Medication with a proven negative effect on male fertility

One of the frequently asked questions to which patients cannot find an answer either on the Internet or at consultations with doctors is the question about the possible “bad” effect of administered drugs on male health.
There are indeed no data on many drugs in this respect. At the same time, quite a few drugs can have a negative impact on male fertility, i.e. the ability to have children. We have tried to summarize the known data and we hope that this summary will be of use to you.
Potentially, male fertility can be impaired by 4 primary mechanisms:

Direct testicular toxicity. Drugs with direct testicular toxicity damage cells producing sperm cells. This may lead to a decrease in sperm cell count or, in grave cases, to their complete absence. The cellular damage can be temporary or permanent, irreversible;
Impact on the higher regulatory centres, the pituitary gland and the hypothalamus. The pituitary gland located in the brain normally produces hormones that stimulate testicular cells to produce sperm cells and the male sex hormone testosterone. Some drugs can disrupt the normal relationship between the pituitary gland and testicles, wherefore the production of sperm cells diminishes;
Decreased libido, an impact on ejaculation and/or erection. For sperm cells to reach the female reproductive tract, a man must achieve an adequate erection and ejaculation. These require a complex coordination and can be disrupted on many levels. Some drugs can reduce the desire to have sex – the libido. Others affect erection and/or ejaculation;
The blockage of a sperm cell’s ability to fertilize an egg cell.

Testosterone. Testosterone agents (Sustanon, Omnadren, Nebido etc.) are usually prescribed as supplementation treatment in case of testosterone deficiency in the organism. They have a pronounced negative impact on the production of sperm cells. The administration of testosterone is accompanied by a blockage of hormonal signals that are normally received by the testicles so that they could produce sperm cells and hormones. Therapy with testosterone entails a decrease in the number of sperm cells, which can result in their complete absence, the so-called azoospermia. Spermatogenesis may recover after a withdrawal from testosterone drugs, but it may take about 6 months or longer and may necessitate a specific stimulating therapy.
Anabolic steroids. This pharmacological class is used to accelerate muscle growth and/or to burn fat. Testosterone is also classified as an anabolic steroid. The use of such drugs is common among men who engage in bodybuilding. Anabolic steroids damage male fertility in a way similar to that of testosterone: they interfere with hormonal signaling that is necessary for the production of sperm cells. The negative effect is largely dependent on the type and the dose of medication and the duration of the course of administration. The recovery of spermatogenesis is expected in 6 to 12 months after a withdrawal from the drugs. However, spermatogenesis does not always recover fully. Considering the grave negative effect anabolic steroids produce on male fertility as well as on other aspects of male health, they should not be taken by men.
Alcohol. Small doses of alcohol have not been shown to influence male fertility. Alcohol abuse lowers the level of testosterone production and at the same time increases the transformation of testosterone into estradiol (female sex hormone) leading to a decrease in the number of sperm cells.
Smoking. Tobacco consumption and especially tobacco smoking are associated with a serious systemic impact on the organism. Children born in families where one or both partners smoke suffer from respiratory diseases such as asthma, pneumonia and ARVI more often. The sudden infant death syndrome is also associated with smoking in the family. Finally, children are more likely to become smokers if the members of their family smoke.
Marihuana. Cannabinol, the main active ingredient of cannabis, decreases the production of sperm cells and reduces the sexual drive by lowering testosterone levels.
Opiates. The intake of opiates can be legal, as a means of alleviating pain, prescribed by a doctor; and illegal, as the consumption of narcotic drugs. The long-term administration of opiates leads to the breakdown of the system controlling the production of testosterone, which in its turn negatively influences the number and the quality of sperm. There are no data testifying to the fact that a short-term intake (for example, for pain control in case of fractures or after a surgery) influences male fertility. Those men who take opiates for weeks or months, should consult their doctors as regards the possible effects of the administration of such drugs.
5-alpha reductase inhibitors (Finasteride, Dutasteride). These agents are widely used in treatment for prostatic hyperplasia, hair loss et cetera. The effect of the medication consists in the reduction of ejaculate volume as well as of the total quantity of sperm cells. Usually, after the discontinuation of treatment, the values recover rapidly.
Alpha blockers. Such drugs as Omnic, Cardura, Dalfaz and other representatives of the group are widely used in treatment for lower urinary tract symptoms induced by prostatic hyperplasia. These drugs are characterized by the reduction of ejaculate volume to such an extent that there can be no ejaculation altogether.
PDE 5 inhibitors. The agents of this group (Viagra, Levitra, Cialis etc) are often used to treat erectile dysfunction. The effects of the drugs on male fertility are contradictory but there is no real evidence in favor of their negative influence.
Selective serotonin reuptake inhibitors. The agents of this group (Paxil, Zoloft, Prozac etc) are widely used to treat depression and anxiety. They can lower the motility of sperm cells as well as delay ejaculation.
Ketoconazole. This medication is meant for the treatment of fungal infections. It can be used as cream, powder or tablets. Tablets have been shown to disrupt testosterone production and lower the concentration of sperm cells.
Other drugs – Spironolactone, Cimetidine, Nifedipine, Sulfasalazine, Colchicin, antiretroviral agents et cetera.
It should be noted that many drugs have not been properly studied as regards their effect on male fertility.
Which is why the following recommendations are in order:

If you take any medication regularly;
If you or your partner is having difficulty conceiving a baby or if you are planning a pregnancy;

you should undergo an ejaculate analysis and discuss the results with your doctor. A decision to discontinue therapy or to switch to another medication can be made.
The table below summarizes the potential effects of different drugs on male fertility:

In conclusion, we would like to make one more point. After a consultation with an andrologist, any man who has encountered the problem of infertility can surely understand the necessity of discontinuing some drugs. If there is such a possibility, that is.
There is yet another side to it. We are used to getting immediate results, almost even before we know it. Consequently, patients often ask to prescribe them all kinds of drugs aimed at “improving the quality of sperm”. As many and as diverse as they come. They are ready to buy up these drugs in bright colorful packs and take them with absolute certainty that they are doing everything they can to improve the testicular function. In these circumstances, the issues of overweight, smoking, alcohol consumption and other kinds of unhealthy self-indulgence recede into the background. Although it is exactly the change of a lifestyle that produces a maximum effect not only on spermatogenesis but also on the general state of male health.