Does Low Testosterone Cause Infertility?

Low T can decrease fertility, but there is hope
Male exercising on gym mat.

Deciding to start or grow your family is an exciting time. If the test keeps coming back negative, though, you may start to worry — “What if it’s never going to happen for us?” 

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It’s a question many people face. The National Institutes of Health estimates 9% of men and people assigned male at birth (AMAB) experience fertility issues.  

In men and people AMAB, decreased fertility is commonly associated with low testosterone levels, commonly referred to as “low T.” Low T = low sperm count = lower likelihood of reproducing. 

The key here, though, is the lower likelihood. Living with low T doesn’t mean you and your partner won’t be able to conceive a child. There are ways to increase your chances. 

We talked with endocrinologist Kevin Pantalone, DO, about how low testosterone affects fertility and how you can increase your chances.     

Testosterone’s role in fertility 

In people whose testosterone levels are in the normal range, a single ejaculation can contain more than 15 million sperm per milliliter. If your testosterone levels are low, your sperm count may also be low, which decreases your chances of conception. 

Let’s get micro for a minute, though. This is the short story of how sperm is created: 

  1. Your pituitary gland (a part of your brain that controls hormone release) produces two hormones: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). 
  2. LH tells your testes to make testosterone. 
  3. Testosterone then works with FSH to produce sperm. 

Dr. Pantalone says a lot of testosterone is needed within your testes to create sperm. So, if you’re experiencing low testosterone, you can get stuck at step 2, which means you ultimately create less sperm.

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“This is the primary issue we see in men related to low testosterone and infertility. Low testosterone means a lower sperm count. That doesn’t mean you can’t conceive, but it does decrease the chances,” Dr. Pantalone notes.  

Additionally, living with low testosterone can impact your sexual function, Dr. Pantalone says. Low libido and erectile dysfunction are common symptoms of low T, which can further lower your odds for conception. 

Testosterone therapy and fertility 

OK, so low T means you need more T, which means you need testosterone therapy, right?

Actually, no. It might sound counterintuitive, but testosterone therapy can actually keep you from producing sperm.

“Testosterone therapy will increase your circulating testosterone in your blood, but it will not increase testosterone in the testicles, which is where it’s needed for sperm production,” Dr. Pantalone explains. “In fact, testosterone therapy can reduce your sperm counter further, so it is not recommended for people who want to start a family.” 

Think of it like supply and demand. When you increase your testosterone through patches, pills, injections or creams, your body thinks it has an ample supply of testosterone and so doesn’t produce more in your testicles. That means the levels of testosterone in your testicles — where it matters for sperm production — will remain low. 

Ways to increase your sperm count

If hormone therapy won’t increase your sperm count, what will?  

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There are a lot of myths about male fertility (no, you don’t have to ditch the tighty-whities if that’s your thing). The truth is that taking care of your overall health can be your best bet to increasing your testosterone levels.  

Proven strategies to increase testosterone and boost sperm production include: 

  • Managing chronic illnesses through diet, exercise and other lifestyle changes. 
  • Injections of human chorionic gonadotropin (HCG) — a hormone therapy that can help your testes increase testosterone levels within your testicles and improve sperm production. 
  • Not smoking. 
  • Not using illegal drugs. 
  • Limiting alcohol use. 

When to see a fertility specialist    

If you know you have low testosterone, or if you and your partner have been trying to conceive for six months to a year without success, a visit to a fertility specialist should be your next step, Dr. Pantalone says.

A fertility specialist can test you and your partner for any fertility issues and recommend options to increase your chances of starting or growing your family. They can also discuss options like intrauterine insemination (IUI) and in vitro fertilization (IVF) with you. Dr. Pantalone says it’s extremely important both you and your partner are evaluated when undergoing an investigation for causes of infertility. 

Living with decreased fertility can be emotionally painful and isolating. People living with fertility issues often report feeling depressed, grief-stricken or inadequate. Supporting your partner, talking with a licensed mental health professional and finding community with others who share your experience can help. Ask your healthcare provider about mental health support, such as therapy and support groups, for people who are experiencing infertility — you’re not alone, and there is hope. 

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