Male reproductive health under environmental, pharmacological, and disease influences: a scoping review

Male reproductive health reflects coordinated spermatogenesis, endocrine regulation, reproductive-tract patency, sexual function, and sperm genomic integrity. This scoping review maps evidence on environmental exposures, pharmacological agents and substance use, and acute or chronic diseases that may influence these domains, with emphasis on biological mechanisms, clinical assessment, prevention, and public-health implications. PubMed was the primary bibliographic database; Google Scholar and official grey literature/guidelines were supplementary sources. The evidence map comprised 105 unique sources: 99 PubMed-indexed peer-reviewed sources and six official grey-literature/guideline sources. Google Scholar supported supplementary discovery and citation chaining, and overlapping PubMed records were counted once after de-duplication; no unique Google-Scholar-only journal source remained in the mapped set. Four additional references were used exclusively to guide scoping-review methodology and reporting, giving 109 references in the complete bibliography. Evidence was charted by exposure or condition, study design, reproductive outcome, quantitative finding where available, mechanistic interpretation, and clinical implication. The mapped literature identifies endocrine-disrupting chemicals, pesticides, metals, air pollution, occupational heat, selected medicines and gonadotoxic treatments, metabolic and infectious diseases, varicocele, genetic disorders, and systemic illness as relevant reproductive-health contexts, but the strength and causal interpretability of evidence vary substantially. Recurrent mechanisms include oxidative stress, inflammation, endocrine disturbance, mitochondrial dysfunction, vascular impairment, sperm DNA damage, and epigenetic alteration. The review supports couple-centred evaluation, source control of avoidable exposures, treatment of reversible disease, fertility preservation before gonadotoxic therapy, and specialist-led medication decisions.