One in seven couples in the United Kingdom experiences difficulty conceiving, according to NICE Fertility Guideline CG156. Male factor infertility — encompassing low sperm count, poor motility and abnormal morphology — contributes in approximately 50 per cent of cases, either alone or alongside female factors. Yet men are far less likely than women to seek help, and community pharmacists may be the first healthcare professional a man approaches.

What pharmacists should know

Male infertility is common, often treatable, and surrounded by misinformation — particularly regarding supplements. Pharmacists are well placed to offer evidence-based advice, manage expectations and ensure timely referral.

A couple is generally advised to seek investigation after 12 months of regular unprotected intercourse without conception (or 6 months if the woman is over 36). Men presenting at the pharmacy counter asking about "fertility supplements" or "sperm health" should be asked whether they have consulted their GP and whether any investigations — particularly a semen analysis — have been performed.

Lifestyle factors with good evidence

Before discussing supplements, pharmacists should address the modifiable lifestyle factors that NICE and the British Fertility Society identify as relevant:

Smoking: Associated with reduced sperm count, motility and morphology. The effect is dose-dependent. Stopping smoking improves semen parameters over 3–6 months. Pharmacists can signpost to NHS stop-smoking services — many community pharmacies offer these directly.

Alcohol: Heavy drinking (more than 14 units per week consistently) is associated with reduced testosterone and impaired spermatogenesis. The advice is moderation, not abstinence — there is no strong evidence that light-to-moderate drinking affects fertility.

Body weight: Obesity (BMI >30) is associated with hormonal changes including lower testosterone and higher oestrogen levels, which can impair sperm production. Weight management support is available through many community pharmacies.

Heat exposure: Prolonged testicular heat — from tight underwear, laptop use on the lap, hot baths, saunas or occupational heat exposure — can temporarily reduce sperm production. Advise loose-fitting underwear and avoiding sustained heat to the scrotal area. The evidence is moderate but the intervention is cost-free.

Anabolic steroids: A critical question for pharmacists to ask, particularly in younger men. Exogenous testosterone and anabolic steroids suppress the hypothalamic-pituitary-gonadal axis, causing azoospermia (complete absence of sperm) in many users. Recovery can take 6–12 months after cessation, and in some cases may not be complete. This is arguably the most impactful single intervention a pharmacist can identify.

Supplements: what the evidence actually shows

The supplement market for male fertility is large and largely unregulated. Pharmacists should guide patients towards evidence-based options and away from expensive, unsupported products.

What to tell patients: "There is some evidence that CoQ10 and zinc may modestly improve sperm parameters, but no supplement has been proven to cure infertility. A semen analysis and GP assessment should come first — supplements are an add-on, not a substitute for investigation."

What to avoid recommending: High-dose antioxidant cocktails marketed as "fertility boosters" often contain ingredients at doses with no evidence, at premium prices. Pharmacists should not endorse specific branded fertility supplements without reviewing the ingredient list against the evidence.

Medicines that may affect male fertility

Pharmacists reviewing medication records should be alert to medicines known to impair male fertility:

• SSRIs: May impair sperm DNA integrity and motility. Not a reason to stop treatment without specialist advice, but worth flagging if a couple is investigating fertility
• Sulfasalazine: Causes reversible oligospermia in up to 60% of men. Switch to mesalazine for IBD patients planning conception
• Testosterone replacement therapy: Suppresses spermatogenesis. Men on TRT who wish to conceive should be referred to endocrinology for managed withdrawal and possible hCG bridging
• Finasteride (1mg for hair loss): May affect sperm count and motility. Discuss with prescriber if fertility is a concern
• Chemotherapy agents: Variable gonadotoxicity. Sperm banking should be discussed before treatment — pharmacists in oncology settings should be aware of local cryopreservation pathways

When to refer

Pharmacists should recommend a GP appointment when:

• A couple has been trying to conceive for 12 months (or 6 months if the woman is over 36) without success
• The man has a history of undescended testes, testicular surgery, varicocele, cancer treatment or known hormonal disorders
• There is a history of recurrent miscarriage (male DNA fragmentation may be a contributing factor)
• The man is taking medicines known to affect fertility and wants to explore alternatives
• There is any testicular lump, pain or swelling — this warrants urgent referral regardless of fertility concerns

The pharmacy opportunity

Male fertility is an area where pharmacists can make a genuine difference through accessible, stigma-free conversations. Men who would not book a GP appointment may ask a pharmacist a quiet question at the counter. Being prepared with evidence-based answers — rather than simply pointing to the supplement shelf — is what distinguishes clinical pharmacy from retail.

For pharmacists interested in men's health roles, the PharmSee job board tracks vacancies across community, hospital and primary care settings. Salary data for these roles is available in the PharmSee salary guide.

Sources: NICE CG156 Fertility problems: assessment and treatment (2013, updated 2024); British Fertility Society guidelines; Cochrane Review on antioxidants for male subfertility (Smits et al., 2019); BNF monographs for listed medicines (accessed April 2026); NHS England community pharmacy contractor records via NHSBSA.