Testosterone therapy suppresses the testes' own production of testosterone. Preserving that production is worth doing, in our view — it is a normal function of the body, and keeping it preserves the other testicular functions that depend on it.
Reviewed by Dr. David Oliak, board-certified surgeon
Updated August 2026
Most of the difference between producing and not producing testosterone is inside the testes. In a working testis, the intratesticular testosterone concentration is many times higher than in the blood. When testosterone therapy suppresses the testes' own production, that concentration falls to a small fraction of normal.
That high intratesticular concentration is a normal part of how the testis works, and suppression removes it.
The high intratesticular testosterone concentration is required for sperm production, which is why suppression reduces fertility. But its role is not only fertility.
It reflects active hormone production within the testis, which also makes other steroids, including neuroactive ones. Preserving the testis's function therefore preserves more than the ability to conceive.
Our view is straightforward: keeping a normal bodily function is better than switching it off. That holds whether or not a man plans to have children — fertility is the most familiar reason to preserve production, but the function is normal and worth keeping in its own right.
There is a second reason. With hCG, many men report feeling better — in energy, mood, and sexual function. In our experience these benefits are common, and they fit with the testis producing more than testosterone alone.
Preservation is done with hCG, which stimulates the testes directly to keep them producing during therapy. hCG is used with testosterone, not in place of it: testosterone treats the symptoms of low testosterone, and hCG keeps the testes' own production going.
On its own, hCG — like clomiphene and enclomiphene — generally cannot relieve the symptoms, so these are not substitutes for testosterone. How hCG is used and dosed is on the Adding HCG to Testosterone Therapy page.
We favor hCG for most men on testosterone therapy, whether or not fertility is a current goal. Our usual approach is testosterone twice weekly with hCG twice weekly, though it is a default rather than a rule.
Suppressing the testes' own production removes a normal function: the intratesticular testosterone that supports sperm production and other testicular activity. In our view keeping that function is better than switching it off, whatever a man's plans for children.
hCG preserves it, and with it many men report feeling better in energy, mood, and sexual function. That is why we favor hCG alongside testosterone for most men.
— Dr. David Oliak, board-certified physician and surgeon
Let's begin
For most men, we include hCG with testosterone, so treating low testosterone does not mean shutting down your own production. The consult is free and includes in-office testosterone testing. To speak with us first, call 714-671-2005.
Adding HCG to Testosterone Therapy: how it's used
Maintaining fertility on TRT
Signs of low testosterone: how to tell
How we administer TRT: steadier levels, fewer side effects
Yes. It suppresses the pituitary signal to the testes, so they make less of their own, and the intratesticular testosterone concentration falls to a fraction of normal. This can be maintained with hCG used alongside testosterone.
Because the intratesticular testosterone concentration is far higher than in the blood and is needed for sperm production and other testicular function. Treating the symptoms with testosterone does not reproduce that concentration; only the testes' own production does.
No. Fertility is the most familiar reason, but that intratesticular concentration supports other testicular function too, and in our view keeping a normal function is worth doing regardless of fertility plans.
Generally no. hCG keeps the testes producing but, on its own, usually cannot relieve the symptoms of low testosterone; the same is true of clomiphene and enclomiphene. They are used with testosterone, not in place of it.
No. We favor it for most men because preserving production is worthwhile, and our usual approach is testosterone twice weekly with hCG twice weekly. But it is a default, not a rule, and some men choose testosterone alone.
