Does TRT cause permanent damage/ shutdown/ infertility?

[improvement87]

Ive asked this question before i think but i would like to get some further input on it.

if i went on TRT... lets say my baseline now is 350 (unliveable, cant have sex,  but i dont feel like i have fucking cancer or something, like the extreme symptoms ive read from people who have levels in teh 100s-200s)

im concerned that lets say after 1,2,3 years of Testosterone therapy, i would become permanently infertile even if i came off.. or that my basline would permanently drop to taht 100-200 level if i came off..

is there permanent damage? or can you go on it for a few years, then come off? if lets say some new drug comes out for secondary hypo or something who knows.. or i want to have children

[Regulus]

Ive asked this question before i think but i would like to get some further input on it.

if i went on TRT... lets say my baseline now is 350 (unliveable, cant have sex,  but i dont feel like i have fucking cancer or something, like the extreme symptoms ive read from people who have levels in teh 100s-200s)

im concerned that lets say after 1,2,3 years of Testosterone therapy, i would become permanently infertile even if i came off.. or that my basline would permanently drop to taht 100-200 level if i came off..

is there permanent damage? or can you go on it for a few years, then come off? if lets say some new drug comes out for secondary hypo or something who knows.. or i want to have children

There is a definite answer to this.   Unfortunately the answer is "maybe".

No one really knows.   I think it's generally believed that if you go off you eventually return to your baseline.   Women can screw up their hormones with birth control pills for decades and recover just fine. 

That said there's not a lot of evidence to say what happens going off after many years. 
I think you have to approach trt with the mindset of this being for life.

[Osprey]

There was a guy on another forum who was on TRT for something like 10 years, then he got married and wanted to have kids. Last I read he had been seeing a fertility specialist for 1 year and still had a zero sperm count.

[ghce]

I can relate my recent experience of going off Andriol after concerns for fertility.
I had been on Andriol (and earlier patches) for just over 2 years
Testing whilst on TRT showed normal volume, motility and sperm count but like 'normal Testosterone range' I think if you are at the lower end you would be in trouble, I was roughly in the middle of all tested ranges.
After I went off for about 1 month I retested and found that progressive motility had increased from 28% to 55% and sperm concentration had gone from an average 15.2 million /ml to a more healthy 37.2 million /ml and perhaps significantly immotile sperm went from a whopping 58% to just 3%
The fertility test done whilst on TRT was done approximately 1 year after commencing TRT.

[Boxcar]

My urologist says that fertility does usually return once you stop TRT, but that this fails to happen about 1% of the time. Like you, I assume the risk depends on how long you take it. So if I am going to stay on long term, I will look into adding HCG, which is supposed to help maintain testicular function.

[PeakT]

My urologist says that fertility does usually return once you stop TRT, but that this fails to happen about 1% of the time. Like you, I assume the risk depends on how long you take it. So if I am going to stay on long term, I will look into adding HCG, which is supposed to help maintain testicular function.

There is also a chance that, as you age, you will not "snap back" all the way, i.e. that TRT would accelerate atrophy and you would not be able to fully recover.  This is one of these things that should have been studied in depth and has not.

[davie12]

There was a guy on another forum who was on TRT for something like 10 years, then he got married and wanted to have kids. Last I read he had been seeing a fertility specialist for 1 year and still had a zero sperm count.

I believe this is the same thread I saw on allthingsmale.com. The guy was in his mid-50s and had been on TRT like 8 years straight and now wanted to have kids. I believe with HCG he got his T levels up but FSH never went up. I remember seeing his semen analysis and it was pretty much zero for over a year after quitting TRT. (I think one of the test had like 50,000 which is essentially the same as being infertile.)

[Dr Justin Saya, MD]

There was a guy on another forum who was on TRT for something like 10 years, then he got married and wanted to have kids. Last I read he had been seeing a fertility specialist for 1 year and still had a zero sperm count.

I believe this is the same thread I saw on allthingsmale.com. The guy was in his mid-50s and had been on TRT like 8 years straight and now wanted to have kids. I believe with HCG he got his T levels up but FSH never went up. I remember seeing his semen analysis and it was pretty much zero for over a year after quitting TRT. (I think one of the test had like 50,000 which is essentially the same as being infertile.)

If that's the case, he should've tried HMG or compounded lyophilized FSH. Both expensive, but will do the job of FSH.

If low swimmers a few months after that, then he has testicular failure!

[Boxcar]

My urologist says that fertility does usually return once you stop TRT, but that this fails to happen about 1% of the time. Like you, I assume the risk depends on how long you take it. So if I am going to stay on long term, I will look into adding HCG, which is supposed to help maintain testicular function.

There is also a chance that, as you age, you will not "snap back" all the way, i.e. that TRT would accelerate atrophy and you would not be able to fully recover.  This is one of these things that should have been studied in depth and has not.

I'm not sure I understand your point about atrophy (doesn't that mostly happen in the first few months as you shut down?).  But yes, I have heard you say that older guys don't always snap back. Which makes sense, but just to play the other side, there is no way of knowing if those are cases of incomplete recovery from TRT or just the lower levels that you would have had without TRT, after years of slowly declining health and advancing age. In any case, it sounds like HCG would provide insurance on the testicular part of the shutdown (which I gather is the greater concern).

[PeakT]

I'm not sure I understand your point about atrophy (doesn't that mostly happen in the first few months as you shut down?).  But yes, I have heard you say that older guys don't always snap back. Which makes sense, but just to play the other side, there is no way of knowing if those are cases of incomplete recovery from TRT or just the lower levels that you would have had without TRT, after years of slowly declining health and advancing age. In any case, it sounds like HCG would provide insurance on the testicular part of the shutdown (which I gather is the greater concern).

Exactly.  Very difficult to test for or prove.