TRT and Anti-Müllerian Hormone (AMH): A Less Explored Connection

Written by Adam Maggio | Medically reviewed by Dr. Mitchell Ross, MD, ABAARM

While Anti-Müllerian Hormone (AMH) is a well-established marker of ovarian reserve in women, its role and clinical significance in men undergoing Testosterone Replacement Therapy (TRT) are less clearly defined. Some evidence suggests a modest decrease in AMH levels with TRT, potentially reflecting changes in Sertoli cell function.

TRT and Anti-MÃ¼llerian Hormone (AMH): A Less Explored Connection

Anti-MÃ¼llerian Hormone (AMH) is a glycoprotein hormone primarily known for its critical role in female reproductive health, serving as a key indicator of ovarian reserve. However, AMH is also produced by the Sertoli cells in the testes of males, where it plays a role in testicular development during fetal life and may continue to be expressed in adulthood. When considering Testosterone Replacement Therapy (TRT), the impact on AMH levels in men is a less extensively studied area compared to other hormonal markers, but it warrants attention for a comprehensive understanding of TRT's effects.

In men, AMH is produced by immature Sertoli cells and its levels are generally high during childhood, declining significantly after puberty. While its precise physiological role in adult male fertility is still being fully elucidated, it's understood to be involved in regulating Sertoli cell proliferation and differentiation. The introduction of exogenous testosterone, by suppressing the hypothalamic-pituitary-gonadal (HPG) axis and subsequently Follicle-Stimulating Hormone (FSH), can indirectly influence Sertoli cell activity, and thus, potentially AMH production.

The Potential Impact of TRT on AMH Levels

Research specifically on TRT's effect on AMH in men is not as robust as studies on LH, FSH, or inhibin B. However, some studies have indicated that testosterone treatment can lead to a modest decrease in AMH levels [1]. This reduction is thought to be a reflection of the altered Sertoli cell function that occurs when the HPG axis is suppressed by exogenous testosterone. As FSH stimulation to the Sertoli cells diminishes, their overall activity, including the production of AMH, may also decrease.

It's important to contextualize this. Unlike in women, where AMH levels are a direct and powerful predictor of ovarian reserve and response to fertility treatments, the clinical utility of AMH as a routine marker in men on TRT is not as well-established. The observed decreases are often described as modest and may remain within what's considered a 'normal' range, suggesting that Sertoli cell function, while altered, might not be severely compromised in terms of AMH production [2].

Nuances and Clinical Significance

The primary concern regarding Sertoli cell function in men on TRT typically revolves around spermatogenesis, which is directly impacted by FSH suppression and reduced intratesticular testosterone. While AMH is a product of Sertoli cells, its correlation with sperm production in adult men is not as strong or direct as inhibin B. Therefore, while a decrease in AMH might signal altered Sertoli cell activity, its direct implications for male fertility on TRT are still a subject of ongoing research and clinical interpretation.

For men undergoing TRT, monitoring AMH levels is not a standard practice unless there are specific research interests or complex fertility concerns. The focus remains on LH, FSH, and inhibin B as more direct indicators of the HPG axis suppression and its impact on spermatogenesis. However, understanding that AMH can be affected provides a more complete picture of the systemic hormonal changes induced by TRT.

Comparison: AMH in Men vs. Women and on TRT

Feature	AMH in Women	AMH in Men (No TRT)	AMH in Men (On TRT)
Primary Role	Ovarian reserve marker	Testicular development, Sertoli cell activity	Potentially modest decrease
Clinical Significance	High (fertility assessment)	Less established (adult fertility)	Limited, not routine marker
Production Source	Granulosa cells of ovarian follicles	Sertoli cells of testes	Sertoli cells of testes

Practical Takeaway

If you're on TRT, understand that your AMH levels might experience a modest decrease, reflecting changes in Sertoli cell function due to HPG axis suppression. While AMH is a crucial marker in female fertility, its direct clinical significance in men on TRT, particularly regarding fertility outcomes, is still being explored. Discuss any concerns about AMH or overall testicular health with your practitioner.