The Possible Impact of SSRIs on Male Sexual Function and Fertility

Men taking SSRIs should be warned about sexual side-effects.

Posted Nov 28, 2008 | Reviewed by Davia Sills

While I've never been impressed with the argument that SSRIs work a whole lot better than a placebo, I am becoming impressed with the list of SSRI-related side effects. I'm also willing to bet that your health care provider did not discuss how serious the sexual side effects can be or that they might be potentially irreversible.

Men who are taking SSRIs should be aware of the potential impact of this class of drugs on their sexual function and fertility.

SSRIs and Male Sexual Function

I mentioned this in an October 3 posting, but I am repeating it because of the latest findings that I've listed in the section that follows (SSRIs and Male Fertility).

According to the Journal of Sexual Medicine (January 2008), any person who has been given a prescription for an SSRIs should be provided with a warning such as the following: "There is a high probability of sexual side effects while on SSRI medications. There are indications that in an unknown number of cases, the side effects may not resolve with cessation of the medication and could be potentially irreversible."

SSRIs and Male Fertility

If you are a man who is taking SSRIs, here's what we know to date about this class of drugs and male fertility. The following is from an announcement issued a few weeks ago by The American Society for Reproductive Medicine as reported by Reuters [please note the part about how a routine sperm test is unlikely to pick up on this kind of sperm damage]:

Treatment with paroxetine (Paxil), which belongs to the selective serotonin reuptake inhibitor (SSRI) class of antidepressant drugs, increases DNA fragmentation in sperm, according to research presented today at the 64th annual meeting of the American Society for Reproductive Medicine in San Francisco.

Although the study did not directly evaluate male fertility, the fivefold increase in the number of men who developed abnormal sperm DNA while being treated with paroxetine is "troubling" and "suggests an adverse effect on fertility," said co-investigator Dr. Cigdem Tanrikut, from Harvard Medical School in Boston.

In a clinical trial she described as "the first study to assess the impact of an SSRI on semen parameters in healthy men," 35 men took paroxetine for five weeks. The drug was administered in once-daily doses of 10 mg the first week, 20 mg in the second week, 30 mg the third and fourth week, and 20 mg in the fifth week.

Tests were conducted on semen samples obtained prior to starting paroxetine and after four weeks of treatment. The average DNA fragmentation score increased from 13.8 percent before paroxetine was begun to 30.3 percent at week four, a statistically significant amount.

The percentage of men who had a fragmentation score of 30 percent or higher before treatment rose from 10 percent to 50 percent.

Semen analyses conducted throughout the study, however, showed normal volume, concentration, movement, and appearance.

Paroxetine was also associated with significant sexual dysfunction, with one-third of men reporting problems with erectile function and nearly half reporting ejaculatory difficulties.

"DNA integrity is crucial to normal fertility," Tanrikut said. For example, increased DNA fragmentation of sperm increases the risk of failure of intrauterine insemination.

"Abnormal sperm DNA integrity even affects pregnancy outcomes of the most advanced assisted reproductive technologies, such as in vitro fertilization (IVF)," she added. "In fact, it is the only male factor finding that has been shown to affect intracytoplasmic sperm injection (ICSI) results."

"A large proportion of patients on (SSRIs) may have their fertility affected," co-investigator Dr. Peter N. Schlegel, at Weill Medical College of Cornell University in New York, observed in correspondence with Reuters Health.

Among infertile men taking an SSRI, "a standard semen analysis won't measure this effect," Schlegel pointed out, and "a special test for DNA fragmentation... should be considered."

The sperm appears to be damaged by a slowing down of their transport through the body, "a novel mechanism of damage," he said. "Most agents affect fertility by knocking down sperm production. Slowing down sperm transport can allow sperm to be damaged (by higher temperatures, or just 'getting too old'—being ejaculated after they should have been)."

"We have seen severe cases where the sperm are slowed down so much that almost no sperm appear in the ejaculate."

Based on these findings, the research team is planning larger studies using other SSRI antidepressants.