<p>Knowledge of the effects of commonly used biologics and small molecules in dermatology on male fertility, teratogenic risk and reproductive outcomes remain sparse, but is important for men planning to conceive. This gap in information leads to uncertainty among prescribing dermatologists and patients who take these medications. To address this knowledge gap, the authors sought to systematically review all available data in order to provide current information on male fertility effects, teratogenic risk and reproductive outcomes in male patients using these medications. In general, most biologics and small molecules included in this review demonstrate no concerning safety signals in the context of male fertility, fertility outcomes and teratogenicity in exposed males. Harm was demonstrated in reproductive outcomes for exposed men only in ritlecitinib, and this was based on animal studies. Only baricitinib was observed to reduce mating performance in exposed male rats. Earlier human studies found that adalimumab can reduce sperm count, but more recent and more well-designed studies have not demonstrated this. Secukinumab had a probable association with erectile dysfunction in a case report, which was reversible six months upon discontinuation. The data in this review can help to clarify potential risks associated with the biologics and small molecules commonly used in dermatology and ease patient and physician anxiety during patient counselling when male patients are looking to conceive.</p>