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Testosterone replacement therapy and spermatogenesis in reproductive age men
Bryan D Naelitz1, Leila Momtazi-Mar2,3, Sanjay Vallabhaneni4
1Department of Urology, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA. naelitb2@ccf.org.
Nature Reviews. Urology
|May 9, 2025
Summary
Testosterone replacement therapy (TRT) impairs sperm production by suppressing natural hormone levels. While sperm production may recover after stopping TRT, the process is variable and can complicate family planning for men.
Area of Science:
- Endocrinology
- Reproductive Medicine
- Men's Health
Background:
- Testosterone is crucial for male reproductive functions like sperm production and libido.
- Testosterone deficiency is common and treated with testosterone replacement therapy (TRT).
- TRT suppresses natural hormone production, negatively impacting sperm production.
Purpose of the Study:
- To review the impact of TRT on spermatogenesis.
- To discuss methods for preserving or restoring sperm production in men undergoing TRT.
- To evaluate newer TRT formulations regarding their effect on fertility.
Main Methods:
- Literature review of studies on testosterone replacement therapy and male fertility.
- Analysis of the effects of exogenous androgens on the hypothalamic-pituitary-gonadal axis.
- Examination of medical therapies and novel TRT formulations for fertility preservation.
Main Results:
- Exogenous testosterone significantly suppresses endogenous testosterone production and spermatogenesis.
- Sperm production recovery after TRT cessation is slow and highly variable.
- Certain medical therapies and novel TRT formulations may partially preserve spermatogenesis.
Conclusions:
- TRT is contraindicated for men seeking conception due to impaired spermatogenesis.
- Strategies exist to preserve or restore fertility in men using TRT.
- Emerging TRT formulations show potential for incomplete suppression of the reproductive axis, possibly aiding fertility preservation.
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