More Than Skin Deep: Psoriasis Could Affect Male Fertility

It has long been known that chronic inflammation is a risk factor for male fertility, largely due to its effects on sperm health. According to a study published in 2015 in the Journal of Reproduction & Fertility, inflammatory reactions in the male genital tract have a negative impact on sperm quality and, consequently, fertility.

A 2021 article cites a connection between chronic inflammation and male fertility in patients with ulcerative colitis, a bowel disease. Other inflammatory conditions that can affect the prostate and sperm include prostatitis, epididymitis and orchitis, which all have infection in common as the cause.

One of the most common inflammatory diseases is psoriasis, which differs from the others in that it is an autoimmune disease. According to the National Psoriasis Foundation, psoriasis is an immune-mediated disease—a disease with an unclear cause that is characterized by inflammation caused by dysfunction of the immune system—that causes inflammation in the body.

Psoriasis affects more than 3 percent of the U.S. population, it can affect any gender, and it can manifest in many ways and in many bodily systems. White people are at a higher risk of developing psoriasis, and it often appears between the ages of 15 and 25.

Many people experience visible signs of inflammation such as raised plaques and scales on the skin, which can be dry, itchy and painful. Unlike in men, however, psoriasis does not affect women's fertility, according to the Psoriasis and Psoriatic Arthritis Alliance.

"Psoriasis is caused by a myriad of factors, including genetic and environmental," said Denise Asafu-Adjei, M.D., a urologist who practices in Chicago.

The link between psoriasis and sperm health

Psoriasis can cause inflammation in the body and affect the hormones and glands associated with reproduction. In a 2017 study published in the journal Dermatology, researchers found participants with psoriasis had a significant decrease in both testosterone and sex hormone-binding globulin (SHBG). This condition can be associated with a decrease in libido and problems with erections.

Since the seminal vesicles and the prostate gland can become inflamed when a male has psoriasis, it can affect his sperm count as well as the overall health and quality of his sperm.

It is important to always remember the difference between causation and correlation, however.

"It's possible that the same inflammatory components present in psoriasis can also impact fertility. But there are other things that may exacerbate psoriasis, such as poor diet and lack of exercise, which can also affect fertility," said Robert Caruso, M.D., a urologist at Clara Maass Medical Center in Belleville, New Jersey. "So there is a correlation between the two. But this doesn't necessarily mean that psoriasis is the cause."

Inflammatory foods' impact on male fertility

Foods that cause inflammation, even healthy choices like nuts and lean meat, can exacerbate psoriasis. Modern industrialization and food-processing methods can contribute to this occurrence.

"For example, our paleolithic hunter-gatherer ancestors had to make the effort of cracking shells to eat nuts, but we can eat a whole bag of shelled nuts without thinking," Caruso explained. "And if the meat we consume comes from animals that eat corn feed instead of grass, then we are likely getting more omega-6 fat, which is more inflammatory, whereas omega-3 is more anti-inflammatory. This same inflammatory response, which can worsen psoriasis, may also have an impact on fertility."

Treatment options

The most typical treatment options for psoriasis include creams and ointments and oral or injected medications. The treatment goal is to stop the skin cells from growing quickly and remove scales that have already formed. Using anti-inflammatory treatments such as anti-TNF agents (medication) has been shown to improve male fertility.

However, according to Fertility Answers, a Louisiana-based specialty fertility clinic, certain types of medication for psoriasis can impair sperm production. If you have psoriasis, a doctor can prescribe a topical or oral solution and explain other possible side effects of this immune disorder.

"However, since most psoriasis treatments don't have extensive studies specifically on male infertility, it is unknown how well men are counseled about the effects of untreated psoriasis on male infertility," Asafu-Adjei said.

Men who are experiencing erectile dysfunction (ED) or low libido should tell their doctor, because this could be related to psoriasis or its potential treatments. Anyone with psoriasis or another autoimmune disorder could benefit from eating more anti-inflammatory foods and fewer processed foods.

As a chronic condition, psoriasis won't go away on its own without proper treatment. It's a condition that recurs and whose flare-ups can be caused by inflammatory foods, stress, or cold and dry weather.

As Caruso noted, impaired male fertility is not always a direct cause of psoriasis, but there can be a correlation. If you've treated your psoriasis and are still experiencing fertility complications, a doctor may need to rule out other reasons for a low sperm count or erectile dysfunction.