Testogel (testosterone gel) can significantly reduce male fertility, though this effect is usually reversible after stopping treatment. When applied daily for testosterone replacement therapy, Testogel suppresses the body's natural production of hormones essential for sperm production—luteinising hormone (LH) and follicle-stimulating hormone (FSH). Many men develop very low sperm counts or even azoospermia (absent sperm) whilst using Testogel. However, reduced fertility does not guarantee complete sterility, making it unreliable as contraception. If you are using Testogel and planning to start a family, or have concerns about your fertility, speak with your GP or endocrinologist before making any changes to your treatment.

Does Testogel Make You Infertile?

Testogel (testosterone gel) can significantly reduce fertility in men, though this effect is usually reversible. When applied daily, Testogel delivers exogenous testosterone through the skin, which suppresses the body's natural hormone production. This suppression affects the pituitary gland's release of luteinising hormone (LH) and follicle-stimulating hormone (FSH), both essential for sperm production in the testes.

Whilst Testogel is licensed for testosterone replacement therapy in men with confirmed hypogonadism, it is not approved as a contraceptive and is not indicated for the treatment of male infertility. According to the Testogel Summary of Product Characteristics (SmPC), the reduction in sperm production can be substantial enough to impair fertility in many users. Studies show that testosterone therapy can reduce sperm counts to very low levels or even zero (azoospermia) in some men, though individual responses vary considerably.

It is crucial to understand that reduced fertility does not mean complete sterility in all cases. Some men may maintain sufficient sperm production to achieve pregnancy, making Testogel unreliable as a sole method of contraception. The Testogel SmPC clearly states that men wishing to father children should discuss alternative treatments with their healthcare provider.

If you are currently using Testogel and planning to start a family, or if you have concerns about your fertility, it is essential to speak with your GP or endocrinologist before making any changes to your treatment. Abruptly stopping testosterone therapy without medical supervision can lead to uncomfortable symptoms and hormonal imbalance.

How Testosterone Gel Affects Sperm Production

The mechanism by which Testogel reduces fertility involves the hypothalamic-pituitary-gonadal (HPG) axis, a complex hormonal feedback system. When you apply testosterone gel, the absorbed testosterone circulates in your bloodstream and signals to the hypothalamus and pituitary gland that adequate testosterone levels are present. In response, these glands reduce their production of gonadotropin-releasing hormone (GnRH), LH, and FSH.

FSH is particularly critical for spermatogenesis — the process of sperm cell development within the seminiferous tubules of the testes. LH stimulates Leydig cells to produce testosterone locally within the testes, which is required at much higher concentrations than circulating levels for normal sperm production. When exogenous testosterone suppresses LH and FSH, intratesticular testosterone levels fall dramatically, and sperm production declines accordingly.

The degree and speed of suppression vary significantly between individuals. Some men experience substantial reductions in sperm count within weeks of starting treatment, whilst others may take several months. Many men on testosterone replacement therapy will develop oligozoospermia (low sperm count) or azoospermia (absent sperm), though the extent and timing of these changes vary widely based on individual factors.

Factors influencing the extent of suppression include the dose of testosterone, duration of treatment, baseline fertility status, and individual hormonal sensitivity. Men with higher baseline sperm counts may retain some fertility longer than those starting with borderline parameters. It is worth noting that whilst sperm production decreases, sexual function and libido typically improve with testosterone therapy, which can create a disconnect between reproductive capability and sexual activity.

Importantly, as stated in the Testogel SmPC, testosterone replacement therapy should not be relied upon as a contraceptive method.

Fertility Recovery After Stopping Testogel

The suppression of sperm production caused by Testogel is generally reversible, though recovery timelines vary considerably between individuals. After discontinuing testosterone gel, the HPG axis gradually resumes normal function, allowing LH and FSH levels to rise and stimulate the testes to produce sperm again.

Many men will see some recovery of sperm production within 3–6 months of stopping Testogel, with continued improvement over the following months. However, complete recovery to baseline fertility levels is not guaranteed for everyone. Research suggests that while most men regain sperm production, some may experience prolonged suppression or incomplete recovery, particularly after long-term use.

Several factors influence recovery time and completeness:

• Duration of testosterone therapy — longer use may require more time for recovery

• Age — older men may experience slower or less complete recovery

• Baseline fertility status — men with pre-existing fertility issues may not return to previous levels

• Testicular size — significant testicular atrophy during treatment may indicate more prolonged recovery

• Concurrent health conditions — obesity, diabetes, and other conditions affecting hormonal balance

If you are planning to stop Testogel to attempt conception, your GP or fertility specialist may recommend semen analysis at intervals to monitor recovery. The frequency of testing will be determined by your specialist based on your individual circumstances. In some cases, additional treatments such as human chorionic gonadotropin (hCG) or selective oestrogen receptor modulators (SERMs) like clomifene may be prescribed to accelerate recovery, though these are used off-licence for this indication in men. NICE Clinical Guideline 156 on fertility problems emphasises the importance of specialist input when managing fertility concerns in men with hypogonadism.

If you experience any side effects from Testogel or after stopping treatment, report them through the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk).

Alternatives to Testogel If You're Planning a Family

If you require testosterone replacement but wish to preserve or maintain fertility, several alternative approaches may be considered in consultation with an endocrinologist or fertility specialist. The optimal strategy depends on the underlying cause of your hypogonadism, your current fertility status, and your timeline for family planning.

For men with secondary hypogonadism (where the problem lies with the pituitary gland or hypothalamus rather than the testes themselves), medications that stimulate the body's own testosterone production may be appropriate. Human chorionic gonadotropin (hCG) injections can mimic LH and stimulate testicular testosterone production whilst maintaining sperm production. This is often combined with FSH injections (human menopausal gonadotropin or recombinant FSH) to directly support spermatogenesis. NICE Clinical Guideline 156 recognises gonadotrophin therapy for men with hypogonadotrophic hypogonadism. Whilst effective, this approach requires regular injections and careful monitoring.

Selective oestrogen receptor modulators (SERMs), such as clomifene citrate, represent another option. These medications block oestrogen receptors in the hypothalamus and pituitary, leading to increased GnRH, LH, and FSH secretion. This can raise both testosterone and sperm production simultaneously in selected men. However, SERMs are used off-licence for male hypogonadism in the UK, and response varies between individuals.

For men with primary hypogonadism (testicular failure), where the testes cannot respond adequately to hormonal stimulation, fertility preservation is more challenging. In such cases, sperm banking before starting testosterone therapy may be the most reliable option if future fertility is desired.

Some men may consider using testosterone therapy intermittently when attempting conception. However, this approach is generally not recommended as standard care, as it means accepting periods of hypogonadal symptoms and requires careful specialist supervision. Your healthcare team can help you weigh the benefits and drawbacks of each approach based on your individual circumstances, symptom severity, and fertility goals.

When to Speak to Your GP About Testogel and Fertility

You should contact your GP or specialist before starting Testogel if you are planning to have children in the future, as discussing fertility preservation options beforehand is far more effective than attempting to reverse suppression later. Your doctor can arrange baseline semen analysis and discuss alternative treatments that may better suit your reproductive goals.

If you are currently using Testogel and wish to start trying for a family, arrange an appointment as soon as possible. Do not stop your treatment abruptly without medical guidance, as this can cause a sudden drop in testosterone levels, leading to fatigue, low mood, reduced libido, and other symptoms of hypogonadism. Your doctor will create a structured plan for transitioning off Testogel or switching to fertility-preserving alternatives, with appropriate monitoring.

Seek medical advice if you have been off Testogel for more than 12 months without recovery of fertility, as indicated by persistently abnormal semen analysis results. Your GP may refer you to a fertility specialist or consultant in reproductive medicine (or a urologist/andrologist) for further investigation and potential interventions to stimulate sperm production.

You should also consult your healthcare provider if:

• You have been using Testogel and your partner becomes pregnant unexpectedly, as you may need adjusted counselling regarding treatment continuation

• You experience significant testicular shrinkage or pain whilst on treatment

• You develop symptoms suggesting testosterone levels are too high or too low

• You have concerns about the impact of treatment on your long-term reproductive health

• You experience acute scrotal pain (requiring urgent assessment)

• You notice a testicular lump (requiring prompt referral via a two-week-wait pathway)

• You develop severe headaches or visual disturbances (which may indicate pituitary issues requiring urgent endocrine referral)

Counselling on fertility effects should be provided and documented when starting testosterone replacement therapy, as highlighted in the Testogel SmPC. If this discussion did not occur when you started treatment, raise it at your next review appointment. Fertility considerations should form part of the ongoing shared decision-making process about your testosterone therapy, with regular reviews to ensure your treatment remains aligned with your life goals and circumstances.

Frequently Asked Questions