Arch Biochem Biophys 2008;478:136142
2 Effects of SSRIs on reproductive cytogenesis 2.1 Effects of SSRIs on male germ cells Several studies have found that fluoxetine disrupts the hypothalamuslobetestis axis, significantly decreasing the serum concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), progesterone, and testosterone, while also affecting several sperm quality parameters, as evidenced by decreased sperm concentrations and viability, increased deoxyribonucleic acid (DNA) fragmentation, and lower reproductive organ weights (Ayala et al., 2018
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Furthermore, unregulated status of zinc leads to oxidative stress, cell cycle progression, damage of DNA, and angiogenesis, finally resulting in hepatocarcinogenesis (71)
The studys limitations include the cross-sectional nature, which precludes establishing causality, self-reporting of anthropometric and demographic data, which might lead to bias, and unidentified confounding