Testicular atrophy and HPT axis suppression is a thoroughly documented side effect of TRT and steroids. Even beginner bodybuilders know that taking steroids will crush their natural testosterone production. They can kind of bring it back by taking short courses and using certain medications after the cycle, but most discover that some permanent damage is being done with each cycle.
There are two problems with framing it as an infertility problem:
1 - It reduces fertility but many users retain some fertility. The bigger problem for most is that natural testosterone production won't come back to the same level if they ever discontinue, so they're on it for life. Managing testosterone injections every week or multiple times per week for the rest of your life is doable but a pain, especially if you have to travel or you're not the best at keeping up with prescriptions. There are also ups and downs and side effects that come from artificial testosterone dosing. Many people are surprised to discover that after the first year or two they don't feel "great" any more and it's just back to where they started, but with a lifetime dependency now. Others get serious side effects like Gynecomastia (breast growth in men, possibly requiring surgery) or secondary hormonal alterations that negatively impact mood, cognition, or libido.
2 - Many young men in their 20s or even teens see infertility as a positive rather than a negative. It's very common for people of this age to think they've made up their mind for life, but they have yet to even have a serious relationship or even know any peers with kids. People who work in fertility fields are starting to see a lot of men who went into TRT or steroids when they were young because they thought the consequences would never be a problem for them.
> Plenty of those "alpha male" guys on social media are shooting blanks.
Honestly, they don't care. I skim the testosterone subreddits occasionally and many people brag and joke about how small their testicles are.
It's crazy to me to see this shift happening. TRT clinics that advertise on the radio, TikTok, and everywhere else will entice people to come in for "free tests" but the trick is that it doesn't matter what your numbers come back as, they'll always find a way to prescribe you TRT because it's easy recurring revenue for them with lifelong dependence attached.