The Impact of Common Medications on Male Fertility: An Updated Systematic Review

Compared with those of cytotoxic treatments, the potential effects of common medications on the fertility of men trying to conceive currently or planning to conceive in the future are less well described. The use of common medications may modify the gonadotropic axis, spermatogenesis, and epididymal maturation or alter male fertility in other ways and are prescribed much more often compare with cytotoxic treatments.

Based on our review published in 2017, we systematically reviewed the effects of common medications on male fertility to provide evidence-based recommendations for clinical management and possible fertility preservation in men of reproductive age.

A systematic review of the literature using the PRISMA 2020 methodology was performed. We included only original studies published from 2016 to 2025 that involved human males exposed to noncytotoxic pharmacological treatments and reported outcomes related to male fertility, including spermatogenesis, semen parameters, and reproductive hormone concentrations. The data were synthesized descriptively and organized by pharmacological class and individual drug.

Among the 16,310 studies retrieved, 184 were included. In addition to the studies describing the deleterious effects of testosterone, sulfasalazine, anabolic steroids, cyproterone acetate, opioids, sertraline, tramadol, GnRH analogues, and sartan that have already been included in the 2017 review, we focused on new studies with good- to high-level evidence for the harmful effects of drugs such as duloxetine, thiopurines, dutasteride, valganciclovir, efavirenz, valproate, or hydroxyurea on male hormones and/or fertility.

In this updated review, evidence-based recommendations for clinical management and for possible fertility preservation or contraception in men of reproductive age receiving common acute or chronic medical treatment are provided, with the goal of making these data more readily available to medical staff.