Cardiovascular/Pulmonary Medications and Male Reproduction

Abstract

Cardiovascular and respiratory medications are used by men of reproductive age although use of the former is most prevalent in advanced age. Many of these drugs have been associated with sexual dysfunction, including erectile and ejaculatory dysfunction, but for most there is insufficient evidence to link their use with testicular dysfunction, reduced semen quality or infertility. Some exceptions are the irreversible α-adrenergic antagonist phenoxybenzamine, which carries a high risk of retrograde ejaculation; the specific α-adrenergic antagonists silodosin and tamsulosin, used primarily to treat BPH/lower urinary tract symptoms, which can cause retrograde ejaculation; and the peripheral β-adrenergic antagonist atenolol, used to treat hypertension, which may decrease testosterone/free-testosterone levels. In this chapter, we review the evidence available regarding adverse reactions on male reproduction of adrenergic receptor agonists/antagonists, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, diuretics, digoxin, and hydralazine. For some of these medications, there is some evidence for male reproductive effects, along with some solid work in experimental and companion animal species suggesting negative effects. In contrast, and of special note, are calcium channel blockers, which have long been included on lists of medications with the potential to cause male infertility. This turns out to be a good example of a substance with profound effects on sperm function in vitro, but with limited evidence for in vivo effects on semen quality or fertility, even in experimental species. We hope that the evidence provided in this chapter will stimulate additional studies for these important classes of medications.

Sport, doping and male fertility

“…Despite being significantly less common than AAS, several substances have been used in different sports in order to enhance performance; however, negative effects of these drugs have been reported concerning sexual and reproductive function. Beta-blockers, often used in order to reduce anxiety and tremors in precision sports, are likely to worsen erectile function [ 122 ]; furthermore, in vitro studies have reported inhibitory effects of beta-blockers on smooth muscle in reproductive tracts, possibly resulting in delayed ejaculation or, in the most severe cases, anejaculation [ 123 ]. In regards to cardiovascular treatments, diuretics, most notably thiazides, might impair erectile function [ 124 ]: these drugs are sometimes used by athletes in order as masking agents for concomitant treatments [ 125 ], but use of these drugs by bodybuilders aiming to improve their physical appearance is an increasingly worrying phenomenon [ 126 ] and their possible side effects might be amplified by coexisting eating disorders [ 127 ].…”

Effects of clinical medications on male fertility and prospects for stem cell therapy

“…Calcium channel blockers which used for cardiovascular diseases are commonly believed to cause male infertility ( Drobnis and Nangia, 2017 ). Voltage-gated Ca 2+ (CaV) channels can be divided into different types of voltage-gated channel according to pharmacology.…”