Fertility Risks of Testosterone Replacement Therapy

Testosterone deficiency is a medical condition that can affect young and old men, alike. Physicians often ignore the symptoms of low testosterone in younger men due to preconceived notions that only men over the age of 50 can suffer from the condition. Doctors keen enough to discover the condition in younger men often withhold treatment fearing side effects such as infertility. Worse yet, some doctors prescribe testosterone to men without warning them of the infertility potential associated with treatment due to their own ignorance. How can low T be treated in men wishing to preserve their fertility? What are the infertility risks associated with testosterone therapy and how can they be mitigated? Here are some answers to these very important questions.

First and foremost, be aware that any form of synthetic testosterone (gel, injection or pellet) will cause low sperm counts in men, often inhibiting sperm production completely. This means your sperm count may be ZERO while taking testosterone, in any form. The dosage of testosterone does NOT matter. Some patients are told by doctors that sperm production is maintained on testosterone therapy as long as the dose is “not excessive”. This is completely FALSE. Any dose of testosterone, can and will, suppress sperm production. There is no “safe” dosage of testosterone when it comes to the issue of fertility.

Another common misconception is that men on testosterone therapy can simply stop treatment if they want to have children. Even doctors will inform patients that sperm production will resume normally once they stop testosterone. This is also, totally FALSE. While it’s true that some men will recuperate normal testicular function with testosterone cessation, some men certainly do NOT. The exact magnitude of infertility risk depends on a multitude of factors. But, the truth is that we cannot predict with accuracy who will be rendered permanently infertile from testosterone. This cold hard fact remains true even when men are placed on drugs to “stimulate” endogenous testicular function after ceasing testosterone therapy.

So, how can we successfully treat men with low testosterone who do not want to jeopardize their ability to father children? The best approach is to utilize medications that signal the testicle to increase testosterone production. Clomiphene and human chorionic gonadotropin are the two most common drugs used to boost “natural” testosterone levels. Neither drug will compromise or impair fertility. An alternative approach is to use injectable testosterone along with HCG (at a lower dose compared to HCG monotherapy) in order to maintain sperm production. The problem with this alterative approach lies in the lack of well powered studies proving long term efficacy. Small studies with limited follow-up have demonstrated that sperm production is maintained. when HCG is combined with synthetic testosterone.

A tactic that should NOT be used to preserve fertility is “cycling”. Cycling is a term often used to describe intermittent testosterone usage. Men go on synthetic testosterone for weeks or months and then stop therapy. Often they will use medications like Clomid or HCG in order to “reboot” their testicles. This approach to testosterone usage is often employed by athletes and body builders who are using testosterone illegally for it’s performance enhancing attributes. This is not a viable, medically acceptable approach to treating testosterone deficiency and it certainly does not guarantee fertility in men abusing steroids.

Keep in mind that some men on testosterone can and will conceive children. Testosterone is certainly NOT a form of birth control. However, testosterone can have deleterious effects on fertility in men being treated for testosterone deficiency syndrome and these concerns must be addressed in a logical manner by an expert in the field.

Testosterone & Prostate Cancer: Facts & Fiction

Movember is a great opportunity for people to learn about important men’s health issues. As a urologist who specializes in the diagnosis and treatment of testosterone deficiency, I wanted to present some facts regarding the relationship between prostate cancer and testosterone. My hope is that a few concrete pieces of information will help men understand this complex relationship so that they can make educated decisions about their healthcare.


  • The prostate gland requires testosterone for NORMAL development.
  • Testosterone deficiency (“low T”) is a medical condition that warrants treatment in properly diagnosed individuals.
  • Contrary to popular belief, low testosterone levels may actually INCREASE the risk of developing prostate cancer.
  • Men with low testosterone may also be at risk for the development of more AGGRESSIVE prostate malignancy.
  • Patients diagnosed with low testosterone MUST be screened for prostate cancer through prostate examination and PSA blood testing.
  • PSA results can be more difficult to interpret in the face of low testosterone levels making it imperative that men seek out a urologist with experience in doing so.
  • Men suspected of having prostate cancer MUST undergo a prostate biopsy before starting testosterone replacement therapy.
  • Men on testosterone therapy MUST be monitored carefully for prostate cancer and therapy should be STOPPED if cancer is suspected.
  • Patients with a history of prostate cancer are often told by doctors that testosterone therapy is “ABSOLULTEY FORBIDDEN”.
  • Once prostate cancer is diagnosed and treated SUCCESSFULLY, testosterone therapy CAN BE safely prescribed by an expert.


  • Testosterone CAUSES prostate cancer.
  • Testosterone therapy will INCREASE a man’s risk for developing prostate cancer.
  • Men on testosterone replacement therapy do NOT require monitoring for prostate cancer.
  • Prostate cancer that develops while using testosterone will be VERY aggressive.
  • Men with prostate cancer can NEVER receive testosterone therapy.

Summarizing, testosterone therapy is safe for the prostate when administered by experts. Men with testosterone deficiency must be screened for prostate cancer before starting testosterone replacement therapy (TRT). Men treated with TRT must be monitored for prostate cancer using prostate exams and PSA testing on a regular basis. PSA results must be interpreted with caution and expertise because subtle changes may indicate cancer. Men who develop prostate cancer while on testosterone therapy must be recognized early so that treatment can be stopped. Once the cancer is successfully treated, many men can safely resume testosterone replacement therapy if they are monitored by an expert.

What is Herbal Viagra, is it Safe?

What is herbal Viagra?
Herbal Viagra is a group of products available without a prescription that purportedly enhance male sexual function. Some of these products contain vitamins, minerals and herbal compounds that may have physiologic effects similar to those of Viagra. Many of these products actually contain sildenafil, the active ingredient in Viagra, or compounds that are chemically similar to sildenafil.

How does Viagra work?
Viagra is only available with a prescription and for good reason. Viagra is in a class of drugs called PDE5 inhibitors that work by dilating the blood vessels that carry blood to the penis when men are sexually stimulated. The vasodilation improves blood flow and serves as an effective treatment for erectile dysfunction.
Is herbal Viagra dangerous? Yes, herbal Viagra can be extremely dangerous and should be avoided at all costs. Even genuine Viagra can be dangerous if not prescribed carefully by an experienced clinician. Men should be aware that erectile dysfunction may be the first sign of a serious underlying medical condition such as heart disease or diabetes. If they are having sexual difficulties they need a thorough medical evaluation. They shouldn’t go out and try to self treat themselves with dangerous OTC products or borrow a friends Viagra. Erectile dysfunction is a serious medical problem that warrants a serious medical investigation before implementing any form of therapy.

Why is herbal Viagra so dangerous?
Keep in mind that genuine Viagra can be a dangerous drug and has significant risks even when prescribed by a medical professional. Herbal Viagra is far more dangerous for a multitude of reasons, first and foremost, it isn’t being prescribed by a doctor who understands sexual dysfunction and the complexities of prescribing any drug. If you need some more reasons, read on below.

  • Herbal Viagra is not regulated by the FDA which means the ingredients listed on the bottle may be completely inaccurate. Manufacturers of herbal Viagra can list pixie dust as an ingredient if they like without any scrutiny by the FDA. The purity and dosage of the listed ingredients are also grossly inaccurate in many cases.
  • Some of the “natural” herbal compounds used in male sexual enhancement products may have Viagra-like activity in the body which can put certain patients at risk and interact with other drugs or OTC products they are ingesting.
  • Many herbal Viagra products actually contain the active ingredient in Viagra, sildenafil, or similar compounds. In some cases, dosages that far exceed the recommended clinical strength of Viagra are contained in these products.
  • Herbal and counterfeit Viagra products are often tainted with some pretty awful stuff including blue printer ink, amphetamines, dry wall compound and rat poison. I don’t know about you, but these are not things I want in my digestive tract.

What are some of the dangers of real Viagra?
Viagra is a drug that dilates blood vessels. If combined with other drugs that lower blood pressure it’s use could be fatal. Drugs used to treat prostate enlargement can also cause a dangerous drop in blood pressure when combined with Viagra. Viagra and other PDE5 inhibitors are dangerous in men who have unstable cardiovascular disease. They should not be used in men who have had a heart attack or stroke in the past six months. Other cardiovascular conditions may also preclude it’s use. Viagra is contraindicated in men with certain disorders of the eye and can cause blindness as well as hearing loss in some men. Viagra dosing needs to be adjusted in men who have kidney or liver disease. Viagra type medications can affect the way other drugs work and lead to dangerous side effects. Certain HIV drugs and antifungal medications to name a few.

How can a patient obtain legitimate Viagra?
Viagra should only be obtained via prescription. Men should be directed to see a physician with experience prescribing Viagra. Over the counter “herbal Viagra” should be avoided altogether. Take your Viagra prescription to a legitimate pharmacy. Don’t buy your Viagra from an online pharmacy in China. If you insist on using an online pharmacy make sure it’s a Verified Internet Pharmacy Practice Sites® (VIPPS®)-accredited online pharmacy.

The Bottom Line
Men with erectile dysfunction should seek out a medical professional with expertise in diagnosing and treating male sexual dysfunction. Avoid over the counter herbal Viagra or any other product that claims to improve sexual function. They are simply unsafe. If your doctor prescribes Viagra ensure that you obtain it from a reputable source. Deviating from these simple recommendations can have serious consequences.

We Are Members of Privia Medical Group

As of month day, year, we are proud members of Privia Medical Group!