Testosterone replacement therapy (TRT) is a treatment option for men with low testosterone levels, but its implications for individuals with azoospermia have been a topic of debate and research. Some research even suggests that TRT can cause azoospermia after prolonged exposure.

Azoospermia is a medical condition characterized by the absence of sperm in semen, leading to male infertility. In obstructive azoospermia, sperm production is normal, but there is a physical blockage that prevents sperm from reaching the semen. This condition may be caused by previous infections, surgery, or congenital issues. In non-obstructive azoospermia, the testes do not produce sperm adequately, leading to a lack of sperm in the semen. This condition can be caused by hormonal imbalances, genetic factors, or testicular damage.

There can be various implications of TRT on men with azoospermia. TRT involves the administration of synthetic testosterone to address low testosterone levels in the body. While TRT may address hormonal imbalances, it is essential to recognize that it does not cure infertility caused by either type of azoospermia. In fact, TRT can further suppress natural testosterone production, exacerbating sperm production issues. Therefore, TRT alone is not a recommended fertility treatment for azoospermic men seeking to conceive.

Some studies have explored the use of TRT in combination with other fertility treatments, such as human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG), to stimulate sperm production in men with non-obstructive azoospermia. However, this approach is considered experimental, without definitive findings. TRT carries some potential risks and side effects, including cardiovascular issues, mood swings, and infertility. In the case of azoospermia, TRT may further reduce sperm production, complicating fertility challenges.

TRT can be beneficial for men with low testosterone levels and certain medical conditions. However, for individuals with azoospermia, especially non-obstructive azoospermia, TRT should be approached with caution. While it may address hormonal imbalances and improve certain aspects of sexual health, TRT alone is not a viable treatment for infertility caused by azoospermia. Instead, individuals with azoospermia should consult with a fertility specialist to explore comprehensive treatment options and to make informed decisions about their reproductive health.

Source: Patel A. et al, 2019; Najari B. 2018