Gout, hyperuricemia, and male reproductive health: a systematic review and meta-analysis.

BACKGROUND

Gout is an inflammatory arthritis characterized by hyperuricemia in humans. Male patients with gout or hyperuricemia have a wide range of reproductive health challenges. However, research on the sexual and reproductive health of male patients with gout or hyperuricemia remains limited.

OBJECTIVE

This systematic review and meta-analysis investigated the impact of gout and/or hyperuricemia and its associated factors on male sexual and reproductive health.

METHODS

The PubMed, Cochrane, Embase, Web of Science, Wanfang Data, and China National Knowledge Infrastructure (CNKI) databases were searched for relevant articles from January 2000 to October 2025. Two reviewers extracted the data and completed quality assessment using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality checklist. Meta-analysis was conducted using Review Manager 5.4 and Stata 18.0. The protocol was registered on PROSPERO (CRD 420261302205). The outcomes such as sexual function, reproductive hormones, and fertility were evaluated.

RESULTS

In the literature search, 1,527 articles were retrieved. Among these, 11 studies met the inclusion criteria. This meta-analysis included 104,277 patients with gout or hyperuricemia and 342,621 control subjects. The meta-analysis results showed that the risk of erectile dysfunction was higher in patients with gout (RR = 1.37; 95% CI = 1.14 to 1.65, P < 0.001). Compared with the control group, patients with gout or hyperuricemia showed lower levels of testosterone and estradiol (testosterone: MD = -1.00, 95% CI = -1.39 to -0.62, P < 0.001; estradiol: MD = -4.67, 95% CI = -9.31 to -0.02, P = 0.05). A single study showed that semen volume and total sperm counts were lower among infertile men in the hyperuricemia group.

CONCLUSION

Male patients with gout or hyperuricemia are more prone to erectile dysfunction and lower levels of reproductive hormones. Patients with gout showed significantly lower testosterone levels in the subgroup analyses. These findings emphasize the clinical need for increased awareness of male reproductive health problems in men with gout and implementation of effective intervention measures.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261302205.