Medically reviewed by Adam Russell, PA-C
For younger service members, fertility may be one of the most important issues to discuss before beginning testosterone replacement therapy. Exogenous testosterone can suppress the hormonal signals involved in sperm production, which can reduce fertility during treatment.
Family-planning goals belong in the first conversation
The Endocrine Society recommends against starting testosterone therapy in men who are planning fertility in the near term. That is relevant to military populations because many service members are screened at relatively young ages.
The 2026 military guidance has drawn fertility questions
In its September 24 response to the DHA guideline, the Endocrine Society specifically raised concerns about fertility-related treatment recommendations. The existence of that professional disagreement is another reason patients should ask detailed questions about the diagnosis, treatment goal, alternatives, and expected effects on fertility.
Questions to ask before treatment
Tell the clinician whether you want children now or later. Ask how the proposed treatment could affect sperm production, whether fertility evaluation is appropriate before treatment, whether alternatives exist, and how recovery of natural hormone production is handled if testosterone is stopped.
Do not start, stop, or add hormone medications solely to preserve fertility without medical supervision. Hormone combinations can create their own risks and require individualized management.
For more context, read the HBC military TRT guide and the broader TRT and fertility resource.