By Pedro Royo Manero (Gynecologist – License No. 312203918).
To understand what happens in these cases, it is important to know how the hypothalamic-pituitary-testicular axis works. This hormonal system regulates much of a man's hormone and sperm production. The hypothalamus, located in the brain, sends signals to the pituitary gland to produce two essential hormones: follicle-stimulating hormone (FSH) and luteinising hormone (LH).
FSH plays a direct role in the function of Sertoli cells and sperm production, while LH stimulates the Leydig cells in the testicles to produce testosterone. However, when a man takes testosterone through injections, gels, implants or other preparations, the brain detects elevated levels of this hormone in the bloodstream and responds by reducing the signals it sends to the testicles. As a result, LH and FSH levels decrease.
This is where the paradox arises. Although blood tests may show high testosterone levels, the concentration of testosterone inside the testicles can fall significantly, precisely because the body's natural production has been suppressed.
Without adequate intratesticular testosterone levels and sufficient FSH stimulation, sperm production may decline dramatically or stop altogether. This mechanism, known as negative feedback on the hypothalamus and pituitary gland, can lead to severe oligozoospermia or azoospermia.
The use of testosterone and anabolic steroids has become increasingly widespread in recent years, particularly in sports, gyms and on social media, where these substances are often promoted as a quick way to build muscle mass, improve physical performance or achieve certain changes in body composition.
However, from a reproductive perspective, there is an important paradox: testosterone administered from outside the body can cause the testicles to stop producing sperm. In other words, a hormone commonly associated with male sexual function can, when used externally without an appropriate medical indication, act as a form of unintended male contraception.
Both the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) warn that exogenous testosterone should not be used by men who are trying to conceive, as it can significantly suppress sperm production and may even stop it altogether.
The severity of these effects depends on several factors, including the dose, duration of use, type of testosterone preparation, simultaneous use of other anabolic steroids and the patient's previous hormonal status. Not all men experience the same changes. However, one of the most common consequences is a substantial reduction in sperm production.
A semen analysis in a man using exogenous testosterone may reveal anything from a significant reduction in sperm concentration to azoospermia, which means that no sperm are present in the ejaculate. Another possible consequence is severe oligozoospermia, a condition in which sperm are still present but in extremely low numbers.
Not every man who uses testosterone will develop azoospermia, as individual responses vary considerably. Nevertheless, exogenous testosterone can almost completely suppress spermatogenesis. This means that a man may maintain his sex drive, erectile function and even high blood testosterone levels while experiencing a substantial reduction in fertility.
When LH and FSH suppression continues over time, various physical changes may occur. As testicular activity decreases, the testicles may become smaller, a condition known as testicular atrophy.
However, this does not necessarily mean that the testicles have permanently lost their function. In many cases, the reduction in activity results from hormonal suppression caused by insufficient stimulation from the brain. Nevertheless, the longer the exposure to testosterone and the older the patient, the more difficult it may be to predict how long hormonal function and sperm production will take to recover.
In most cases, yes. Sperm production can recover after stopping exogenous testosterone, although this does not happen immediately. Under normal conditions, spermatogenesis takes several weeks. In addition, the hormonal axis that has been suppressed must first recover its normal function.
Some men begin producing sperm again within a few months of stopping testosterone, while others may need 6, 12 or even more months. Recovery time depends on several factors, including how long testosterone or anabolic steroids have been used, the doses taken and the type of preparation.
Older age and prolonged exposure also appear to slow down recovery. Itis also important to distinguish between the return of some sperm to the ejaculate and the recovery of semen parameters sufficient to achieve a natural pregnancy. These two milestones do not necessarily occur at the same time.
In some sporting and bodybuilding environments, post-cycle therapy (PCT) refers to combinations of medications that individuals take after a course of anabolic steroids in an attempt to restart their natural hormone production. However, post-cycle therapy should never be undertaken without medical supervision.
In selected patients, medications such as human chorionic gonadotrophin (hCG), clomiphene or other hormonal modulators may be used to support the recovery of testicular function. Nevertheless, their suitability, dosage and duration must be determined according to each man's hormonal profile and reproductive circumstances.
When a man has used testosterone or anabolic steroids and wishes to become a father, the first step is to assess his current reproductive health. Not every patient will require the same treatment. The following steps can help guide the assessment and recovery of male fertility.
If testosterone is being used without a medical indication, the first step is generally to discontinue its use, always with professional guidance. However, if testosterone replacement therapy has been prescribed to treat hypogonadism, it should never be stopped or modified without consulting a doctor. In these cases, alternative treatment strategies may be considered to help manage symptoms while minimising unnecessary risks to fertility.
A semen analysis determines whether sperm are present in the ejaculate and, if so, assesses their concentration, motility and morphology. A hormonal assessment may also include:
FSH and LH levels are particularly useful for determining whether the hormonal axis remains suppressed and for distinguishing between different types of hormonal dysfunction.
For many men, stopping testosterone and allowing sufficient time for recovery enables the hormonal axis to gradually resume its normal function. However, in other cases, particularly when azoospermia persists, when faster recovery is desired for reproductive reasons or when hormonal suppression remains significant, a specialist may consider hormonal treatment.
One option is human chorionic gonadotrophin (hCG), which acts in a similar way to LH and stimulates testosterone production within the testicles. In some cases, FSH may also be administered to stimulate spermatogenesis directly.
Selective oestrogen receptor modulators, such as clomiphene, may also be considered for certain patients to encourage the body's natural production of gonadotrophins. However, these treatments must be tailored to each individual. The choice of treatment depends on semen analysis results, hormone levels, duration of testosterone use, age and reproductive priorities.
Having used testosterone or anabolic steroids does not necessarily mean that you have permanently lost the ability to become a father. In many cases, sperm production can recover. However, identifying the most appropriate approach requires understanding the extent to which testicular function has been suppressed.
At IVF-Life, our male fertility assessment evaluates semen analysis results, hormonal profiles and any history of testosterone or anabolic steroid use. This allows our specialists to determine whether it is advisable to wait for spontaneous recovery, consider specific treatment or explore assisted reproductive techniques when necessary.
Some patients recover sufficient sperm production to attempt conception naturally. In others, recovery may be partial, and techniques such as in vitro fertilisation (IVF) with intracytoplasmic sperm injection (ICSI) can make it possible to work with very small numbers of sperm.
The most important thing is to avoid attempting to resolve the problem through unsupervised combinations of hormonal medications. The same hormonal manipulation that initially affected fertility may make recovery more difficult if further treatments are used without understanding what is happening in the body.
Therefore, if you wish to become a father, a specialist fertility assessment is essential to establish your current reproductive health and develop a personalised strategy aimed at restoring sperm production and maximising your chances of achieving a pregnancy.
American Urological Association (AUA), American Society for Reproductive Medicine (ASRM).
Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline Part II.
.
2021;
62–69
Consultar la guía clínica de la AUA/ASRM sobre el tratamiento de la infertilidad masculina.:
https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-aua-asrm-guideline-part2/
Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM.
Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline.
.
2018;
1715–1744
Consultar la guía de la Endocrine Society sobre el tratamiento con testosterona en hombres con hipogonadismo:
https://www.endocrine.org/clinical-practice-guidelines/testosterone-therapy
Rajmil O, Moreno-Sepulveda J.
Recovery of spermatogenesis after androgenic anabolic steroids abuse in men. A systematic review of the literature.
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2024;
116–124
Consultar la revisión sistemática sobre la recuperación de la espermatogénesis tras el consumo de esteroides anabolizantes:
https://pubmed.ncbi.nlm.nih.gov/37567343/
McBride JA, Coward RM.
Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use.
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2016;
373–380
Consultar la revisión sobre la recuperación de la espermatogénesis tras el uso de testosterona o esteroides anabolizantes:
https://pubmed.ncbi.nlm.nih.gov/26908067/
Crosnoe LE, Grober E, Ohl D, Kim ED.
Exogenous testosterone: a preventable cause of male infertility.
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2026;
106–113
Consultar el artículo sobre la testosterona exógena como causa prevenible de infertilidad masculina:
https://pubmed.ncbi.nlm.nih.gov/26813847/
Tatem AJ, Beilan J, Kovac JR, Lipshultz LI.
Management of Anabolic Steroid-Induced Infertility: Novel Strategies for Fertility Maintenance and Recovery.
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2020;
141–150
Consultar la revisión sobre las estrategias para preservar y recuperar la fertilidad tras el uso de esteroides anabolizantes:
https://pubmed.ncbi.nlm.nih.gov/30929329/
Al Hashimi M, Pinggera GM, Shah R, Agarwal A.
Clinician's guide to the management of azoospermia induced by exogenous testosterone or anabolic-androgenic steroids.
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2025;
330–341
Consultar la revisión clínica sobre el manejo de la azoospermia inducida por testosterona exógena o esteroides anabolizantes:
https://pubmed.ncbi.nlm.nih.gov/39820213/
Wenker EP, Dupree JM, Langille GM, Kovac J, Ramasamy R, Lamb D.
The Use of HCG-Based Combination Therapy for Recovery of Spermatogenesis after Testosterone Use.
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2026;
1334–1337
Consultar el estudio sobre el uso de terapia combinada con hCG para recuperar la espermatogénesis tras el tratamiento con testosterona:
https://pubmed.ncbi.nlm.nih.gov/25904023/
Esposito M, Salerno M, Calvano G, Agliozzo R, Ficarra V, Sessa F.
Impact of anabolic androgenic steroids on male sexual and reproductive function: a systematic review.
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2023;
43–50
Consultar la revisión sistemática sobre el impacto de los esteroides anabolizantes en la función sexual y reproductiva masculina:
https://pubmed.ncbi.nlm.nih.gov/35146992/
Solanki P, Eu B, Smith J, Allan C, Lee K.
Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review.
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2023;
e230358
Consultar la revisión sobre la recuperación física, psicológica y bioquímica del hipogonadismo inducido por esteroides anabolizantes:
https://pubmed.ncbi.nlm.nih.gov/37855241/
Privacy Policy
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