Is it possible to get pregnant when taking exogenous testosterone injects

1. How exogenous testosterone acts on reproductive biology — two different mechanisms

Exogenous testosterone feeds back on the hypothalamic–pituitary–gonadal (HPG) axis: in people with testes it suppresses GnRH, LH and FSH and often reduces or halts spermatogenesis; in people with ovaries/testes depending on anatomy, testosterone can change menstrual cycles but does not reliably eliminate ovulation, so it cannot be treated as contraception ^{[5] [6] [1]}.

2. For sperm-producing people on testosterone: high probability of reduced fertility but not absolute contraception

Clinical and review literature consistently shows that injectable and long‑acting testosterone formulations commonly produce oligozoospermia or azoospermia by lowering intratesticular testosterone needed for sperm production, and many authorities warn that TRT should be avoided by men actively trying to conceive ^{[3] [5] [6]}. Nevertheless, studies and reviews note residual viable sperm in some men and that semen parameters do not perfectly predict pregnancy outcomes; the published literature lacks robust pregnancy-outcome data, so residual fertility and occasional pregnancies remain possible ^{[3] [7] [4]}.

3. Timing and recovery are variable — fertility can return but unpredictably

Recovery of spermatogenesis after stopping testosterone is common but slow and individual: model-based data and clinical series show a range from months to over a year, with recovery probability influenced by dose, duration, age, and delivery method (short‑acting vs long‑acting) ^{[7] [8]}. Reviews emphasize the literature’s limitations on time to fecundity and pregnancy outcomes, which creates real uncertainty for couples planning conception ^{[3] [7]}.

4. Medical workarounds and fertility preservation options

There are documented strategies to preserve or restore fertility: human chorionic gonadotropin (hCG) and selective estrogen receptor modulators (SERMs) can maintain or restart intratesticular testosterone and spermatogenesis in some men; sperm cryopreservation before starting TRT is a recommended option for those who may want biological children later ^{[3] [9] [8]}. Some studies combining hCG with TRT reported preserved sperm parameters and pregnancies, but such approaches require specialist care and are not risk‑free ^[8].

5. For people with a uterus using testosterone: contraception counseling is required

Public health guidance explicitly warns that testosterone is not a reliable contraceptive for transgender, gender‑diverse, and nonbinary people with a uterus and that providers should offer contraceptive counseling and services to those at risk who do not want pregnancy; testosterone is also teratogenic and may masculinize a fetus if pregnancy occurs while on therapy ^{[1] [2]}. Evidence about how often pregnancies occur in this population while on testosterone is limited, but the CDC advises against assuming testosterone equals contraception ^[1].

6. Conflicting incentives, gaps in evidence, and the practical takeaway

The scientific record is clear that exogenous testosterone commonly suppresses male fertility and that it is teratogenic to a developing fetus, yet the literature repeatedly notes gaps — especially a lack of systematic pregnancy-outcome data — and some clinicians still prescribe testosterone without fully discussing fertility risks, creating potential for preventable reproductive surprises ^{[3] [10] [7]}. The practical position emerging from professional reviews and public‑health guidance: do not rely on testosterone as birth control; if avoiding pregnancy is the goal, pursue proven contraception or fertility‑preserving strategies and consult reproductive specialists about options such as hCG, SERMs, or sperm banking ^{[1] [9] [8]}.