Special Message for Men Who Are on Testosterone Therapy for "Low T"

Testosterone (T) therapy inhibits sperm production by the testes. In our personal experience, about 70% of men on T therapy have no sperm in their semen.

VASECTOMY: We offer men who are on T therapy the option to bring a semen specimen when they come to our main office in Lutz for their vasectomies. For men who are seeing us at one of our outfield locations, and for men who are coming to the Lutz office from a long distance, we can send you a mailer, which you use to mail a semen specimen to our office before your appointment date.

If your semen contains no sperm, you are VERY unlikely to cause a pregnancy (nearly as unlikely as a man who has had a vasectomy) as long as you stay on T therapy; and you may not want to have a vasectomy. The risks of vasectomy are exceedingly low, but perhaps more than the risk of causing a pregnancy if you have no sperm in your semen. Not to mention the fact that you'll save the cost of a vasectomy, and the inconvenience of a trip to one of our offices.

What does the medical literature say?
One study published in 1990 followed 157 men who had become azoospermic (no sperm in the semen) on testosterone therapy for one year. One of those men caused a pregnancy for a rate of 1 of 157 per year or 0.6% per year. By contrast, the rate of pregnancy of women on birth control pills is 8 pregnancies per 100 women per year or 8% per year.
Another study published in 1996 reported NO pregnancies caused by men with T-induced azoospermia over 230 person years (for example, 23 men monitored for 10 years or 46 men monitored for 5 years), AS LONG AS THOSE MEN STAYED ON TESTOSTERONE.

Most men who are on T therapy like it, and continue with it indefinitely. We have never had a patient with no sperm on T therapy who showed a return of sperm to the semen on repeat testing or who reported a pregnancy (without a vasectomy), as long as he remained on the T therapy and did not add any other medications like clomiphene or HCG (which stimulate sperm production). Any man with no sperm on T therapy should reconsider vasectomy if he ever comes off testosterone or starts another med to prevent shrinkage of the testes.

We do not require a semen test of men on T therapy. Some men want to proceed with vasectomy even if their semen contains no sperm. (Personally, I [Dr. Stein] would not have a vasectomy if my semen were free of sperm on T therapy. But such decisions are based upon partner considerations and how a couple might manage an exceedingly unlikely pregnancy.) Please NOTE: If you are on T and your post-vasectomy semen test shows no sperm, this may be a result of using T rather than a result of the vasectomy itself. Therefore, the post-vasectomy semen test should be repeated if you stop T therapy, at least one year after stopping the T therapy.

If a man with no sperm on T therapy would choose to have a vasectomy despite the absence of sperm in his semen, there is really no need to test for sperm in the semen AFTER the vasectomy.

Some men on T therapy take a second medication like HCG to stimulate the testes so that they don't experience testicular atrophy (shrinkage). This probably decreases the likelihood of complete azoospermia (no sperm in the semen), but we recommend pre-vasectomy semen testing nonetheless.

If you are not ready to schedule a vasectomy but would like to determine whether there are sperm in your semen, you may purchase a home test kit at your local pharmacy for about $60. One is called SpermCheck Fertility. Or, after we receive your online registration, you can bring a specimen to our office in Lutz, or we can send you a mailer.

VASECTOMY REVERSAL: What about men on T therapy who have new partners with whom they want children? They cannot be tested for sperm because they have had vasectomies. We generally recommend that they stop testosterone and switch to clomiphene (Clomid), which will stimulate the testes (to produce both sperm and testosterone) but usually not result in T levels as high as T therapy. So men may feel a little less energy and libido than when on testosterone, but that may be the price to pay for optimizing fertility and chances of a pregnancy following vasectomy reversal.