Ibuprofen, aspirin and others nonsteroidal anti-inflammatory drugs (NSAIDs), are popular pain over-the-counter relievers that have been used for decades -and in the case of aspirin, over 100 years. But are they totally safe? While the answer is no being “totally safe,” a growing number of studies are linking ibuprofen and other NSAIDs to infertility and lower testosterone (lot T). I was intrigued as I am sure most other men are too. So in this review, let's look at the research linking ibuprofen (Advil) to low testosterone and infertility and see what we can discover. Also read How to lower blood pressure naturally.
Evidence Linking Ibuprofen To Lower Testosterone and Infertility
While this review is really about the latest research on ibuprofen and infertility /low testosterone, research suggests all of the popular OTC pain reliever drugs appear to be anti-androgenic.
Previous studies of pregnant women who took acetaminophen (Tylenol) while pregnant noted that the pain reliever seemed to “impair male sexual behaviour in adulthood.” In other words, taking it during pregnancy impacted men many years later.
Other researchers have noted that Tylenol (also called paracetamol) was associated with couples taking longer to get pregnant.
Another study noted that when taken during the first trimester of pregnancy, ibuprofen caused a “direct endocrine disturbances in the human fetal testis and alteration of the germ cell biology.” In other words, ibuprofen, changed how the testes worked.
What about aspirin? This also seems to be anti-testosterone. At least one study has shown that aspirin inhibits luteinizing hormone (LH) the compound that stimulates testosterone production.
In other small study, 13 healthy adult men (18-35 years of age) were given 1200 mg of ibuprofen or placebo for 44 days.
Researchers noted that even though ibuprofen raised luteinizing hormone (LH) by 33%, it did NOT raise testosterone levels. You'd think that if it raised LH, that testosterone would go up too. But that's not what happened.
Taking ibuprofen also caused a significant 23% reduction in the testostreone/LH/ratio after the 44 day study.
The researchers concluded that ibuprofen caused “compensated hypogonadism”(sub-clinical hypogonadism).
These researchers also exposed adult testicle cells to ibuprofen in an amount equal to 1200 mg (what the men in the study took). Within 24 hours of use, ibuprofen inhibited testosterone production by the testicle cells. To make testosterone, it has to be converted to the hormone from cholesterol. These researchers also showed that ibuprofen inhibited genes involved in turning cholesterol into testosterone.
What is Compensated Hypogonadism?
Most people have never heard of compensated hypogonadism before so let's talk about it. Gonads refer to the testicles. The testicles make most of the testosterone in men. Hypogonadism is a syndrome associated with low levels of testosterone (low T). Compensated hypogonadism refers to when testosterone levels are normal – yet other hormones, like luteinzing hormone are out of balance. That is exactly what we saw in the study above of the men taking 1200 mg of ibuprofen.
Compensated hypogonadism can be associated with erectile dysfunction and lack of interest in sex. Normally compensated hypogonadism occurs in older men. Because researchers saw that ibuprofen seemed to cause this condition in younger men (18-35) is concerning.
Studies like those mentioned above will no doubt promote many questions by men and women. Let's try to cut to the chase and address some of those questions and concerns below.
Does Ibuprofen Cause Infertility?
Some previous areas of research hint long term use of OTC pain relievers may be linked to infertility. We know lower sperm counts have been happening in men over the years. Other studies have found couples taking NSAIDs took longer to get pregnant. Could these two things be related or a just coincidence? Could the finding of compensated hypogonadism be part of the reason for decreased sperm counts and longer times to get pregnant? Big questions indeed. The answer will take larger studies to know for sure.
Does Ibuprofen Reduce Sex Drive?
While from the research above, it's tempting to think NSAIDs promote a loss libido, no studies have directly linked the two. Sex drive is complicated and a loss of libido can be caused by many things. For example, a drop in sex drive might be caused by stress, high triglycerides, being overweight and even too much exercise.
Does Ibuprofen Cause Fatigue?
One of the signs of aging and hypogonadism is fatigue. It's temping to say fatigue is linked to long term ibuprofen use given it may promote sub-clinical hypogonadism. Right now I'd say it's an intriguing thought but we need better research to know one way or the other. Fatigue can be caused by many things like lack of regular exercise, being overweight or eating lots of junk food.
Can Ibuprofen Reduce Muscle Growth?
If long term use of ibuprofen is linked to hypogonadism, what does this mean for muscle growth? Might taking ibuprofen for years reduce muscle growth? What about other OTC analgesic non-steroidal anti inflammatory meds, like aspirin?
For years, I cautioned athletes against long term use of COX2 inhibitors (NSAIDs like ibuprofen, aspirin etc.) when they performed bouts of exercise close to each other because of speculation the same chemicals NSAIDs inhibited (prostaglandins) to reduce pain might also be involved in muscle recovery.
Given that ibuprofen might promote sub-clinical hypogonadism (also called compensated hypogandism), leading to reduced testosterone, a natural extrapolation would be to assume these drugs also reduce muscle growth. Its interesting to discuss but research linking anti-inflammatory drugs to reduced muscle hypertrophy or muscle strength needs more research.
For healthy people who do strength training exercise, my instincts tell me any effect would probably not be significant. For older folks who do not workout (those in nursing homes for instance), I am less certain.
Those concerned with how ibuprofen might limit hypertrophy, muscle strength and recovery, may want to consider limiting their use until more is known.
Speaking of exercise, remember that NSAIDs might also impair kidney function. Kidney failure is also a symptom of rhabdomyolysis (muscle fiber death). This is another reason to be cautious of OTC pain medications after exercise.
Can Ibuprofen Cause Depression?
Over the counter pain relievers are very popular. As is reported by Scientific American, antidepressants are the 3rd most popular class of drugs in the US. While testosterone is mostly noted for us muscle building ability, a drop in this hormone may also play a role in depression.
So, if ibuprofen promotes hypogonadism and this reduces testosterone, might this in turn increase the odds of depression? This is a touch call to make and so I wont try to. Depression is complicated. On the plus side, some research has noted less depression in osteoarthritis patients when they take NSAIDs. These studies did not measure testosterone and my guess is the depression was reduced due to the people feeling less pain and maybe greater ability return to their normal activities. Again, this is complicated. Currently no studies directly link ibuprofen or other OTC pain meds to depression.
Other Ibuprofen Side Effects
Ibuprofen is a highly studied anti-pain medication. Like all medications, it can have side effects. Just some of the possible side effects of ibuprofen are the following:
|Heart problems (stroke, heart attack)||Liver damage||Ulcers|
|Headaches||Kidney damage||Changes in vision|
|Itchy skin||Tinnitus (ringing in the ears)||Hypertension|
I don't list side effects these to scare anyone but rather to just point out that over-the-counter medications are powerful and it's always wise to consult a trained medical professional when using them, especially if you're using them long term.
Real Life Advice
No doubt news linking ibuprofen and other NSAIDs to hypothyroidism, infertility and lower testosterone is going to get attention. Before jumping to conclusions, always speak to a pharmacist and your doctor for updates on the information and how relevant all this is for you. Don't believe all the hype on TV or websites. Remember the science is complicated and for many people, NSAIDs can be godsends.
While I think more research is needed, based on the studies to date, for couples trying to get pregnant, it may be worth limiting ibuprofen and other NSAID use when trying to conceive and also during the first trimester of pregnancy. When in doubt, men concerned about all this might want to get their testosterone levels checked too.