Can Drugs Lower Your Sperm Count?

If you’re dreaming of becoming a parent, it’s important to know that certain drugs, both legal and illegal, can have a negative effect on your fertility.

Urologist Sarah Vij, MD, walks you through some of the most common substances that can affect fertility in men and people assigned male at birth, from antidepressants to opioids.

What effects can substance use have on male infertility?

Medications and recreational drugs alike can impact your ability to create a pregnancy. In most cases, these effects are temporary and can be reversed once you’ve stopped taking the drug — but this isn’t always the case, and some of them can lead to male infertility.

“If parenthood is your goal, now or down the road, start talking to your healthcare provider about any drugs you’re taking and their possible effects on your fertility,” Dr. Vij advises.

And when it comes to recreational drugs, their overall impact on your physical and mental well-being can be far-reaching, which puts your health at risk in a number of ways. Seeking treatment isn’t just good for your health; it can also help create a safer and more stable environment for your future child.

Substances that can affect male fertility

What should you do if you see a medication that you take listed here? First of all, don’t panic. Remember: Much of the time, their effect on your fertility is reversible, so it’s important to talk to a doctor about your options.

“If you’re taking a medication that causes an unexpected side effect, including fertility issues, you may need to try a different one,” Dr. Vij says. She delves deeper into some of the prescription medications that can make it harder for you to create a pregnancy.

Alpha-blockers

Alpha-blockers are used to treat urinary symptoms caused by an enlarged prostate. There are a few different types of this medication, and they all affect your fertility in different ways.

“In particular, silodosin and tamsulosin (or Rapaflo® and Flomax®, respectively) can both cause a sharp decrease in the volume of ejaculation, or they may inhibit ejaculation completely,” Dr. Vij says.

If you take one of these medications, see a urologist to discuss their possible impact on your fertility and other possible treatment options.

Antidepressants

Your mental health is critical, but if you want to become a parent, you may want to make sure you’re not taking an antidepressant medication that hinders your chances.

“Selective serotonin reuptake inhibitors, or SSRIs, are the most common medications prescribed to treat depression and anxiety,” Dr. Vij notes, “but these medications can cause sexual dysfunction, particularly prolonged time to ejaculation.”

Luckily, SSRIs aren’t the only options for treating depression and anxiety. If you’re currently taking an SSRI, talk to your doctor or mental health provider about the possibility of other medications.

Chemotherapy medications

Going through cancer is difficult enough without worrying about your future fertility, too. Unfortunately, all chemotherapy medications used to treat cancer can significantly decrease or stop sperm production all together.

“Depending on the type of chemotherapy you’ve had and the duration of your treatment, your sperm production may return within two years,” Dr. Vij says, “but in many people, sperm production never returns, which results in infertility.”

If you’re preparing to start chemotherapy, talk to your doctor about freezing your sperm beforehand.

Opioids (narcotics)

Opioids, which interact with your nerve cells to reduce pain, include both illegal street drugs and prescription medications for treating pain and addiction.

“Long-term opioid use can disrupt the signals that control testosterone production, which can cause low testosterone and decrease both the quantity and quality of your sperm,” Dr. Vij explains. “The extent of the impact depends on which opiates you’re taking, what your dose is and how long you’ve been using them.”

Short-term use hasn’t been shown to have a negative effect on fertility, like if you’re on a short course of opiates to control pain after surgery or a broken bone. But opioids are highly addictive, so turn to your healthcare provider with any concerns you might have about responsible short-term use or past issues with addiction.

Testosterone

Testosterone replacement (also called supplemental testosterone) has a strong negative effect on sperm production. The most likely outcomes are a very low sperm concentration or a complete absence of sperm from the semen.

“When you take testosterone, the hormonal signals that tell your testicles to make testosterone and to make sperm are blocked,” Dr. Vij says. “Your natural testosterone production then stops, which causes the level of testosterone in the testicles to drop sharply — too low to support strong sperm production.”

In most people, this effect is reversible, though it can take six to 12 months or more for sperm production to return to normal.

Ketoconazole

Used to treat fungal infections, this medication is typically applied to the skin as a cream, ointment or powder.

“Applying it to your skin isn’t thought to have any impact on your fertility,” Dr. Vij assures, “but when it’s taken as a pill, ketoconazole hurts testosterone production and decreases sperm production.”

5-alpha-reductase inhibitors

These medications (including Propecia® and Avodart®) are used to treat hair loss and prostate enlargement. Their impact on your fertility is usually mild and will reverse once you stop the medication, but while you’re taking them, it could be more difficult for you to create a pregnancy.

“If you take one of these medications to treat hair loss, the data is conflicting about the impact on sperm production,” Dr. Vij says. “But taking it for prostate enlargement can cause a decrease in the volume of semen and total number of sperm in your semen, which can make it more difficult to get someone pregnant.”

Up to 5% of people who take this medication for either reason will have a reduction in their sperm numbers, so if you’re having trouble creating a pregnancy, be sure to talk to a doctor.

One other thing: They can also cause your sex drive to take a nosedive. But in most cases, that, too, should go back to normal when you stop taking the medication.

Other medications

Some other prescription medications can cause fertility problems, though most of them are reversible. They include:

• Anti-epilepsy medications,like carbamazepine, oxcarbazepine and valproate.
• Antiretrovirals, medications primarily used to stop HIV from replicating.
• Some antibiotics, which fight bacterial infections.
• Blood pressure medications,like nifedipine and spironolactone.
• Cimetidine, which can be used to treat acid reflux and ulcers.
• Colchicine, a gout medication.
• Sulfasalazine, used to treat ulcerative colitis or rheumatoid arthritis.

If you’re taking any of these medications and are having trouble creating a pregnancy, it’s important to see a urologist for semen testing.

How recreational drugs affect fertility

A variety of recreational substances, including drugs, alcohol and tobacco, can impact your fertility. Dr. Vij explains.

Alcohol

Light drinking doesn’t appear to affect fertility, which is good news for the occasional toast or a pint with pals. But heavy alcohol consumption — defined as 10 to 14 drinks or more per week — is another story. It may:

• Decrease testosterone production.
• Increase the rate at which testosterone is cleared from your bloodstream.
• Increase your estrogen levels.

“All of this can lower your testosterone levels, which can harm sperm production,” Dr. Vij warns. If you think you may be living with alcohol use disorder, learn more about how to identify signs of addiction and pursue treatment.

Anabolic steroids

Athletes and bodybuilders sometimes abuse anabolic steroids to enhance their performance or change their physical appearance. But they’re very unsafe.

“Anabolic steroids harm male fertility by interfering with the hormone signals that are needed to produce sperm,” Dr. Vij states. “The amount of damage they do to your fertility depends on what you take, how much of it you take and how long you take it.”

Many people recover sperm production three to 12 months after stopping anabolic steroids. But the health effects can be so serious that you shouldn’t take them unless your healthcare provider prescribes them for a specific medical condition.

And be careful taking fitness and muscle-building supplements. Products from disreputable sources are sometimes tainted with anabolic steroids that you might not even know about.

Marijuana

Because of the negative effects that THC, the active ingredient in marijuana, can have on fertility, you (and your partner) should stop all use while you’re trying to conceive.

“THC can decrease sperm production and weakens sexual drive by interfering with testosterone production,” Dr. Vij explains. “It may also limit movement of sperm.”

There are other risks, too. Marijuana is sometimes laced with heavy metals like lead to increase its weight, or it can be cut with more addictive illicit drugs, like cocaine. Both can be harmful to your overall health and your fertility.

Tobacco

Tobacco use in general, and smoking in particular, is linked to all sorts of serious health conditions. And you can add fertility troubles to the list.

“Smoking has a negative impact on your sperm production and the movement of sperm,” Dr. Vij warns. It can be hard to quit smoking, but there are many, many reasons to make the effort — including your hopes of expanding your family.

Methamphetamine

Meth, as it’s often known, is a highly addictive, synthetic stimulant that affects your body in a variety of ways, none of them positive. It can increase blood pressure and heart and respiratory rates, cause mood disturbances and psychosis and even lead to death.

Research isn’t yet clear on how or if methamphetamine use impacts male fertility in humans. But it has been shown to reduce sperm motility in mice and rats, which increases the likelihood of infertility.

Beware ‘men’s health supplements’

“Be especially careful with supplements that claim to boost sexual desire and performance,” Dr. Vij cautions. “They’re not approved by the U.S. Food and Drug Administration, so even though they may be widely advertised as enhancers, they haven’t been scientifically evaluated and may cause harm.”

When to see a doctor about male infertility

If you’re having trouble creating a pregnancy, see a doctor for a physical and complete medical history. They may then refer you to a urologist for a semen analysis, which tests the quantity and quality of your sperm. It’s the first step in detecting male fertility issues.

“If you’ve gone your whole life assuming that it will be easy for you to eventually become a parent, it can be a real challenge to learn that this goal will be harder to achieve than you’d anticipated,” Dr. Vij says. “Urologists and other fertility specialists are here to do everything we can to help you reach that goal.”