Understanding male health

Here’s what no one tells you about starting TRT

The benefits are real — more energy, better mood, improved strength. But there’s one thing your clinic might not mention until it’s too late.

8 min read · May 31, 2024

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What you really need to know before starting TRT

Testosterone replacement therapy helps bring your testosterone levels up to normal and counteract symptoms of low T.
Your sex drive, sexual function, and mood should improve quickly after starting TRT, while symptoms like insulin resistance and increased fat will likely take longer to resolve.
It’s important to be aware of potential side effects of TRT, like infertility and possible cardiovascular issues. If you want to grow your family in the future, you may need to freeze your sperm before starting TRT.

Learn about at-home sperm freezing

What is testosterone and why does it matter?

Testosterone is essential for:

Sex drive and erections
Sperm production
Bone density and muscle mass
Mood and energy

When testosterone drops too low (below 300 ng/dL), it’s known as hypogonadism — and it can seriously affect your well-being and fertility.

What exactly is TRT?

Testosterone replacement therapy (TRT) adds testosterone back into your body via:

Gels or patches (daily)
Injections (every 1–2 weeks)
Pellets (implanted every few months)

The goal is to bring your testosterone back to healthy levels and ease symptoms like fatigue, low libido, and depression.

What to expect when you start TRT

In the first few weeks, you might feel:

More sexual desire
Boosted energy
Better mood
Morning erections returning

Over time (3–6 months+), you may notice:

Leaner muscle mass
Less body fat
Weight loss
Stronger bones
Improved insulin sensitivity

BUT — some symptoms like memory, sleep, and overall life quality may not improve significantly, especially for those with conditions like diabetes or sleep apnea.

The hidden cost of TRT: Your fertility

Here’s what many don’t realize: TRT often shuts down your sperm production.

Even though testosterone is needed to make sperm, adding extra testosterone signals your body to stop producing it naturally.

Within 4 months, many men develop azoospermia — no sperm in their semen.
Testicles may shrink.
Fertility may not return after stopping TRT — or it may take up to 2 years

Learn how to protect your fertility before TRT

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Can I still have kids after stopping TRT?

It depends.

Most men regain sperm production within 1 year.
Some take up to 2 years, especially older men.
In some cases, fertility never returns to baseline.

That’s why doctors recommend freezing your sperm before starting TRT — just in case.

What happens if I stop taking TRT?

You can stop, but do so under medical supervision.

After quitting TRT, your testosterone will drop again. Some benefits may linger for a few months, but most symptoms return unless another treatment is started.

If you’re on TRT for age-related low T and see no sexual improvement after 1 year, the American College of Physicians recommends stopping it.

Are there side effects of TRT?

Yes. While many men feel better on TRT, potential risks include:

Infertility — very common
Smaller testicles
Liver issues
Acne
Enlarged breasts or prostate
Blood clots or heart risk (especially if over 65)
Sleep apnea
Fluid retention and swelling

That’s why doctors monitor hormone levels, red blood cell count, and prostate health regularly during treatment.

Bottom line: TRT can absolutely improve quality of life — but it comes at a cost to your fertility.

If kids are in your future plans, freezing your sperm now is a smart move. Legacy makes it:

Private — collect your sample from home
Fast — sperm frozen in just a few days
Secure — clinically tested cryostorage

Learn how to protect your fertility before TRT

Get started

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Legacy is for people with sperm who want to learn more about their personal health. Legacy tests are exclusively intended to be used for wellness purposes. While the tests we offer provide detailed results, they cannot provide a diagnosis and are not intended to replace the advice of your physician. Legacy cannot provide you with medical advice or diagnose you with any disease or condition. Our tests are available anywhere in the United States. We currently are unable to provide tests for international clients.