Pharmacologic Influences on Leydig Cell Steroidogenic Function and Testosterone

Pharmaceuticals used to treat human disease have the potential to affect a wide variety of healthy tissues and cells across all organs. This may include effects on the gonads, which can result in impaired androgen production and hypogonadism. In-utero exposure to medications that impair Leydig cell steroidogenesis during a critical period of fetal development has the potential to result in the development of a variety of male reproductive disorders, while exposure during adulthood may result in hypogonadism that can be reversible over time. Some of the most commonly used medications, such as azole antifungals, have predictable effects on testosterone production consistent with known mechanisms of action involving inhibition of Leydig cell steroidogenesis. Other medications, such as analgesics, may impair androgen production through less well-defined mechanisms. In this chapter, we will discuss the potential for pharmaceuticals to impair Leydig cell testosterone production, using azole antifungals, estrogens, analgesics, and anti-epileptics as examples.