In a variety of studies, testosterone was found to be significantly decreased in people with psoriasis.

In men, lower levels of testosterone are associated with:

  • decreased sperm production
  • decreased sperm motility (movement)
  • decreased libido
  • decreased sexual functioning (ability to achieve or maintain an erection)

As you might expect, studies also revealed that total sperm count, sperm motility and percent of sperm with normal morphology were significantly reduced in participants with psoriasis.

Fewer available sperm and sperm motility issues can make it harder to conceive spontaneously.

These findings suggest that untreated psoriasis may impair male fertility.

The link between psoriasis and decreased fertility may be due to how systemic inflammation affects the production of sex hormones.

Inflammation triggers a cascade of inflammatory cytokines (a type of protein), which can have a destructive impact on a variety of organ systems, including reproductive systems. This influx of cytokines may lead to decreasing sex hormone production and sperm production.

The link may also be related to the inflammation of sexual accessory glands. In one small 2017 study, 70 percent of participants with psoriasis were found to have ultrasound signs of inflammation of the accessory glands. No one in the non-psoriasis control group showed these signs.

Sexual accessory glands in men include the seminal vesicles and prostate. These glands help to create the fluids in semen that protect and transport sperm. Inflammation in these glands could also negatively affect sperm, decreasing chances of conception.

Psoriasis treatments aimed at decreasing systemic inflammation, such as anti-TNF agents, have been shown to improve male fertility.

Anti-TNF medications currently approved by the Food and Drug Administration (FDA) for treating psoriasis include:

However, some other immunosuppressant medications, like sulfasalazine, show evidence of decreasing sperm quality. That said, there currently isn’t enough evidence to definitively determine which are beneficial or harmful to sperm production and fertility.

Any autoimmune disease or condition that leads to significant systemic inflammation can affect fertility.

This includes conditions like:

  • inflammatory bowel disease
  • lupus
  • type 1 diabetes
  • rheumatoid arthritis (and other autoimmune arthritis)
  • vasculitis
  • autoimmune thyroiditis

Yes, by seeking early treatment to prevent and control any systemic inflammation.

The first step is working with your doctor on a treatment that manages the disease well enough to avoid systemic inflammation. Your treatment is likely to include medications and lifestyle modification to help avoid flares.

These lifestyle modifications may include things like:

  • Exercising regularly. Aim to exercise at least 30 minutes a day.
  • Getting adequate rest. Aim for at least 8 hours per night.
  • Adjusting your diet. Consider eating more anti-inflammatory foods, like vegetables, fruits, nuts, and fish. Avoid processed foods and excess sugar.
  • Reducing stress. Seek out support and devote time to stress-reducing activities like meditation.
  • Quitting smoking and limiting alcohol. If you’re able to stop smoking and limit alcohol intake, it can positively impact your psoriasis, fertility, and overall health.

Dr. Susan Bard is a NYC-based board certified dermatologist and fellow of the American College of Mohs Surgery. Dr. Bard received her medical degree from SUNY Downstate. She completed her dermatology residency at the University of Miami as well as a clinical research fellowship in pediatric dermatology and a procedural dermatology fellowship, where she further trained in Mohs micrographic surgery, lasers, and cosmetic surgery.