Common medications, supplements, and gay male fertility

People take daily medications and supplements for a wide variety of reasons: to treat chronic medical conditions, to boost overall health, or to improve their cosmetic appearance. Others take supplements to relax, while a range of substances are sometimes used for recreational purposes.

Gay men tend to use medication, supplements, recreational drugs, and other substances at higher rates than the general population. For instance, while alcohol and tobacco are the most commonly used substances in the US and the world, gay men use both at higher levels than straight men. This trend is reflected at all levels of use, from casual use to problematic abuse.

An established link exists between acceptance of homosexuality and substance abuse: the less accepted gay men feel by their families, their society, and even themselves, the more they smoke and drink. This varies by age, location, socioeconomic status, etc. Younger gay men may drink at higher rates before coming out to alleviate some of the psychological stress they feel due to lack of support from family and friends. Lower socioeconomic status men may drink more and in more unhealthy ways, like binge drinking, than wealthier gay men who may drink socially.

Of course, such trends are just that: trends. You may have no issues with alcohol, tobacco, or other substances. If you do, however, and if you’re planning on starting a family through surrogacy and egg donation, you should understand how such substances affect male fertility. It may be necessary to limit or eliminate the use of certain medications, recreational drugs, or supplements to improve sperm count and motility prior to donor egg fertilization in order to produce the healthiest child possible.

Does drinking affect male fertility?

Heavy alcohol consumption (more than fifteen drinks per week) is known to directly impact sperm in multiple ways:

• Drinking alcohol can lower testosterone and raise estrogen levels, each of which reduces sperm production. The combination of both changes has a more pronounced effect than either change alone.
• Heavy drinking can affect the testes, sometimes causing testicular tissue damage, impotence, or infertility.
• Alcohol use can affect ejaculation and alter the shape, size, and quality of sperm.

Thankfully the effects of heavy drinking can be reversed in as little as three months if alcohol consumption is stopped or significantly reduced. If you are considering parenthood, limiting or eliminating alcohol is an effective way to improve your sperm count and motility.

Does smoking affect fertility in males?

Men who smoke heavily experience similar fertility issues to those caused by alcohol. Tobacco use can lead to lower sperm concentration, abnormal sperm shape, and reduced motility (movement). If smoking is combined with drinking, the effect on sperm quality and fertility is cumulative.

If you smoke, you may encounter the following fertility issues:

• Higher than normal incidences of erectile dysfunction.
• Decreased sperm density (the number of sperm present in semen)
• Damage to sperm caused by cadmium, lead, and other heavy metals present in tobacco products.

As with alcohol use, studies have shown that it only takes a few months after smoking cessation to mostly recover sperm function.

How do recreational drugs affect fertility in men?

Much like alcohol and tobacco use, gay men tend to use recreational drugs at higher rates than straight men, and for similar reasons. Among them, cocaine and marijuana decrease sperm production and sperm quality. Hard drugs that are an increasingly common problem among gay men, like methamphetamine, also harm sperm count and physiology and can lead to lower fertility or infertility.

Do testosterone boosters affect sperm count?

Hormone replacement therapy or supplementation can hurt sperm health. Many gay men, especially middle-aged and older men, take testosterone injectables, gels, patches, or implantable pellets to improve their sex drive and performance, as well as to maintain their physique.

Although testosterone is crucial in sperm production, exogenous testosterone (i.e. testosterone therapy – not the body’s testosterone) can affect other hormones which play key roles in sperm production, leading to lower sperm production and a negative effect on fertility. Other anabolic steroids can have a similar effect. Unlike tobacco and alcohol use, the effects of these drugs may not be fully reversible depending on your age and duration of use.

How does HIV affect sperm health?

HIV can have a significant impact on sperm quality. If you live with HIV, the disease may affect sperm volume, motility, concentration, and shape, all of which can adversely affect fertility.

This does not, however, mean that a man with HIV cannot become a parent through egg donation and surrogacy. If you are HIV-positive, a process called sperm washing prevents you from passing HIV to your child. HIV is not transmitted by sperm itself but instead is transmitted through seminal fluid. Sperm washing removes seminal fluids, bacteria, and non-moving sperm cells from your semen sample, leaving only the sperm itself, which is then used to safely fertilize donor eggs.

Improving sperm count and motility

While some of the medications, drugs, or supplements mentioned above are well-known causes of reduced sperm count, sperm quality, and fertility issues, others may not immediately strike you as potential problems. In most cases, removing the substance from your daily routine can fully reverse the negative effect in a matter of months. It is very important, therefore, to speak to a doctor about all medications and supplements you may be taking, and to be honest about alcohol consumption, smoking, and even recreational drug consumption. This makes it easier to identify the source of any potential fertility problems at the earliest stage possible, to address such issues, and to make sure the highest quality and quantity of sperm will be available to fertilize donated eggs.

You likely have many questions about egg donation, surrogacy, and gay family planning. Please reach out to us at Santa Monica Fertility with any questions you may have. We’ll provide you with the information you need to make an informed choice about building your future family.