Male factor infertility (MFI) accounts for 30% of all cases of difficulty with conception. Medical management of MFI revolves around the manipulation of the hypothalamic-pituitary-gonadal axis to promote intra-testicular testosterone production and spermatogenesis. Hormonal agents such as gonadotrophins and non-hormonal agents such as aromatase inhibitors, selective oestrogen receptor modulators and dopamine agonists are the most common drugs used. Exogenous testosterone replacement represents an increasingly common cause of MFI and consideration of a patient’s fertility goals is essential prior to the initiation of testosterone therapy. Treatment of MFI frequently requires the couple to adopt assisted reproductive techniques; the hazards of drugs used in IVF need to be considered in the context of pharmacological management of the infertile couple.