Millions of American men are on a drug to help with fertility, not knowing they may be “compromising” the very thing they’re trying to protect.
That’s what Dr. Justin Dubin, MD, a urologist and director of men’s sexual health at Herbert Wertheim Cancer Institute, tells The Post.
As many as 11 million men are on testosterone replacement therapy, or TRT, in the US. After all, it’s easier than ever: Online sellers offer scripts without seeing a doctor in person at all.
Testosterone takers range from younger folks looking to get more sculpted muscles, to older men looking to boost bone health and focus, while combating fatigue.
But sexual health is one of the biggest reasons: Getting extra testosterone will help improve those with low T improve their sex drive, sex performance, and treat erectile dysfunction.
As men age, testosterone naturally declines. For those who have trouble making enough naturally, TRT is a common prescription.
Dubin says certain men should avoid it, even if you can get it.
“Taking testosterone kills your sperm and causes infertility in men,” he said. “If you are a man interested in future family planning, I do not recommend taking testosterone.”
Testosterone doesn’t literally kill sperm, but it does cause sperm production to drop dramatically. In fact, it was even considered as a contraceptive.
Because the body detects enough testosterone, it stops making more. Without testosterone signals, sperm production stops. In three to six months, many men totally stop producing any sperm.
Usually, it takes months, up to two years, for sperm production to return after patients get off TRT. But the return of sperm not guaranteed. Some people on TRT may stop making sperm permanently.
Disappearing sperm just one of many issues
TRT can also shrink your balls.
On TRT, all the tubes that are no longer being used as often to release hormones “shut down and shrink,” said Dr. Alexander Pastuszak, a urologist and the CEO of Paterna Biosciences. Testicles may noticeably wither “within a few months of consistent use.”
As long as testosterone stays in a normal range, Dubin says, taking TRT is safe. That requires frequent monitoring from your doctor to make sure things aren’t going awry.
There have historically been concerns that TRT increases risk of heart attacks and prostate cancer. Recently, the Trump administration rolled back restrictions on TRT citing research that TRT didn’t increase risk of heart events.
As for prostate cancer, TRT doesn’t cause it. But the drug can cause existing tumors to grow. It’s possible that patients might not know about their cancer, and end up making it much worse by going on TRT. That’s another reason why the drug needs to be taken with cancer screening and doctor supervision.
Then there’s the question of taking testosterone when you don’t really need it. One study showed only 12% of men on it actually met conditions that warranted a prescription.
Without proper doctor supervision, testosterone can stay high in your system, causing risks to the heart, acne and even breast development, Dubin said. This can happen if the dose is too high, or the patient doesn’t metabolize the drug fast enough between doses.
Abnormally high testosterone is above 1000 nanograms per deciliter in the blood — which is why Dubin recommends “seeing a healthcare provider every 3-6 months for assessment and evaluation of blood work.”
High testosterone causes increased red blood cell production, raising blood pressure and straining the heart.
Excess testosterone overstimulates the skin’s sebaceaous glands, making more oil and clogging pores, causing acne. Breasts might develop because of aromatization, a natural body process that converts extra testosterone into estrogen. Estrogen signals breast tissue to grow.
Going on TRT
Testosterone may seem like an easy fix, but may be missing the root of the problem, only making things worse.
“Treating low testosterone in the setting of sleep apnea without addressing the sleep apnea can often make the sleep apnea worse,” Dubin said. “Treating your testosterone levels without changing your diet or exercise regimen may not result in the weight loss or sugar control we are hoping for.”
Skipping the doctor’s visit and getting TRT online makes it harder to get an accurate understanding of your health, which with testosterone, is often complicated and intertwined.
“Low testosterone is rarely an isolated health issue — it can be impacted by habits like poor diet, lack of sleep, and sedentary lifestyle and disease like obesity, diabetes, cancer, and chronic diseases,” Dubin said.
He recommends looking into alternatives like clomiphene and enclomiphene, as well as human chorionic gonadotropin (hCG). These “can increase your testosterone, preserve and potentially improve your fertility,” he said.
