Gout Linked to Erectile Dysfunction and Lower Reproductive Hormones
Key Clinical Summary
- A systematic review and meta-analysis included 11 observational studies, with 104,277 men with gout or hyperuricemia and 342,621 controls.
- Men with gout had a higher risk of erectile dysfunction than controls (relative risk, 1.37; 95% CI, 1.14–1.65).
- Testosterone and estradiol levels were lower in pooled analyses of men with gout or hyperuricemia. Evidence on semen quality came from one study of infertile men.
A review published in Frontiers in Immunology links gout and hyperuricemia with several measures of male reproductive health. The strongest reported sexual health finding was a higher risk of erectile dysfunction among men with gout. The authors, based at institutions in Hangzhou, China, also found lower reproductive hormone levels, while emphasizing that the observational evidence cannot establish causation.
Study Findings
Investigators searched six databases for studies published from January 2000 through October 2025. Of 1,527 records retrieved, 11 studies met inclusion criteria. The review examined sexual function, reproductive hormones, and fertility measures in men with gout or hyperuricemia compared with controls.
Seven studies contributed to the erectile dysfunction analysis, while 6 studies contributed reproductive hormone data. Compared with controls, men with gout or hyperuricemia had lower testosterone levels (pooled mean difference, −1.00; 95% CI, −1.39 to −0.62; P<.001) and estradiol levels (mean difference, −4.67; 95% CI, −9.31 to −0.02; P=.05). A subgroup analysis also found significantly lower testosterone levels among men with gout.
Fertility evidence was much narrower. One study reported lower semen volume and total sperm counts among infertile men with hyperuricemia. The authors cautioned that this result cannot be generalized to men with gout or hyperuricemia more broadly.
Clinical Implications
The findings give clinicians a reason to include sexual and reproductive health in discussions with male patients who have gout or hyperuricemia, particularly those of reproductive age. The authors recommend comprehensive reproductive health assessment when clinically appropriate, but the review does not establish that gout or elevated urate causes erectile dysfunction, hormone changes, or infertility.
All included studies were observational. The authors noted that coexisting obesity, hypertension, diabetes, and other cardiometabolic conditions could contribute to the associations. Hormone data were limited to total testosterone; the included studies did not report sex hormone–binding globulin or calculated free testosterone. None provided a comprehensive assessment of fertility, and only one supplied semen data. These gaps limit how directly the pooled findings can guide individual patient care.
Expert Commentary
Jiping Mao and colleagues at Zhejiang Chinese Medical University and its Second Affiliated Hospital in Hangzhou wrote that clinicians should pay greater attention to reproductive health when caring for men with gout or hyperuricemia. They described the fertility findings as “preliminary” and called for larger studies that address confounding and assess male reproductive health more comprehensively.
The review identifies an association between gout and erectile dysfunction alongside differences in reproductive hormone levels. Further research is needed to clarify causation and determine whether these findings translate into measurable fertility outcomes or changes in care.
Reference: Mao J, Xu M, Tang Y, Chen J, Zhou J, Wu D. Gout, hyperuricemia, and male reproductive health: a systematic review and meta-analysis. Front Immunol. 2026;17:1889720. doi:10.3389/fimmu.2026.1889720
