Klin Farmakol Farm. 2026;40(2):134-138 | DOI: 10.36290/far.2026.004

Over-the-counter products, SARMs and dietary supplements as hidden causes of male hypogonadism and subfertility: a clinical overview and practical management

Marek Broul^1-3, Aneta Hujová³, Kateřina Langmaierová⁴

¹ Sexuologické oddělení, Krajská zdravotní, a. s. - Masarykova nemocnice v Ústí nad Labem, o. z.

² Urologické oddělení, Krajská zdravotní, a. s. - Nemocnice Litoměřice, o. z.

³ Fakulta zdravotnických studií, Univerzita J. E. Purkyně v Ústí nad Labem

⁴ Oddělení klinické farmacie, Krajská zdravotní, a. s. - Masarykova nemocnice v Ústí nad Labem, o. z.

Objective: To summarize clinically relevant exposures to over-the-counter (OTC) products and dietary supplements that may cause secondary hypogonadism and impaired male fertility, and to propose a pragmatic diagnostic and management pathway relevant to Czech clinical practice.

Methods: Narrative review with targeted searches of MEDLINE/PubMed, Embase and the Cochrane Library (2000-2025), complemented by regulatory sources (FDA, WADA) and Czech resources on dietary supplement oversight and nutrivigilance.

Results: Selective androgen receptor modulators (SARMs) carry the highest risk of suppressing the hypothalamic-pituitary-gonadal axis and remain prohibited in sport. Short randomized trials demonstrated reductions in total testosterone with selected SARMs. Prior exposure to androgenic substances may be under-recognized in men evaluated for hypogonadism. For so-called "testosterone boosters", evidence of clinically meaningful androgenic effects is weak, and higher doses of some ingredients may lower testosterone; moreover, some products may contain undeclared prescription drugs. In the EU, oral ketoconazole was restricted due to hepatotoxicity and is not routinely available in the Czech Republic; topical forms have very low systemic absorption. High-dose ibuprofen has been associated with a compensated hypogonadism laboratory pattern.

Conclusion: OTC exposures represent an under-recognized but often reversible cause of male hypogonadism and subfertility. Standardized exposure history, early laboratory assessment and fertility-preserving management may accelerate recovery.

Keywords: male hypogonadism, male infertility, SARMs, dietary supplements, post-cycle therapy, ketoconazole, ibuprofen, diagnosis, management.

Received: December 22, 2025; Revised: January 20, 2026; Accepted: January 26, 2026; Published: July 1, 2026  Show citation