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Male Fertility and Testosterone Replacement Therapy (TRT)

TRT and Male Fertility

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Testosterone Replacement Therapy can be a game-changer for the millions of men living with low testosterone – or Low T. But are there risks involved for your future fertility? And how can we best protect our sperm health when taking the medication?


What is Testosterone Replacement Therapy?

Testosterone Replacement Therapy (TRT) is a type of medication taken to boost your natural levels of testosterone. It can be taken in many different forms – from pellets to patches, injections to gels.

Unlike anabolic steroids, TRT is approved by doctors for cases where men are suffering from low testosterone, and the much lower dose has fewer side effects – as the medication is regulated.

In some cases, you can get TRT on the NHS, but to avoid long waitlists you can also get tested and have medication prescribed through approved private specialists like Alphagenix.


Who Can Benefit From Testosterone Replacement Therapy?

TRT is mainly used to treat men who are struggling with low testosterone. Millions of men worldwide face this problem – and yet it is so often misunderstood and misdiagnosed. Let’s discuss some of the signs that you could be suffering from low T:

Symptoms of Low Testosterone

Low Libido

This is one of the most common symptoms associated with lower levels of testosterone, as testosterone is the hormone responsible for your sex drive.

Low Energy

Testosterone is a hormone that gives us our get up and go, so if you are constantly struggling with fatigue and low energy it could be a sign of Low T.


The lack of energy won’t be helped by another common symptom of Low T – insomnia. Hormonal imbalances can impact our sleep quality and circadian rhythm.

Reduced Muscle Mass or Weakness

Testosterone also plays a role in our strength and the growth of muscles. Many men with Low testosterone struggle to put on muscle mass.


Physical fitness is one area that can be heavily affected by low testosterone and this can lead to some men struggling with an unhealthy amount of body fat.


Low testosterone is very often misdiagnosed as depression in men because the symptoms of low energy and low mood are very similar.

Lack of Motivation

The combination of depression-like symptoms and low energy can lead to a lack of motivation, which can have a huge impact on your quality of life.

Lowered Self-Confidence

All of the above can put a huge dent in your self-esteem and mental well-being, especially as so many men living with low testosterone feel embarrassed, and suffer in silence.

Whilst the acute symptoms of low testosterone are already pretty devastating, it can have an even bigger impact in the long term. If left untreated, low testosterone levels can lead to a number of health conditions including an increased risk of osteoporosis, heart attacks and even early death.


Causes and Conditions Associated With Low Testosterone

But what causes low testosterone? Well, one factor is age. We talk a lot about the decrease in female fertility after a certain age – but men are not immune to the tick of the biological clock. On average, testosterone actually decreases by around 1% each year after thirty.

However, there are other things that can contribute to low T including injury, illness and hormonal imbalances. There are also conditions like Klinefelter Syndrome, where you are born with an extra X chromosome which can impact your testosterone levels.


Risks of Testosterone Replacement Therapy

For men living with low testosterone, TRT can be a game-changer and have far-reaching benefits for their overall health. But as with any medication, there are always some risks and side effects involved. One such potential risk of TRT is an impact on your fertility.

When we add synthetic testosterone into our bodies, your body may slow down your natural production of testosterone to balance things out. This can have a knock-on effect on your sperm production. As men with low testosterone can often already have issues with sperm health, it’s really important to be aware of the risks surrounding your fertility and do what you can to protect your swimmers whilst on TRT.

Before starting any treatment of TRT, always make sure to seek professional medical advice.


How To Support Your Sperm Health During TRT

Monitoring Your Sperm Health

Before embarking on TRT, it’s a great idea to test your sperm. Even if you aren’t planning on having children any time soon, understanding your base pre-TRT sperm count and motility is really important. You can then monitor your sperm health every few months whilst on TRT and if you notice a shift in your sperm health, you can talk to your health practitioner about either changing up your dosages, freezing your sperm, or considering other treatment options. Testing your sperm can be done without needing to go into a clinic through the ExSeed Completely At Home Sperm Test, a fast and easy way to test and track your sperm health from the comfort of your home.

Nutrition and Supplements

Your diet is one of the most important ways you can support your sperm health. Make sure that you are eating nutrient-dense sperm superfoods like dark, leafy greens full of iron and folate, Omega-3 Fatty Acids found in oily fish, diverse, colourful vegetables full of antioxidants and coenzyme Q10, found in liver, fatty fish, and whole grains. You can also supplement a healthy diet with a good men’s health supplement created specifically with sperm health in mind, like our ExSeed Multi.


Exercise is great for giving your testosterone levels a boost and it’s also helpful for protecting your sperm health. Your swimmers don’t love a sedentary lifestyle! However – too much exercise can also create a lot of oxidative stress in the body which can have a negative impact on sperm quality. It’s all about balance and finding something you enjoy. Aim to be active for at least 45 minutes every day and mix up low-impact exercises like yoga and walking with more high-intensity workouts like running or weight lifting.

Healthy Habits

Obviously, as well as keeping on top of your health habits, it’s a good time to drop some bad ones. Smoking is one of the worst things you can do for sperm health – and vaping is not great either – so definitely consider quitting. It’s also a good idea to reduce your alcohol and caffeine intake and also limit your stress levels.

Consider Freezing Your Sperm

If you are concerned about your future fertility, one option may be to freeze your sperm before starting TRT, to give yourself a safety net should you experience a decline in motile sperm count over time. Unlike for cancer patients, sperm freezing for men on TRT is not readily available on the NHS, but there are several good private options for sperm cryopreservation if this is a direction you wish to pursue.

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Wearing tight pants and underwear

Studies show that men who wear looser underwear have higher sperm concentration and total sperm count compared to men who wear tighter underwear. So, lose the tight clothes and wear something loose to give your testicles some air.

CONCLUSION: learn more about how heat can affect sperm quality here.


Besides higher mortality rate and various diseases, stress is associated with low sperm quality. Stress is known to be associated with lower testosterone levels and oxidative stress with both playing an essential role in producing and maintaining healthy sperm cells.

CONCLUSION: If you feel stressed, we recommend you get some help so you can have a balanced mental health. For a stress management guide, download the ExSeed app for free and start your personalized action plan today.

Physical activity

Scientific studies show that men who are physically active have better semen parameters than men who are inactive. Fertility specialists also state that regular physical activity has beneficial impact on sperm fertility parameters and such a lifestyle can enhance the fertility status of men.

Prioritizing exercise can help improve your overall health and result in healthy, fast swimming sperm cells that have good chances of fertilizing an egg.

CONCLUSION: Try incorporating exercise in your weekly schedule to you ensure exercising at least twice weekly. We recommend a combination of cardio training and strength exercise. Read more about exercise and male fertility on our blog.


Fast Food
Processed foods damage the health of sperm-producing cells and cause oxidative stress, which lead to poorer sperm quality. Heavy consumption of junk food (every week) can increase the likelihood of infertility since men who consume vast amounts of unhealthy food are at risk of having poor sperm quality. Besides harming your fertility, junk food enlarges your waistline, harms your cardiovascular system, kidneys, and more.

Eating more fruit and vegetables can increase your sperm concentration and motility. It’s important that you consume a healthy diet filled with antioxidants and that you eat vegetables every day. Foods such as apricots and red bell peppers are high in vitamin A, which improves male fertility by nurturing healthier sperm. Men who are deficient in this vitamin tend to have slow and sluggish sperm.

Sugary snacks/beverages: several times a week Excessive consumption of high sugar items can lead to oxidative stress, which negatively impacts testosterone levels and sperm motility. Sugary snacks and beverages are also highly associated with obesity and low fertility.
CONCLUSION: To boost sperm quality, stay away from fast food, processed food, and sugary snacks or beverages. You need to implement a healthy prudent diet filled with necessary superfoods needed for good sperm production. Check out our guide to Male Fertility Superfoods. For personalized guidance and support on how you can start improving your sperm health, check out the Bootcamp.


Direct heat can inhibit optimal sperm production and cause Sperm DNA damage. Sperm cells like environments that are a couple of degrees lower than body temperature. Avoid overheating from warm blankets, seat warmers, heat from your laptop, hot showers, and saunas.

Cigarette smoking

The exposure to tobacco smoke has significant negative effects on semen quality. The damage of cigarettes and nicotine of course depends on how many cigarettes you smoke per day and for how long, but even low usage (up to 10 cigarettes / day) can inhibit healthy sperm production.  

CONCLUSION: Stay as far away from cigarette smoking as possible if you care about your general health and your fertility. Read more here.

Cell phone

When you have your cell phone in your front pocket, your testicles are exposed to electromagnetic radiation, which studies have shown to damage the sperm cells. Put your phone in the back pocket of your pants or in your jacket pocket.


There is a clear association between obesity and reduced sperm quality. At least part of the reason for this is that obese men may have abnormal reproductive hormonal profiles, which can impair sperm production and lead to infertility. 

A BMI higher than 30 can lead to several processes in the body (overheating, increase in oxidative stress in the testes, sperm DNA damage, erectile dysfunction) that can have a negative impact on male fertility. This can result in problems when trying to conceive.  

CONCLUSION: BMI is one of the risk factors that influence semen quality and, for example, sperm motility.  


A beer or glass of wine now and then do not really harm sperm quality. But excess alcohol drinking (more than 20 units per week) can reduce the production of normally formed sperm needed for a successful pregnancy.

CONCLUSION: If you want to stay safe, stay under 14 units of alcohol per week. For more information on how alcohol can affect male fertility, take a look at our blog: “Alcohol and Sperm Quality”.


Studies show that women younger than 35 and men younger than 40 have a better chance of getting pregnant. Men can produce sperm cells almost through their entire life, but the sperm cell DNA is more fragile and prone to damage after the age of 40.

As men age, their testes tend to get smaller and softer resulting in a decline in sperm quality and production. These changes are partly because of an age-related decrease in testosterone level, which plays a very important role in sperm

production. Higher male age (>40 years) is not only associated with a decline in sperm production but also with increased sperm DNA fragmentation and worsened morphology (shape) and motility (movement). These negative effects make the sperm cells less qualified for egg fertilization.

CONCLUSION: with an age under 40, you shouldn’t have to worry much about age as a factor in itself. However, studies have shown a slow decline after the age of 30-35 years

and if you are above 40 years of age, your sperm quality can be affected due to increased sperm DNA damage resulting in a decrease of sperm motility and concentration. Remember that you cannot evaluate the quality of a sperm sample by just looking at it – this requires a sperm analysis.