Can you conceive after testosterone treatments? Many individuals taking testosterone for medical or gender-affirming reasons have concerns about their future fertility. Testosterone significantly suppresses reproductive function by disrupting the hormonal signals needed for ovulation or sperm production. However, fertility can often return after stopping treatment, though recovery is not guaranteed for everyone. The timeline and completeness of recovery vary based on treatment duration, dosage, age, and individual factors. Understanding how testosterone affects fertility, what to expect after discontinuation, and when to seek medical support can help you make informed decisions about family planning and reproductive health.

How Testosterone Treatment Affects Fertility

Testosterone treatment, whether prescribed for hypogonadism or used for gender-affirming care, has significant effects on reproductive function. When exogenous testosterone is administered, it disrupts the hypothalamic-pituitary-gonadal (HPG) axis through negative feedback mechanisms. The body detects elevated testosterone levels and responds by reducing the production of gonadotropin-releasing hormone (GnRH) from the hypothalamus, which subsequently decreases luteinising hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary gland.

This hormonal cascade has profound implications for fertility. In individuals assigned female at birth, testosterone suppresses ovulation by inhibiting the normal menstrual cycle. The reduction in FSH and LH prevents follicular development and oocyte maturation, making conception highly unlikely during active treatment. In individuals assigned male at birth, the suppression of FSH and LH leads to reduced or absent spermatogenesis (sperm production), as these hormones are essential for maintaining testicular function and sperm development.

The degree of fertility suppression varies based on several factors:

• Dosage and duration of testosterone treatment

• Individual baseline fertility status

• Age at initiation of treatment

It is crucial to understand that testosterone is not a reliable contraceptive method. Whilst fertility is significantly reduced during treatment, ovulation or sperm production may still occur unpredictably in some individuals. Those wishing to avoid pregnancy should use appropriate contraceptive methods alongside testosterone therapy. The Faculty of Sexual and Reproductive Healthcare (FSRH) recommends that people at risk of pregnancy consider long-acting reversible contraception or progestogen-only methods while taking testosterone.

Important safety information: Testosterone must not be used during pregnancy as it may harm the developing foetus. If pregnancy occurs or is suspected while taking testosterone, stop treatment immediately and seek urgent advice from your GP or early pregnancy service.

If you are considering testosterone treatment and wish to preserve fertility options, discuss fertility preservation strategies with your healthcare provider before commencing therapy.

Can You Conceive After Stopping Testosterone?

The encouraging news for many individuals is that fertility can return after discontinuing testosterone treatment, though this is not guaranteed for everyone. The reversibility of testosterone-induced infertility depends on multiple factors, and outcomes vary considerably between individuals. Research indicates that many people do regain reproductive function following cessation of therapy, but the timeline and completeness of recovery differ significantly.

For individuals assigned female at birth who have used testosterone, menstruation typically resumes within several months of stopping treatment, which generally indicates the return of ovulatory function. Studies suggest that the majority of transgender men who discontinue testosterone for conception purposes are able to achieve pregnancy, though comprehensive long-term data remains limited. The endometrium (uterine lining) and ovarian function generally recover once testosterone levels normalise and the HPG axis re-establishes its natural rhythm.

For individuals assigned male at birth, sperm production may resume after stopping testosterone, but recovery is often more variable and potentially incomplete. Factors that influence recovery include the duration of testosterone use, baseline testicular function before treatment, age, and any concurrent testicular atrophy that may have occurred. Some studies indicate that men who have used testosterone for bodybuilding or performance enhancement may experience prolonged recovery periods, and in some cases, significant impairment of spermatogenesis may persist, requiring specialist treatment.

Important considerations include:

• Pre-existing fertility issues may become apparent after stopping testosterone

• Age-related fertility decline continues during treatment

• Some individuals may require medical assistance to conceive

• Current evidence does not suggest an increased risk of birth defects in children conceived after testosterone has been stopped and cleared from the body

Preconception advice: If planning pregnancy, start taking folic acid (400 micrograms daily, or 5mg if advised by your doctor) before conception to reduce the risk of neural tube defects. Review any medications with your GP, optimise lifestyle factors (reduce alcohol, stop smoking, maintain healthy weight), and consider a preconception health check.

If you are planning to conceive after testosterone treatment, consult your GP or a fertility specialist for personalised assessment and guidance.

Timeline for Fertility Recovery After Testosterone

The timeline for fertility recovery after discontinuing testosterone treatment varies considerably and depends on individual physiology, treatment duration, and dosage. Understanding realistic timeframes helps manage expectations and informs family planning decisions.

For individuals assigned female at birth, menstrual cycles often resume within three to six months after stopping testosterone, though some may experience return of menstruation within weeks, whilst others may take up to a year or longer. The first few cycles may be irregular as the HPG axis re-establishes normal function. Ovulation may occur before menstruation resumes, meaning conception is theoretically possible even before the first post-testosterone period. Waiting for one normal menstrual cycle before attempting conception can help with pregnancy dating, but conception is not contraindicated once testosterone has been stopped.

For individuals assigned male at birth, spermatogenesis recovery is typically slower and less predictable. The complete cycle of sperm production takes approximately 74 days under normal circumstances, but recovery after testosterone suppression often requires considerably longer. Studies of men recovering from testosterone-based contraception or anabolic steroid use suggest that sperm may reappear in semen within three to six months, but optimal sperm parameters (count, motility, and morphology) may take six months to two years to recover, if full recovery occurs at all.

Factors affecting recovery timeline:

• Duration of use: Longer treatment periods generally correlate with longer recovery times

• Dosage: Higher doses may cause more profound suppression

• Age: Younger individuals typically recover more quickly

• Baseline fertility: Pre-existing fertility issues may prolong recovery

When to seek medical evaluation:

• If menstruation has not resumed within 3-6 months of stopping testosterone

• If sperm production remains absent (azoospermia) after 3-6 months

• If you have been trying to conceive for 12 months without success (or 6 months if over 36 years old)

• If you have known fertility risk factors

Regular monitoring through semen analysis (for sperm production) or menstrual tracking and ovulation monitoring (for ovarian function) can help assess recovery progress. Your GP can refer you for appropriate fertility investigations in line with NICE guidelines (CG156).

Medical Support for Conception After Testosterone Use

Many individuals who have used testosterone and wish to conceive may benefit from medical support, particularly if natural conception does not occur within a reasonable timeframe or if fertility recovery is incomplete. The NHS and private fertility services offer various interventions to assist with conception following testosterone treatment.

Your first point of contact should be your GP, who can perform initial fertility assessments, including hormone level testing (FSH, LH, oestradiol, testosterone) and other tests as clinically indicated. Those with ovaries may be offered a pelvic ultrasound, while those with testes may have semen analysis. These investigations help determine whether fertility has recovered and identify any barriers to conception. NICE guidelines (CG156) recommend specialist fertility referral if conception has not occurred after 12 months of regular unprotected intercourse (or sooner if the person trying to conceive is over 36 years old or there are known fertility concerns).

For individuals with persistent anovulation (lack of ovulation) after stopping testosterone, ovulation induction medications such as letrozole or clomifene citrate may be prescribed under specialist supervision. These medications stimulate the ovaries to produce and release eggs. For those with impaired sperm production, treatments may include human chorionic gonadotropin (hCG) injections or selective oestrogen receptor modulators (SERMs) like clomifene to stimulate the testes to produce sperm. Note that these treatments for male infertility are often prescribed off-label and should only be initiated by fertility specialists.

Assisted reproductive technologies (ART) may be considered when:

• Natural conception has not occurred despite adequate recovery time

• Sperm parameters remain suboptimal

• There are additional fertility factors (tubal issues, endometriosis, advanced age)

• Time is a critical factor

Options include intrauterine insemination (IUI), in vitro fertilisation (IVF), or intracytoplasmic sperm injection (ICSI) for severe male factor infertility. Fertility preservation options used before starting testosterone (egg or sperm freezing) can be utilised if natural fertility does not recover. NHS funding criteria for fertility treatments vary by region, so check your local Integrated Care Board (ICB) policies for eligibility criteria.

Protecting Fertility During Testosterone Treatment

For individuals who may wish to conceive in the future, proactive fertility preservation before starting testosterone treatment is the most reliable strategy to protect reproductive options. This is particularly important given that fertility recovery after testosterone is not guaranteed, and age-related fertility decline continues during treatment.

Fertility preservation options include:

• Egg freezing (oocyte cryopreservation): For individuals assigned female at birth, mature eggs are collected after ovarian stimulation and frozen for future use. This process typically takes 2-3 weeks and is most successful at younger ages (ideally before 35).

• Embryo freezing: Eggs are fertilised with sperm (from a partner or donor) before freezing, which may offer slightly higher success rates than egg freezing alone.

• Sperm freezing (sperm cryopreservation): For individuals assigned male at birth, sperm samples are collected and frozen before starting testosterone. This is a straightforward, non-invasive procedure.

• Ovarian tissue freezing: A specialised option available at selected UK centres, involving surgical removal and freezing of ovarian tissue, which may be considered in specific circumstances.

These procedures are available through NHS fertility services in some areas, though eligibility criteria vary significantly between different Integrated Care Boards (ICBs). Private fertility clinics offer these services throughout the UK, with costs varying widely. According to the Human Fertilisation and Embryology Authority (HFEA), private costs typically include initial treatment fees plus annual storage charges. For current pricing information, check the HFEA website or contact clinics directly.

If you are already taking testosterone and did not preserve fertility beforehand, discuss your future family planning goals with your prescribing clinician. In some cases, temporarily stopping testosterone to attempt conception may be appropriate, though this decision should be made collaboratively, considering both your physical and mental health needs.

When to contact your GP:

• Before starting testosterone if you have any concerns about future fertility

• If you wish to conceive and need guidance on stopping testosterone safely

• If menstruation has not resumed within 3-6 months of stopping testosterone

• If you have been trying to conceive for 12 months without success (or 6 months if over 36)

If you are taking testosterone and do not wish to become pregnant, remember that testosterone is not a reliable contraceptive. The FSRH recommends using effective contraception, with progestogen-only methods and long-acting reversible contraception being suitable options.

Comprehensive counselling about fertility implications should be part of informed consent before initiating testosterone treatment, ensuring you can make decisions aligned with your long-term reproductive goals.

Frequently Asked Questions