSH and spermatogenesis. Men with current or near-term fertility goals are evaluated for Enclomiphene instead. Fertility may recover after discontinuation, but recovery is not guaranteed.
Full answer
Exogenous testosterone suppresses pituitary LH and FSH, which suppresses intratesticular testosterone and spermatogenesis. Most men become functionally infertile on TRT. Recovery after discontinuation occurs in most men but is not guaranteed and can take 6–24 months. Men with current or near-term fertility goals are evaluated for Enclomiphene (a SERM that raises endogenous testosterone while preserving the HPG axis). hCG can be added in selected provider-reviewed cases. Sperm banking is a reasonable option for men who want optionality.
Educational. Not a substitute for individualized provider review.
- Testosterone Optimization pathway — Primary source · oMeds
- Reviewed by Dr. Laura Purdy, MD, MBA · Clinical Director, oMeds · Last reviewed 2026-06-03