Adverse effects of common medications on male fertility

Abstract

An increasing number of patients require long-term medication regimens at a young age, but the adverse effects of medications on male reproduction are often inadequately considered, recognized and investigated. Medications can affect male reproduction through central hormonal effects, direct gonadotoxic effects, effects on sperm function or on sexual function. For example, exogenous testosterone inhibits spermatogenesis through central suppression of the hypothalamic-pituitary-gonadal hormonal axis. 5α-reductase inhibitors can impair sexual function, decrease semen volume and negatively affect sperm parameters, depending on dose and treatment duration. α-Blockers might decrease seminal emission and cause retrograde ejaculation, depending on the receptor specificity and dose of the agent. Phosphodiesterase inhibitors seem to have variable effects based on the isoform inhibited and evidence is conflicting. Antihypertensive and psychotropic agents can affect sperm, sexual function and hormonal parameters. For antibiotics, the literature on effects on sperm and sperm function is limited and dated. Many chemotherapeutic agents have a direct gonadotoxic effect, depending on agents used, dosing and number of treatment cycles. Overall, many medications commonly used in urology can have effects on male fertility (mostly reversible) but conclusive evidence in humans is often limited. Men should be counselled appropriately about potential drug-related adverse effects on their fertility.

Curcuma longa normalized cimetidine‐induced pituitary‐testicular dysfunction: Relevance in nutraceutical therapy

“…There is a gradual, but steady, increase in the incidence of chemically induced infertility globally . Job demands and/or lifestyle may predispose an individual to health conditions that require long‐term regimens, which are often associated with deleterious effects on body organs, including those of reproduction . Damage to the reproductive organs threatens the continuation of life itself, and therefore the toxic effects of drugs and environmental toxicants on reproductive functions are becoming a major health concern worldwide …”

Laboratory testing of extravascular body fluids in Croatia: a survey of the Working group for extravascular body fluids of the Croatian Society of Medical Biochemistry and Laboratory Medicine

“…of the sperm quality. Drug intake is generally not listed on test requests although drugs may influence sperm production and quality ( 28 ). In assessing sperm number and concentration, it is recommended that a total of 400 spermatozoa are counted, to obtain a sampling error of less than 5% ( 27 ).…”

Drug use among men with unfulfilled wish to father children: a retrospective analysis and discussion of specific drug classes

“…Unfortunately, the European guideline on male fertility evaluation does not explicitly advice on this . A recently published review by Samplaski et al strongly recommends to question patients about their drugs in detail and to discuss alternative therapies if drugs are suspected to affect male fertility …”

“…Additionally, data derived from animal studies have to be judged carefully, as time for spermatogenesis differs widely with 74 days in humans, 48 days in rats and 35 days in mice . Poor and conflicting data have also been complained by Samplaski et al…”

“…Additionally, data derived from animal studies have to be judged carefully, as time for spermatogenesis differs widely with 74 days in humans, 48 days in rats and 35 days in mice. 59 Poor and conflicting data have also been complained by Samplaski et al 25 It would have been desirable to include information on mutagenic or genotoxic drug effects in our analysis. Unfortunately, data are often lacking, and interpretation of results is difficult.…”