Intuniv and Male Infertility
Based on FDA labeling and current evidence, Intuniv (guanfacine) can cause impotence but there is no documented evidence that it causes male infertility or affects sperm parameters. 1
Direct Evidence from FDA Drug Label
The FDA-approved prescribing information for guanfacine lists impotence as a recognized adverse effect under reproductive system disorders in males, but does not mention any effects on sperm production, sperm quality, or fertility. 1
- In clinical trials, impotence was reported as a reason for treatment dropout among patients receiving guanfacine 1
- Sexual dysfunction (impotence) affects sexual function but is distinct from fertility impairment 1
- No testicular toxicity, oligospermia, or azoospermia has been documented in the FDA labeling 1
Context from Male Fertility Guidelines
The 2024 AUA/ASRM male infertility guidelines do not list guanfacine or alpha-2 agonists as medications that negatively impact male fertility. 2
The most recent 2025 EULAR guidelines on antirheumatic drugs and reproduction specifically note that when there is "limited or no data available on the impact of male treatment" with certain medications, clinicians should "consider switching to an alternative" in men trying to conceive. 2 However, guanfacine is not mentioned in these reproductive medicine guidelines, suggesting it has not emerged as a clinical concern for male fertility.
Medications That DO Cause Male Infertility
For comparison, medications with established effects on male fertility include:
- Exogenous testosterone: Suppresses spermatogenesis through central hormonal axis suppression, potentially causing oligospermia or azoospermia 3
- Cyclophosphamide: Dose-related risk for irreversible infertility with permanent azoospermia likely at doses ≥4000 mg/m² 2
- 5α-reductase inhibitors: Can negatively affect sperm parameters depending on dose and duration 3
- Chemotherapeutic agents: Direct gonadotoxic effects 3, 4
Clinical Recommendation
Men taking Intuniv who are planning to conceive do not need to discontinue the medication based on fertility concerns. The primary reproductive concern is erectile dysfunction (impotence), not infertility. 1
If Fertility Issues Arise:
- Obtain a standard semen analysis to objectively assess sperm parameters (volume ≥1.4 mL, concentration ≥16 million/mL, total count ≥39 million, progressive motility ≥30%, normal morphology ≥4%) 5
- Evaluate other well-established risk factors: smoking, exogenous testosterone use, anabolic steroids, obesity, occupational exposures 5, 3
- Consider consultation with reproductive endocrinology if abnormal parameters are found, but do not automatically attribute problems to guanfacine given the lack of evidence 5
Important Caveat:
The absence of evidence is not evidence of absence. 6, 7 Medication effects on male reproduction are inadequately studied, and many commonly prescribed drugs lack robust human data on fertility outcomes. 6, 8, 7 However, clinical decision-making must be based on available evidence, and currently there is no documented association between guanfacine and male infertility. 1