A UK survey highlights gaps in fertility awareness among testosterone and steroid users. Understand the estimate, evidence limits and clinical implications.
On November 1, 2026, the Centre for Reproductive and Genetic Health (CRGH) published findings from a survey commissioned with Examen on awareness of fertility risks from testosterone replacement therapy (TRT) and anabolic steroids.
This article is for informational purposes only and is not medical advice. Decisions about hormone treatment and fertility require individual assessment by a qualified clinician.
CRGH estimates that 600,000 British men are taking hormone medications that suppress natural sperm production. Metro's coverage on November 2, 2026, described an estimated 600,000 steroid users. The underlying clinic account uses the broader category of hormone medications.
That distinction matters because the report includes both TRT and anabolic steroids. It does not establish that everyone included in the estimate was taking an unregulated product or obtaining drugs through a gym.
CRGH reported these separate findings:
These figures address different questions. The finding about active users concerns awareness of possible suppression to zero sperm counts. The broader awareness figure concerns the surveyed young men rather than active users alone.
Knowledge and priorities also deserve separate attention. Understanding a possible effect is not the same as deciding how much that effect matters to future plans. For a clinical conversation, both questions are relevant.
CRGH explains that external testosterone suppresses natural hormone production. Its account links that suppression with reduced sperm production. This makes the relationship between hormone feedback and fertility relevant even when the original concern is testosterone.
The NHS lists reduced sperm count, infertility, shrunken testicles and erectile dysfunction among possible effects of anabolic-steroid misuse in men. Its guidance supports the reproductive-health concern raised by the survey.
The European Association of Urology (EAU) guideline says testosterone therapy is contraindicated in infertile males. It also strongly recommends against using testosterone therapy to treat male infertility.
That guidance makes an important distinction about the purpose of treatment. Addressing a testosterone concern and treating male infertility are not the same clinical task. A discussion about hormone treatment therefore needs to include reproductive goals rather than assuming they are addressed by the prescription.
The report's practical implication is to discuss current or future plans for biological children with the prescribing clinician before treatment begins. Fertility should be part of the explanation of a proposed treatment, not an issue left until a pregnancy is being attempted.
CRGH discusses private testosterone prescribing alongside unregulated products obtained through gym-floor and social-media-driven black markets. These are different sources of exposure. Prescribed testosterone and non-prescribed anabolic steroids should not be treated as interchangeable categories.
The clinic argues that suppression from external testosterone remains relevant whether exposure comes from an unmonitored private prescription or a black-market product. This is its explanation of the biological concern. The place a medication was obtained does not answer every question about its fertility implications.
For a clinical discussion, the useful details include the specific product and why it is being used. Whether it is prescribed and what monitoring accompanies it are also relevant. The report supports asking about these details rather than relying on a broad label such as “testosterone treatment.”
A prescription should come with an explanation of reproductive effects. Equally, a discussion about non-prescribed use needs accurate information about the exposure rather than assumptions based on appearance or training habits.
CRGH says OnePoll surveyed 2,000 UK men aged 18 to 40 between October 2 and 8, 2026. CRGH commissioned the research in partnership with Examen. Responses were weighted by age, region and relationship status to reflect national census profiles.
Weighting does not extend the reported age range. The findings do not directly describe men aged 41 to 60, including many readers considering TRT in midlife. The commissioned nature of the research is also relevant when assessing how the findings were presented.
This was a survey of reported awareness and attitudes. It was not a clinical trial measuring sperm counts or treatment outcomes. None of the awareness percentages represents a measured rate of infertility among users.
The response about not caring about fertility is an attitude reported in a questionnaire. It does not demonstrate that those respondents had fertility problems. The survey supports a concern about understanding and communication rather than a prediction about an individual user's reproductive health.
The available account does not provide the detailed calculation behind the 600,000 estimate or confidence intervals for it. This is an estimate reported by the commissioning clinic rather than an official national count.
The survey also does not quantify the respective contributions of private prescribing and black-market supply. It does not establish that either source caused a national increase in use. Nor does it show that private testosterone care is uniformly safe or unsafe.
Metro reported Brett Cole's account of being told in 2019 that his sperm count was zero after years of trying for a child. The article says he was told that regular steroid use sourced through his martial-arts gym had affected his fertility.
Metro also reported that he had a son from an earlier relationship. He and his wife later had a daughter after private fertility treatment.
His account illustrates why previous fatherhood should not replace a current fertility discussion. A single case does not establish how often this outcome occurs or what recovery another person should expect. Neither the case nor the survey shows that every exposed man becomes infertile or that fertility effects are always permanent.
This report is a reason to strengthen fertility conversations within existing care. It does not introduce a new recommendation to use testosterone differently when treating male infertility. The EAU guideline already advises against testosterone therapy for that purpose.
The survey's contribution is evidence of an awareness gap among some people using TRT or anabolic steroids. The appropriate response is clearer communication about reproductive effects and treatment goals. That is different from making a treatment decision based on a headline or a population estimate.
Topics for a clinician-led conversation include:
For men already using non-prescribed steroids, the practical implication is to discuss that exposure candidly with a qualified clinician. The NHS identifies reproductive effects among the possible harms of misuse. Accurate information about what has been used gives that conversation a clearer starting point.
Symptoms or a testosterone result should not be treated as evidence of fertility status. For someone researching hormone concerns, assessment before a treatment decision provides a more appropriate framework than interpreting one result in isolation.
The bottom line is that this survey should reinforce fertility counseling rather than replace current medical guidance. It does not justify an immediate change to an individual's treatment plan. Personal decisions about testosterone and reproductive health remain matters for a qualified clinician who can assess the treatment purpose and fertility goals together.
Treating a fertility-awareness survey as a verdict on every TRT prescription confuses reported risks with individual outcomes, a distinction Testostra keeps visible through careful explanation of emerging evidence. Its coverage of TRT risks and monitoring gives readers context for discussing fertility concerns with qualified clinicians without turning population findings into personal treatment advice.
Testostra follows testosterone research, clinical guidance and emerging evidence without turning general information into personal treatment advice.
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