Current as of September 28, 2026. General information, not medical advice.
Short answer: Testosterone suppresses sperm production, often to zero. If children are anywhere in your plans, the options are hCG, which is FDA-approved in men for hypogonadotropic hypogonadism, or clomiphene, which works but is used off-label and is not approved for men at all. Enclomiphene, despite how it is marketed, has never been approved by the FDA.
What testosterone does to fertility
This is not a small effect and it is worth seeing the actual numbers.
In a WHO study of 271 men on weekly testosterone enanthate, 65 percent were azoospermic, meaning no measurable sperm, within six months. A larger WHO study of 670 men found 97 percent suppressed below 5 million per milliliter.
Recovery usually happens. An analysis of 30 studies and 1,549 men found 67 percent back to 20 million per milliliter by six months, 90 percent by twelve, 96 percent by sixteen, and 100 percent by twenty-four.
Read that timeline as a planning problem. Two years is a long time to wait, and "usually" is not "always."
Every major guideline lands in the same place. The AUA says exogenous testosterone should not be prescribed to men currently trying to conceive, a strong recommendation. The male infertility guideline says do not prescribe it for men interested in current or future fertility. The Endocrine Society recommends against it in men planning fertility in the near term. And the September 2026 DoD clinical guideline says flatly that where fertility is desired or undecided, exogenous testosterone will not be initiated.
hCG, the approved option
Human chorionic gonadotropin carries an FDA-approved indication in males: selected cases of hypogonadotropic hypogonadism, meaning hypogonadism secondary to a pituitary deficiency.
That makes it the only agent in this conversation with an on-label use in men. The DoD guideline names it first among the fertility-preserving options.
Two practical notes. hCG is now regulated as a biologic, and as of March 2020 it lost its compounding pathway, so a clinic offering compounded hCG is not operating the way it should be. And every hCG label opens with a capitalized warning that it has not been shown effective for weight loss, which tells you something about how the drug has been marketed historically.
Clomiphene, the off-label option that works
Clomiphene is approved for ovulatory dysfunction in women desiring pregnancy. That is the whole indication.
Its own label affirmatively disclaims male use: there are no adequate or well-controlled studies demonstrating effectiveness in the treatment of male infertility, and testicular tumors and gynecomastia have been reported in males using it, with the causal relationship unknown.
So any use in men is off-label. Off-label is legal and common, and it is also something you should be told rather than discover.
The evidence is genuinely decent. A 2025 meta-analysis of 10 randomized trials and 819 men found clomiphene raised total testosterone by about 274 ng/dL over placebo. Against testosterone gel, the difference in total testosterone was statistically indistinguishable, while sperm concentration was about 70 million per milliliter higher on clomiphene. Its authors note high heterogeneity and that it is underpowered on safety, and the paper drew a published challenge. Treat it as encouraging rather than settled.
An older comparison found clomiphene took men from 247 to 504 ng/dL, gels from 230 to 412, and injections from 224 to 1,104, with no difference in satisfaction scores.
Guidelines split on it. The AUA says clinicians may use aromatase inhibitors, hCG, or selective estrogen receptor modulators in men wanting to maintain fertility, a conditional recommendation at evidence grade C, while noting only hCG is FDA-approved in males. The Endocrine Society says clomiphene has been used empirically but neither its efficacy nor its safety has been demonstrated in randomized trials. Both are current. We tell patients about the disagreement rather than picking the quote we like.
Enclomiphene, and what is actually true
You will see enclomiphene sold as the cleaner, approved version of clomiphene. It is not approved.
There are zero FDA applications for it. The FDA said so on the record at a 2022 advisory committee meeting: no FDA-approved drugs contain enclomiphene as an active ingredient. The company that tried received a complete response letter in December 2015 saying the phase 3 design was no longer adequate to demonstrate clinical benefit. European regulators refused authorization in 2018.
On compounding, the same advisory committee voted 8 to 4 against adding it to the bulk substances list, and the FDA's own position was that the criteria weigh against it. No final rule has issued, so it sits in a category of substances still under evaluation.
Anyone selling it to you as approved is either uninformed or counting on you being.
If you are still serving
Two extra constraints.
Clomiphene is prohibited in Army aviators, and chronic use will not be waived. More broadly, clomiphene and enclomiphene both appear on the DoD prohibited dietary supplement ingredients list. That list governs supplements rather than lawful prescriptions, but it tells you how the institution views these molecules.
Under anti-doping rules, clomifene is prohibited at all times as a hormone and metabolic modulator, hCG is prohibited at all times in males, and testosterone is prohibited at all times. If you are subject to testing, none of this is free.
What good practice looks like
Ask about fertility at the first appointment, before anything is prescribed. A semen analysis before you start is cheap and tells you where you are beginning.
Discuss sperm banking. It is the only option that does not depend on your body cooperating later.
And if children are the priority right now, the honest answer is that testosterone is the wrong drug, whatever it would do for your symptoms.
Questions people actually ask
Does TRT make you infertile? It suppresses sperm production, often to zero within six months. Most men recover within a year or two after stopping, though not all.
Is Clomid approved for men? No. Its only indication is ovulatory dysfunction in women. Use in men is off-label, and the label itself says effectiveness in male infertility has not been demonstrated.
Is enclomiphene FDA-approved? No. There are no approved products containing it, and the FDA has said so publicly.
What is approved for men who want fertility? hCG carries an approved indication in males for hypogonadotropic hypogonadism.
Can I bank sperm first and then start testosterone? Yes, and it is the option that removes the uncertainty. Raise it before your first dose.
Where we fit
We ask about fertility first, not last, and we will tell you when the right answer is a drug we are not prescribing.
Semen analysis before therapy where fertility matters, a real conversation about hCG and clomiphene including the off-label part, and cryopreservation discussed in advance rather than mentioned afterward.
Discounted pricing for military, law enforcement and first responders. Request a consultation at hewhealth.com or call (850) 820-8850.
Hew Health, LLC is a private medical practice. General information as of September 28, 2026, not medical advice. Clomiphene is not FDA-approved for use in men. Enclomiphene is not an FDA-approved drug. Testosterone is a Schedule III controlled substance. FDA-approved testosterone products are indicated for men with low testosterone caused by an associated medical condition, and none are approved for men with low testosterone who lack an associated medical condition.
Sources: Clomid prescribing information, SPL effective January 31, 2025. hCG prescribing information, SPLs effective March and April 2025. World Health Organization Task Force, Lancet 1990 (PMID 1977002) and Int J Androl 1995 (PMID 7558380). Liu et al., Lancet 2006 (PMID 16650651). Randomized-trial meta-analysis, Arch Endocrinol Metab, October 2025 (PMID 41066380). Ramasamy et al., J Urol 2014 (PMID 24657837). Wiehle et al., Fertil Steril 2014 (PMID 25044085); Kim et al., BJU Int 2016 (PMID 26496621). Endocrine Society clinical practice guideline 2018 (PMID 29562364). AUA Testosterone Deficiency Guideline 2018, validity confirmed 2024, statements 23 and 27. AUA/ASRM Male Infertility Guideline 2020, amended 2024, statement 42. DHA clinical practice guideline, Testosterone Deficiency in the Male Service Member, September 17, 2026. FDA Pharmacy Compounding Advisory Committee transcript, 2022. WADA 2026 Prohibited List.