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Ostdiek-Wille GP, Bavitz KC, Kohn TP, Deibert CM. Attention-deficit hyperactivity disorder medication use is associated with testosterone hypofunction-results from a national claims database analysis. Int J Impot Res 2024; 36:403-407. [PMID: 38129694 DOI: 10.1038/s41443-023-00805-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/13/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Abstract
Male hypogonadism is not a risk associated with attention-deficit hyperactivity disorder (ADHD) stimulant medications, but recent studies have explored this connection. Though the pathophysiologic connection remains unclear, we predicted that long-term use of ADHD stimulant medications could increase the risk of hypogonadism in post-pubertal males. Utilizing TriNetX, LLC Research Network data from January 2000 through December 2019, men older than 18 with ADHD receiving long-term stimulant medication (>36 monthly prescriptions) were selected for the study population. Two control groups were constructed: individuals with ADHD but no stimulant medication use, and individuals without ADHD or stimulant medication use. A diagnosis of testicular hypofunction (ICD-10: E29.1) within five years of long-term ADHD stimulant medication use was the chosen primary outcome. After propensity score matching, 17,224 men were analyzed in each group. Of the men with long-term ADHD stimulant medication use, 1.20% were subsequently diagnosed with testicular hypofunction compared to 0.67% of individuals with ADHD without stimulant medication use (RR: 1.78, 95% CI: 1.42-2.23) and 0.68% in men without ADHD or stimulant medication use (RR: 1.75, 95% CI: 1.39-2.19). Therefore, chronic ADHD stimulant medication use was found to be significantly associated with a subsequent diagnosis of testicular hypofunction.
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Affiliation(s)
| | - Kyle C Bavitz
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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da Costa Nunes Gomes AC, Bellin CS, da Silva Dias S, de Queiroz de Rosa T, Araújo MP, Miraglia SM, Mendes TB, Vendramini V. Increased sperm DNA damage leads to poor embryo quality and subfertility of male rats treated with methylphenidate hydrochloride in adolescence. Andrology 2022; 10:1632-1643. [PMID: 36029003 DOI: 10.1111/andr.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Methylphenidate hydrochloride (MPH) is a psychostimulant widely used in the treatment of attention deficit hyperactive disorder (ADHD), as well as a performance enhancer, for at least 60 years. Despite the notable effectiveness as a psychostimulant, ADHD is a chronic disorder and has a two-third chance of accompanying the individual throughout life. Long-term use of MPH has been associated not only with an increase in the development of neurodegenerative diseases, but it also has side effects on male fertility in experimental animals. OBJECTIVES To investigate whether methylphenidate poses a risk to sperm DNA structure and to the quality of embryos conceived after treatment during adolescence in rats. MATERIALS AND METHODS Wistar rats at 38 days of age were treated either with 5 mg/kg body weight of MPH, in a single daily dose for 30 days, via gavage or with distilled water-only protocol. Levels of oxidative stress in testicular and epididymal tissues were evaluated. Sperm chromatin quality and acrosome integrity was assessed under flow cytometry. From 107 days of age, animals were mated with untreated females. The effects of the paternal contribution at two different embryo development moments - cleavage stage (2.5 days post coitum) and late gestation (20 days post coitum) - were analyzed. RESULTS MPH caused high levels of sperm DNA damage, which was reflected in 40% of decrease in early embryo quality and a lower number of live pups at 20 dpc. DISCUSSION The high level of fragmentation seen in the embryos sired from the MPH group is consistent with the poor chromatin structure of the sperm, and does not seem to be a result of oxidative stress in the reproductive tissues. CONCLUSIONS The results presented here suggest that the subchronic use of MPH during male prepubertal phase may cause long term subfertility and compromise embryo survival. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ana Clara da Costa Nunes Gomes
- Department of Morphology and Genetics, Laboratory of Reproductive and Developmental Biology (LabReD), Paulista School of Medicine, Federal University of Sao Paulo - EPM/UNIFESP, Sao Paulo, Brazil
| | - Camila Souza Bellin
- Department of Morphology and Genetics, Laboratory of Reproductive and Developmental Biology (LabReD), Paulista School of Medicine, Federal University of Sao Paulo - EPM/UNIFESP, Sao Paulo, Brazil.,Paulista School of Nursing, Federal University of Sao Paulo - EPE/UNIFESP, Sao Paulo, Brazil
| | - Stephanie da Silva Dias
- Department of Morphology and Genetics, Laboratory of Reproductive and Developmental Biology (LabReD), Paulista School of Medicine, Federal University of Sao Paulo - EPM/UNIFESP, Sao Paulo, Brazil.,Paulista School of Nursing, Federal University of Sao Paulo - EPE/UNIFESP, Sao Paulo, Brazil
| | - Thalita de Queiroz de Rosa
- Department of Morphology and Genetics, Laboratory of Reproductive and Developmental Biology (LabReD), Paulista School of Medicine, Federal University of Sao Paulo - EPM/UNIFESP, Sao Paulo, Brazil.,Paulista School of Nursing, Federal University of Sao Paulo - EPE/UNIFESP, Sao Paulo, Brazil
| | - Marina Pereira Araújo
- Department of Morphology and Genetics, Laboratory of Reproductive and Developmental Biology (LabReD), Paulista School of Medicine, Federal University of Sao Paulo - EPM/UNIFESP, Sao Paulo, Brazil.,Paulista School of Nursing, Federal University of Sao Paulo - EPE/UNIFESP, Sao Paulo, Brazil
| | - Sandra Maria Miraglia
- Department of Morphology and Genetics, Laboratory of Reproductive and Developmental Biology (LabReD), Paulista School of Medicine, Federal University of Sao Paulo - EPM/UNIFESP, Sao Paulo, Brazil
| | - Talita Biude Mendes
- Department of Morphology and Genetics, Laboratory of Reproductive and Developmental Biology (LabReD), Paulista School of Medicine, Federal University of Sao Paulo - EPM/UNIFESP, Sao Paulo, Brazil
| | - Vanessa Vendramini
- Department of Morphology and Genetics, Laboratory of Reproductive and Developmental Biology (LabReD), Paulista School of Medicine, Federal University of Sao Paulo - EPM/UNIFESP, Sao Paulo, Brazil
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Abdalla TE, Kotsonis D, Best J, Ramasamy R, Wood E. Stimulant-Induced Pituitary Failure and Reversible Azoospermia. Cureus 2021; 13:e14269. [PMID: 33959450 PMCID: PMC8093113 DOI: 10.7759/cureus.14269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a commonly diagnosed disorder that is managed with stimulant medications, which function by increasing the levels of dopamine in the brain. Excess dopamine has been known to affect several body systems, including the endocrine system. This case presents male factor infertility caused by a negative interaction between excess dopamine and the endocrine system, inducing pituitary failure, which led to azoospermia. The patient and her partner presented to the fertility clinic for evaluation after one year of failing to conceive. The patient’s partner had been treated throughout the conception of their first three pregnancies for ADHD with methylphenidate (Ritalin) for many years; however, eight months prior to presentation at the clinic, the partner had been switched to amphetamine-dextroamphetamine (Adderall) for treatment of ADHD. A fertility evaluation revealed azoospermia which was confirmed via two separate semen analyses two weeks apart. In addition, the patient’s total testosterone, prolactin, luteinizing hormone, and follicle-stimulating hormone were below normal limits. A normal semen analysis was obtained after a five-month withdrawal of amphetamine-dextroamphetamine, which was followed by a naturally conceived pregnancy. The possibility of pre-testicular azoospermia caused by medication-induced pituitary failure should be considered in males prescribed stimulant medication who are seeking to reproduce.
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Affiliation(s)
- Tori E Abdalla
- Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | | | - Jordan Best
- Medical Education, Nova Southeastern University, Miami, USA
| | | | - Ellen Wood
- Reproductive Endocrinology and Infertility, IVFMD, Cooper City, USA
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Abdollahifar MA, Zangiabadian M, Moradi A, Rezaei F, Fadai S, Khatmi A, Ezi S, Norozian M, Moghoddam MH, Razminia Y, Fazli S, Aliaghaei A. Chronic Administration of Methylphenidate Induced Degeneration of Spermatogenesis in Adult Male Rats. Pharm Chem J 2020. [DOI: 10.1007/s11094-020-02257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Danborg P, Valdersdorf M, Gøtzsche P. Long-term harms from previous use of selective serotonin reuptake inhibitors: A systematic review. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2019; 30:59-71. [PMID: 30714974 PMCID: PMC6839490 DOI: 10.3233/jrs-180046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Millions of people are treated with antidepressants like selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). This clinical practice is based on short-term trials that have exaggerated the benefits and underestimated the harms. We also know too little about long-term harms. AIM To assess harms of SSRIs and SNRIs that persist after end of drug intake. METHODS Systematic review of placebo-controlled randomised trials of any length in patients with a psychiatric diagnosis and a follow-up of at least six months. Our primary outcomes were mortality, functional outcomes, quality of life and core psychiatric events. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials and checked the references for eligible articles. One researcher extracted data and another checked the data extraction. RESULTS Our searches returned 9,153 unique records. We included 22 papers for 12 trials on SSRIs. Median intervention and follow-up periods were 15 and 52 weeks, respectively. Median number of randomised participants was 51; only two trials had a drop-out rate below 20%.Outcome reporting was less thorough during follow-up than for the intervention period and only two trials maintained the blind during follow-up. All authors concluded that the drugs were not beneficial in the long term.All trials reported harms outcomes selectively or did not report any. Only two trials reported on any of our primary outcomes (school attendance and number of heavy drinking days). CONCLUSION The randomised trials currently available cannot be used to investigate persistent harms of antidepressants.
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Affiliation(s)
- P.B. Danborg
- Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark
| | - M. Valdersdorf
- Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark
| | - P.C. Gøtzsche
- Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark
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