Does Adderall (amphetamine and dextroamphetamine) affect fertility in men?

Adderall's Impact on Male Fertility

Adderall (amphetamine and dextroamphetamine) does not appear to have significant negative effects on male fertility, and may actually be associated with improved sperm parameters in some cases. 1

Effects of Adderall on Male Reproductive Function

• The FDA label for amphetamine lists "impotence" and "changes in libido" as potential endocrine adverse effects, which could indirectly affect fertility by impacting sexual function 2
• However, a recent retrospective analysis of 9,769 semen samples found that methylphenidate (another stimulant medication for ADHD) was actually associated with increased sperm concentration, total sperm count, and total sperm motility compared to non-users 1
• This study specifically found that progressive motility and total motile sperm count were significantly increased following methylphenidate use, suggesting stimulants may not negatively impact male fertility 1

Hormonal Considerations

• Unlike testosterone therapy, which should not be prescribed for males interested in current or future fertility due to its suppressive effects on spermatogenesis, stimulants like Adderall do not directly suppress the hypothalamic-pituitary-gonadal axis 3
• Adderall is not included in the list of medications known to significantly impair male fertility in the AUA/ASRM guidelines on male infertility 3
• Some psychotropic medications can increase prolactin levels and decrease testosterone, but stimulants like Adderall are not typically associated with these hormonal changes 4

Clinical Implications

• If a man taking Adderall is experiencing fertility issues, a complete semen analysis should be performed to assess sperm parameters 3
• Multiple abnormal semen parameters are of greater clinical significance than a single abnormality when evaluating male fertility 3
• For men with abnormal semen analyses, evaluation by a male reproductive expert is recommended, but discontinuation of Adderall would not be a first-line recommendation based on current evidence 3

Risk Factors and Considerations

• While many medications can potentially affect male fertility, the evidence specifically linking Adderall to male infertility is limited 3
• Clinicians may discuss medication usage as a potential risk factor for male infertility, but should counsel patients that current data on most risk factors (including Adderall) are limited 3
• If fertility concerns exist while taking Adderall, consider:
  • Obtaining a semen analysis to establish baseline parameters 3
  • Evaluating for other common causes of male infertility 3
  • Discussing the risk-benefit ratio of continuing Adderall treatment versus the potential impact on quality of life from untreated ADHD 3

Conclusion

Based on the available evidence, Adderall does not appear to significantly impair male fertility and may not need to be discontinued in men trying to conceive. The benefits of treating ADHD symptoms with Adderall may outweigh any theoretical concerns about fertility, especially given the lack of evidence showing harm and some evidence suggesting potential benefits to sperm parameters with stimulant medications 1.