World J Mens Health. 2026 Feb 06.
Lu Zhou,
Xiucheng Lan,
Meijing Wang,
Xiaoya Li,
Xin Zeng,
Sixue Peng,
Jingyi Zhang,
Junjun Li,
Liang Dong,
Xujun Yu,
Fang Yang.
Male reproductive aging manifests as progressive declines in testosterone synthesis, spermatogenic efficiency, and fertility, driven by multi-system dysfunction. This review synthesizes evidence establishing the nicotinamide adenine dinucleotide (NAD⁺)-Sirtuins axis as a central regulator of testicular homeostasis and its age-related dysregulation. Mechanistically, NAD⁺ depletion impairs energy metabolism (glycolysis/TCA cycle), antioxidant defenses, and steroidogenesis, while reduced Sirtuins activity (SIRT1/SIRT3/SIRT6) disrupts spermatogonial stem cell maintenance, blood-testis barrier (BTB) integrity, epigenetic programming, and immune privilege. Key pathological features include: (1) Structural compromise (lysosomal dysfunction in Sertoli cells, BTB disruption); (2) Metabolic-oxidative stress (lipid accumulation, mitochondrial failure, reactive oxygen species overproduction); (3) Chronic inflammation (NLRP3 inflammasome activation, T-cell infiltration); (4) Epigenetic dysregulation (aberrant histone acetylation, ncRNA imbalances); and (5) hormonal synthesis disorder. Interventions targeting this axis-NAD⁺ precursors (NMN/NR), Sirtuin activators (resveratrol/quercetin), and lifestyle strategies (intermittent fasting/exercise)-demonstrate efficacy in preclinical models: NMN restores sperm quality (+40% normality) and testosterone synthesis; resveratrol reduces sperm DNA fragmentation by 45% via SIRT3 activation. Clinical data suggest improved physiological parameters (e.g., muscle function, biological age) with NMN supplementation. Critical knowledge gaps persist regarding tissue-specific Sirtuin functions, long-term safety of NAD⁺ boosters, and individualized intervention protocols. Future research should prioritize testicular-targeted delivery systems, NAD⁺-based biomarkers, and randomized trials. Restoring NAD⁺-Sirtuins signaling represents a promising therapeutic strategy against age-related male infertility.
Keywords: Aging, male; NAD; Sirtuins; Testosterone/biosynthesis; Therapeutics