A retrospective study of 1,302 reproductive-aged men with ADHD found that recent stimulant use was linked to a modest but statistically significant 6.4% lower semen volume, with median volume 2.7 mL vs 2.9 mL in matched controls, while sperm concentration, motility, and other semen parameters were unchanged. The findings were presented at the 2026 Annual Meeting of the American Urological Association in the study, “Stimulant Use Is Associated With Reduced Semen Volume in Reproductive-Aged Men.”

Why It Matters To Your Practice

• Men taking methylphenidate, amphetamine, lisdexamfetamine, dextroamphetamine, or methamphetamine may ask whether ADHD treatment affects fertility.

• This analysis suggests stimulants are not associated with broad impairment in semen quality, but may have a small effect on semen volume.

• The observed difference was modest — about 0.2 mL — and did not appear to shift patients into clinically low semen volume ranges.

Clinical Benefits

• You can reassure patients that semen concentration, motility, and other measured semen parameters were not significantly different with recent stimulant exposure.

• The study supports continuing evidence-based ADHD treatment when clinically indicated rather than stopping stimulants solely over generalized fertility fears.

• It may help frame counseling: fertility depends more on healthy sperm presence and function than ejaculate volume alone.

Managing Risks

• If a patient is undergoing fertility evaluation, review stimulant use as one possible contributor to slightly lower semen volume.

• Consider other reversible factors that may affect ejaculatory volume, including hydration, appetite suppression, and accessory gland or ejaculatory function.

• Use caution in overinterpreting these findings: this was a retrospective, single-center study presented at a meeting, not proof of causation.

The Bottom Line

• Among reproductive-aged men with ADHD, recent stimulant use was associated with a small 6.4% reduction in semen volume but no significant changes in sperm quality measures.

• For NPs and PAs, the practical message is reassurance: stimulants do not appear to meaningfully impair male fertility based on current data, though prospective study is still needed.