TRT and fertility: hCG, enclomiphene and alternatives

This is the page most clinic consultations skip. Standard TRT suppresses the brain signals that drive sperm production — for some men the effect is significant and, after years, sometimes not reversible. If children are anywhere in your future plans, resolve this before starting.

What actually happens

Testosterone therapy raises blood T but switches off LH and FSH (the pituitary hormones). FSH drives sperm production — with it suppressed, sperm counts fall, often dramatically, within months.

The options if fertility matters

hCG alongside TRT. hCG mimics LH and can maintain intratesticular testosterone; adding it preserves partial sperm production for many men. It costs extra (£25–£50/month typical add-on pricing seen at UK clinics) and needs its own monitoring.
Enclomiphene/clomiphene. A SERM that raises LH/FSH and your own testosterone instead of switching them off. Not a licensed UK product (prescribed off-label); widely used by fertility-aware clinics and US telehealth.
Deferred TRT. Bank sperm first (cryopreservation, ~£150–£400/year storage at UK clinics), start TRT, and know the option exists.
Wait. If fertility is a 1–3-year plan, completing the family first is the cleanest path — discuss the timescale honestly.

Questions to ask before signing anything

"I may want children later — what is your protocol for that?"
"Do you offer hCG or enclomiphene alongside TRT, and at what cost?"
"Will you check LH/FSH before starting, and semen analysis if I ask?"
"What fraction of your patients on TRT+hCG maintain measurable sperm counts?"

For men already on TRT who now want children

Do not stop cold — see a fertility specialist. TRT cessation recovers sperm production in most men within 3–6 months (faster with hCG), but the recovery is individual. Private fertility assessment (semen analysis + hormonal panel) costs £150–£400.

This page is general information from published clinical sources, not medical advice. Sources: BSSM-aligned publications; clinic published pages verified 2026-10-08.

Affiliate disclosure: Some pages contain affiliate or advertising links, marked with 'sponsored'. Listings are never sold ranking — featured status is labelled on the page. Clinic data is published free regardless of commercial relationships.

Information directory — medically reviewed sources cited per page · Source-checked 2026-10-09 · Independent information directory — not medical advice.