Can Adderall (amphetamine and dextroamphetamine) use in males cause birth defects?

Male Adderall Use and Birth Defects

There is no evidence that Adderall (amphetamine and dextroamphetamine) use in males causes birth defects in their offspring. The available medical literature does not indicate any association between paternal Adderall use and congenital malformations.

Effects of Adderall on Male Fertility

• Adderall's FDA label does not contain any warnings about male fertility or birth defects resulting from male use of the medication 1
• Unlike some medications that can affect sperm parameters, Adderall has not been specifically identified as causing DNA fragmentation or other sperm abnormalities that could lead to birth defects 2
• Research on methylphenidate (a similar stimulant medication) actually showed increased sperm concentration, total sperm count, and improved sperm motility in users compared to non-users, suggesting stimulants may not negatively impact male fertility parameters 3

Paternal vs. Maternal Medication Exposure

• The American Journal of Obstetrics and Gynecology guidelines focus exclusively on maternal use of ADHD medications during pregnancy and lactation, with no mention of paternal use causing birth defects 4
• Birth defect concerns with Adderall are primarily related to maternal use during pregnancy, as the medication crosses the placenta and directly exposes the developing fetus 4
• While some medications can affect male reproductive function through various mechanisms (hormonal disruption, direct testicular toxicity), Adderall is not listed among medications with established negative effects on male fertility that could lead to birth defects 5

Safety Profile of Adderall in Pregnancy (Maternal Use)

• For maternal use, amphetamines do not appear to be associated with major congenital malformations, including cardiac malformations, or other significant adverse obstetrical or developmental outcomes 6
• There is a possible small increased risk for gastroschisis with maternal use (adjusted odds ratio 3.0; 95% CI 1.2-7.4), though the absolute risk remains very small given the rarity of gastroschisis (population prevalence of 0.05%) 6
• These concerns apply only to maternal use during pregnancy, not paternal use 6

Medications Known to Affect Male Fertility and Offspring Health

• Certain medications are known to potentially affect male fertility and possibly offspring health, including some cancer therapeutics, hormonal treatments, and specific psychotherapeutics 7
• Adderall is not included in comprehensive reviews of medications that disrupt male reproductive functions in ways that could lead to birth defects 5
• When evaluating medications for potential effects on offspring through paternal exposure, researchers typically look for DNA damage in sperm or hormonal disruption, neither of which has been established for therapeutic Adderall use in males 2

Clinical Implications

• Men taking Adderall who are planning to father children do not need to discontinue their medication based on concerns about birth defects 3
• Unlike some medications where a washout period before conception is recommended for men, there is no evidence supporting such a recommendation for Adderall 5
• The focus of birth defect prevention should remain on maternal exposures during pregnancy, as these have direct access to the developing fetus 4, 6

In summary, while medication effects on male fertility are an important consideration in reproductive health, current evidence does not suggest that Adderall use in males contributes to birth defects in their offspring.