Autoimmune diseases affect millions of people around the world, and some of them appear more often or more severely in men. These conditions usually cause inflammation and organ problems, but they also affect fertility — a side effect that’s often overlooked. Below, we explore five autoimmune diseases that are more common in men and explain how each can harm reproductive health.
Ankylosing Spondylitis (AS)
What it is:
Ankylosing Spondylitis is a type of inflammatory arthritis that mainly affects the spine and lower back joints. It often begins in early adulthood and occurs about two to three times more often in men (Braun & Sieper, 2007).
Impact on fertility:
- Chronic inflammation raises oxidative stress, which can harm sperm shape, movement, and DNA (Ricci et al., 2009).
- Inflammatory hormones can lower testosterone and slow sperm production.
- Pain, stiffness, and fatigue often lead to erectile problems and lower libido.
- Drugs called TNF inhibitors (such as etanercept or adalimumab) seem safe for fertility and may even improve sperm health (Mahmoud et al., 2011).
Psoriasis and Psoriatic Arthritis (PsA)
What it is:
Psoriasis is a long-term skin condition that causes red, scaly patches. Around 30% of people with psoriasis also develop Psoriatic Arthritis, which causes joint pain and swelling. These conditions tend to appear earlier and progress faster in men.
Impact on fertility:
- Inflammation increases oxidative stress in semen, which can reduce sperm count and movement.
- Visible skin symptoms and pain can affect confidence and lead to sexual avoidance.
- Inflammatory chemicals like TNF-alpha and IL-17 can disrupt hormone balance and reduce testosterone.
- Treatments that block these cytokines, such as TNF or IL-17 inhibitors, are generally safe for men who want to have children (Micu et al., 2023).
Rheumatoid Arthritis (RA)
What it is:
Rheumatoid Arthritis is an autoimmune disease that mainly attacks the joints but can also affect the whole body. Although it’s more common in women, men often experience a more aggressive form of the disease.
Impact on fertility:
- Men with RA often have lower testosterone and higher LH levels, a sign of hormonal imbalance (Kiss et al., 2005).
- Ongoing inflammation can damage sperm DNA and reduce its quality.
- Depression, fatigue, and joint pain can lower libido and affect sexual performance.
- Common RA drugs, including methotrexate and biologics, usually do not harm fertility, but doctors sometimes advise taking a short break before trying to conceive.
Type 1 Diabetes Mellitus (T1DM)
What it is:
Type 1 Diabetes is an autoimmune condition that destroys insulin-producing cells in the pancreas. It usually starts in childhood or the teenage years and requires daily insulin treatment.
Impact on fertility:
- High blood sugar increases oxidative stress and damages small blood vessels, which can harm sperm DNA and reduce motility (Agbaje et al., 2007).
- Nerve damage may cause erectile dysfunction or retrograde ejaculation.
- Poor glucose control can disrupt hormones and lower testosterone.
- Insulin treatment itself does not harm fertility, but keeping blood sugar steady protects reproductive health.
Primary Sclerosing Cholangitis (PSC)
What it is:
PSC is a chronic liver disease that causes inflammation and scarring of the bile ducts. It affects men more often than women and often occurs alongside ulcerative colitis, an inflammatory bowel disease.
Impact on fertility:
- Liver problems can interfere with hormone balance, lowering testosterone and sex drive.
- Constant fatigue may cause sexual difficulties and reduce motivation.
- Although data are limited, inflammation likely contributes to oxidative sperm damage.
- Drugs such as ursodeoxycholic acid (UDCA) and TNF blockers used for IBD generally appear safe for male fertility.
Conclusion
Autoimmune diseases bring many challenges for men — not only pain and fatigue but also potential effects on fertility. Inflammation, oxidative stress, and hormonal shifts can all damage sperm and affect sexual health. However, there’s good news: most modern treatments, especially biologic drugs, appear safe for male reproductive function.
Men living with autoimmune conditions can use at-home sperm testing kits to track fertility health — including sperm count, shape, and motility. Testing before or during treatment helps men make confident decisions and work more closely with their doctors.
By managing disease activity early and monitoring fertility regularly, men can protect their reproductive health and plan for future parenthood with confidence.
