Dozens of widely prescribed medications can lower testosterone, some by design and others as an unintended side effect. Opioid painkillers, corticosteroids, certain psychiatric drugs, heartburn remedies, and even cholesterol-lowering statins have all been linked to reduced testosterone levels in men and, in some cases, women. The list is long enough that if you are experiencing symptoms like low energy, reduced sex drive, or mood changes while taking a medication, there is a reasonable chance the drug itself is involved.
Opioid Pain Medications
Opioids are one of the most common culprits behind medication-induced low testosterone, a condition sometimes called opioid-induced hypogonadism. These drugs act on receptors in the brain that suppress the hormonal signal telling the testes to produce testosterone. The result is a drop in luteinizing hormone, which in turn means less testosterone gets made downstream.1PubMed Central. Long-term Opioids Linked to Hypogonadism and the Role of Testosterone Supplementation Therapy This applies to virtually all opioids, whether short-acting drugs like hydrocodone and oxycodone or long-acting ones like methadone and sustained-release morphine. The effect becomes more pronounced the longer someone takes them and the higher the dose, but even moderate therapeutic use over weeks to months can measurably suppress testosterone.
What makes opioid-induced testosterone suppression particularly important is sheer numbers. Millions of people take prescription opioids for chronic pain, and many of them experience fatigue, depression, reduced libido, and erectile dysfunction without realizing their pain medication might be contributing. If you are on long-term opioid therapy and noticing these symptoms, a simple blood test for total testosterone and luteinizing hormone can clarify whether your medication is the cause.
Corticosteroids
Long-term use of oral corticosteroids like prednisolone and prednisone suppresses testosterone. In one study, men on long-term oral prednisolone had testosterone levels roughly a third lower than controls.2PubMed. Testosterone levels during systemic and inhaled corticosteroid therapy The mechanism appears to be a direct effect on the Leydig cells in the testes, the cells responsible for making testosterone. Even a single dose of prednisolone has been shown to impair the ratio of testosterone to luteinizing hormone, consistent with reduced testicular function rather than a brain-level hormonal signal problem.3PubMed Central. Single-dose prednisolone alters endocrine and haematologic responses and exercise performance in men
Inhaled corticosteroids used for asthma and COPD appear to have a much smaller effect, if any, at standard doses. The concern is mainly with oral or injectable corticosteroids taken over weeks or months, which is common in conditions like rheumatoid arthritis, inflammatory bowel disease, and severe asthma exacerbations. People who cycle on and off steroid bursts several times a year should be aware that repeated courses may have a cumulative hormonal impact.
Hormonal Therapies for Prostate Cancer
Some medications are specifically designed to crash testosterone levels to near zero, because prostate cancer cells rely on testosterone to grow. These drugs produce the most dramatic testosterone suppression of any medication category.
GnRH agonists like leuprolide and goserelin work by overstimulating the pituitary gland until it stops responding, ultimately shutting down testosterone production. They replaced surgical castration as the standard approach for advanced prostate cancer. One drawback is that they cause an initial testosterone surge before levels fall, which can temporarily worsen cancer symptoms. GnRH antagonists like degarelix avoid that surge by directly blocking the pituitary signal, leading to a faster and smoother decline in testosterone.4PubMed. Considerations for the use of gonadotropin-releasing hormone agonists and antagonists in patients with prostate cancer
Abiraterone takes a different approach, blocking an enzyme called CYP17A1 that is needed for testosterone synthesis. In castration-resistant prostate cancer, where the disease progresses even after standard hormone therapy, abiraterone can push tumor testosterone levels down to near-undetectable concentrations.5PubMed Central. Resistance to CYP17A1 inhibition with abiraterone in castration-resistant prostate cancer: induction of steroidogenesis and androgen receptor splice variants Both GnRH-based drugs and abiraterone come with significant side effects including hot flashes, bone loss, fatigue, and metabolic changes, because testosterone is being eliminated rather than merely reduced.
Anti-Androgens in Gender-Affirming Hormone Therapy
Transgender women and some nonbinary individuals use anti-androgen medications alongside estrogen to suppress testosterone to female-typical ranges. The two most widely used options are cyproterone acetate and spironolactone, and they differ substantially in how effectively they lower testosterone.
Cyproterone acetate is considerably more potent. In one study, about 90% of people taking cyproterone achieved testosterone levels below the target threshold, compared with roughly 40% of those on spironolactone.6PubMed Central. Cyproterone acetate or spironolactone in lowering testosterone concentrations for transgender individuals receiving oestradiol therapy Cyproterone is not available in the United States but is used widely in Europe, Canada, and elsewhere. Importantly, research from a large European study found that even a low daily dose of 10 mg was just as effective at suppressing testosterone as higher doses of 25, 50, or 100 mg, while producing fewer side effects.7PubMed Central. Toward a Lowest Effective Dose of Cyproterone Acetate in Trans Women: Results From the ENIGI Study That finding matters because higher doses of cyproterone carry risks including liver problems and a rare type of brain tumor called meningioma.
Spironolactone, the main option in the U.S., was originally developed as a blood pressure medication and diuretic. It has anti-androgenic properties, but the head-to-head data comparing it with cyproterone remain limited.8PubMed. Anti-Androgenic Effects Comparison Between Cyproterone Acetate and Spironolactone in Transgender Women: A Randomized Controlled Trial Spironolactone works partly by blocking testosterone from binding to its receptor and partly by mildly reducing production, but it often needs higher doses and the addition of estrogen to bring testosterone into female-typical territory.
Psychiatric Medications
Two classes of psychiatric drugs have drawn attention for their effects on testosterone: antipsychotics and SSRIs.
Many antipsychotic medications, particularly older ones like haloperidol and risperidone, raise prolactin levels. Elevated prolactin in turn suppresses the hormonal cascade that drives testosterone production, leading to lower testosterone and contributing to sexual side effects that are common complaints among men with schizophrenia on these drugs.9PubMed. Levels of prolactin and testosterone and associated sexual dysfunction and breast abnormalities in men with schizophrenia treated with antipsychotic medications Not all antipsychotics raise prolactin equally. Newer agents like quetiapine and aripiprazole tend to have less impact on prolactin and therefore less effect on testosterone, which is worth discussing with a prescriber if sexual side effects are a concern.
SSRIs, the most commonly prescribed antidepressants, also appear to affect testosterone. A laboratory study that tested all six major SSRIs on steroid-producing cells found that every one of them decreased testosterone production and shifted the balance toward estrogen at concentrations close to what patients actually reach in their blood.10PubMed. The six most widely used selective serotonin reuptake inhibitors decrease androgens and increase estrogens in the H295R cell line The clinical relevance in living humans is harder to pin down, because depression itself lowers testosterone, exercise habits often change during depressive episodes, and SSRIs can cause weight gain, all of which complicate the picture. Still, the cell-level evidence is consistent enough that anyone experiencing new hormonal symptoms on an SSRI should not dismiss the possibility of a drug effect.
Heart and Blood Pressure Medications
Statins, taken by tens of millions of people worldwide for high cholesterol, can modestly lower testosterone. Cholesterol is the raw material the body uses to build sex hormones, and statins work by slowing cholesterol production. A meta-analysis found that typical statin doses lowered testosterone by roughly 4% in men.11PubMed Central. Do statins lower testosterone and does it matter? That is a small decline on paper and unlikely to cause symptoms on its own, but in someone whose testosterone was already borderline low, even a few percentage points could tip levels below the threshold where symptoms appear.
Beta-blockers, another mainstay of cardiovascular treatment, have also been linked to lower testosterone levels. Several studies have shown a depression in testosterone among patients on beta-blockers, possibly because the sympathetic nervous system plays a role in stimulating testosterone release.12PubMed Central. A review of the positive and negative effects of cardiovascular drugs on sexual function: a proposed table for use in clinical practice – Section: β-blockers The sexual side effects commonly attributed to beta-blockers, including erectile problems and decreased libido, may be partly explained by this hormonal effect rather than being purely a blood-flow issue.
Antifungals and Stomach Acid Reducers
Ketoconazole, an antifungal drug, is one of the most potent incidental testosterone-lowering medications ever identified. At higher doses, it blocks several enzymes in the steroid production pathway, effectively shutting down both testicular and adrenal testosterone synthesis.13PubMed. Steroid synthesis inhibition by ketoconazole: sites of action This property is so pronounced that ketoconazole has actually been repurposed as a treatment in certain hormone-driven cancers. The topical cream and shampoo versions used for skin fungal infections and dandruff do not reach high enough blood levels to significantly affect testosterone, but oral ketoconazole at therapeutic doses almost certainly will.
Cimetidine, the original H2-receptor blocker sold for decades as Tagamet for heartburn and ulcers, has well-documented anti-androgenic activity. Animal studies showed it directly blocks testosterone from binding to its receptor in target tissues and reduces uptake of the active form of testosterone in the prostate.14PubMed. Cimetidine is an antiandrogen in the rat In humans, case reports have documented men developing breast tenderness, sexual dysfunction, and low testosterone on cimetidine, with symptoms resolving and testosterone levels normalizing after stopping the drug, only to recur when it was restarted.15JAMA Internal Medicine. Cimetidine Blocks Testosterone Synthesis Newer acid reducers like ranitidine (now withdrawn for other reasons) and famotidine do not share the same anti-androgenic properties, so the effect appears specific to cimetidine’s chemical structure rather than being a class effect of all H2 blockers.16PubMed. The effects of histamine H2 receptor antagonists on androgen action in vivo and dihydrotestosterone binding to the rat prostate androgen receptor in vitro
Anticonvulsants
Certain antiseizure medications, particularly older ones like phenytoin, carbamazepine, and valproate, affect sex hormone levels in complex ways. These drugs increase a protein called sex hormone-binding globulin, which grabs onto testosterone in the bloodstream and makes it unavailable for use by tissues. Research in men with epilepsy on anticonvulsants found that while total testosterone actually went up, free testosterone, the biologically active form, went down.17PubMed Central. Sex hormones, sexual activity and plasma anticonvulsant levels in male epileptics This distinction matters because standard blood tests often only measure total testosterone. A man on anticonvulsants could have a “normal” total testosterone reading while his free testosterone, the fraction his body can actually use, is low enough to cause symptoms. If symptoms of low testosterone appear in someone taking these medications, requesting a free testosterone measurement in addition to total testosterone gives a more accurate picture.
Anabolic Steroids and Exogenous Testosterone
This is the most counterintuitive entry on the list. Taking testosterone or anabolic steroids from outside the body powerfully suppresses the body’s own testosterone production. The brain detects high androgen levels and shuts off the hormonal signals that tell the testes to make testosterone, essentially putting them into hibernation.18The Journal of Clinical Endocrinology & Metabolism. Diagnosis and Management of Anabolic Androgenic Steroid Use While someone is actively using, circulating androgen levels are high, so they do not feel hypogonadal. The problem hits when they stop. Without the external supply, and with the body’s own production suppressed, testosterone can plummet to very low levels.
This also applies to prescribed testosterone replacement therapy, not just illicit steroid use. Exogenous testosterone suppresses the hormonal axis that controls both natural testosterone production and sperm production.19PubMed Central. Exogenous testosterone replacement therapy versus raising endogenous testosterone levels: current and future prospects Men who are prescribed testosterone for genuine hypogonadism should understand that coming off it may leave them in a temporary hormonal deficit that can take weeks to months to resolve. Recovery depends on age and how long the suppression lasted, with physical changes like testicular shrinkage generally reversing over months to years and biochemical testosterone levels typically normalizing within a few months, though psychological symptoms can linger.20PubMed Central. Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review
Chemotherapy
Many cancer chemotherapy drugs are toxic to the Leydig cells in the testes, which are the body’s primary testosterone factory. Unlike the brain-level suppression caused by opioids or GnRH agonists, chemotherapy often causes direct cellular damage. A study of men who had received cytotoxic chemotherapy found that more than half had elevated luteinizing hormone levels, the brain’s attempt to push damaged testes to produce more testosterone, and about a third showed clear evidence of Leydig cell impairment with testosterone stuck in the lower half of the normal range.21PubMed. Testicular function after cytotoxic chemotherapy: evidence of Leydig cell insufficiency Alkylating agents like cyclophosphamide and platinum-based drugs like cisplatin are among the most damaging to testicular function. The degree of recovery varies widely depending on the specific drugs used, the total dose, and the individual’s age at treatment.
Herbal Supplements and Unexpected Sources
Not all testosterone-lowering substances come from a pharmacy. Licorice root, consumed as a supplement or in large quantities as candy (real licorice, not the artificially flavored kind), has been shown to reduce serum testosterone. In a study of healthy women given licorice over two months, testosterone dropped substantially during supplementation and returned to normal after stopping.22PubMed. Licorice reduces serum testosterone in healthy women The active compound, glycyrrhizin, blocks enzymes involved in testosterone synthesis. Similar effects have been reported in men. This is worth knowing because licorice root extract shows up in herbal teas, supplements marketed for digestive health, and traditional remedies, and people rarely think of it as hormonally active.
Spearmint tea is another herbal product with some evidence of anti-androgenic effects, though the human data are limited mainly to women with elevated androgen levels. The broader point is that “natural” does not mean hormonally inert, and someone investigating unexplained low testosterone should consider supplements and herbal products alongside prescription medications.
When Multiple Medications Stack Up
Many people take more than one of the drugs listed above simultaneously. A man with chronic pain might be on an opioid and a corticosteroid. Someone with heart disease could be taking a statin and a beta-blocker. A person with epilepsy and depression might use both an anticonvulsant and an SSRI. Each drug’s individual effect on testosterone might be modest, but the combination can push levels meaningfully lower than any one drug alone would. This additive effect is rarely studied directly in clinical trials, because trials typically test one drug against placebo, but it is a practical reality for the millions of people on multiple medications.
If you suspect a medication is affecting your testosterone, the first step is a blood test, ideally drawn in the morning when testosterone peaks. Measuring both total and free testosterone, along with luteinizing hormone, can help distinguish whether the problem originates in the brain’s signaling system or in the testes themselves. That distinction shapes what your doctor can do about it, whether that means switching to a different drug in the same class, adjusting doses, or considering whether testosterone monitoring should become part of your routine care while you remain on the medication.