Medical Oncologist
Fertility and pregnancy safety
Fertility, Pregnancy and — Contraception on Enzalutamide
Enzalutamide can harm a developing baby, and this applies whether you are a man or a woman taking the drug. Clear contraception rules apply during treatment and for a defined period after your last dose.
Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed August 2026
- Both sexes are affected — Male and female patients on enzalutamide both have contraception requirements under the prescribing rules.
- The washout period matters — The drug stays active in the body after you stop. Contraception must continue for a set time after your last dose.
- Semen is also a risk — Male patients must use condoms even if their partner uses another method, because enzalutamide is present in semen.
- Act before you start — If you want children in the future, fertility preservation needs to happen before treatment begins, not during or after.
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Enzalutamide can seriously harm a developing baby and must not be taken during pregnancy. If you are a man taking enzalutamide, the Xtandi prescribing rules require contraception during treatment and for three months after your last dose. If you are a woman taking it, contraception is required during treatment and for one month after stopping.
What do the contraception rules say for men and women?
| Requirement | Male patients | Female patients of reproductive age |
|---|---|---|
| Contraception during treatment | Required — condoms plus at least one other effective method | Required — highly effective contraception |
| Contraception after last dose | Required for 3 months after stopping | Required for 1 month after stopping |
| Reason for the rule | Enzalutamide is present in semen and can affect a partner's pregnancy | Enzalutamide can cause fetal harm if the drug is present during pregnancy |
| If pregnancy is discovered | Tell your oncology team immediately and use condoms for the remainder of the pregnancy | Tell your oncology team immediately — do not stop the drug without guidance |
| Fertility preservation option | Sperm banking before treatment starts, if future fatherhood is a priority | Egg or embryo freezing before treatment starts, if future pregnancy is a priority |
What should you do before your first dose?
- Tell your oncologist if you are pregnant, think you may be pregnant, or are trying to conceive right now.
- Ask about sperm banking (men) or egg and embryo freezing (women) if you want children in the future — this must be arranged before treatment begins.
- Confirm which contraception method you will use and that it is in place before your first dose.
- Tell your partner about the contraception requirements, including the need for condoms (for male patients) even if your partner already uses another method.
- Ask your oncologist how long you will need to continue contraception after your last dose.
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Why does enzalutamide affect a pregnancy you are not having?
Enzalutamide works by blocking male sex hormones. Those hormones are critical to fetal development, and disrupting them during pregnancy — even indirectly — can cause serious harm to the baby.
For male patients, enzalutamide is present in semen. This is why condoms are required on top of any contraception a partner is already using. The aim is to prevent the drug from reaching a partner's body during sex.
For female patients, the drug is directly present in the body at levels that could affect a pregnancy. Contraception is required to prevent pregnancy from occurring while the drug is active.
What happens to fertility during and after treatment?
Enzalutamide can affect sperm quality in men during treatment. Whether this fully reverses after stopping is not established with certainty, so banking sperm before starting is the safest option if fatherhood matters to you.
For women, the evidence on long-term fertility impact is less complete. Discuss egg or embryo freezing with your oncologist before your first dose if a future pregnancy is important to you.
Do not assume fertility has returned because the washout period has passed. Talk directly with your oncology team — and a reproductive specialist if needed — before attempting to conceive.
What else do people ask about enzalutamide and pregnancy?
My partner is already pregnant. Can I still take enzalutamide?
This is a question for your oncologist, not a reason to delay or stop treatment on your own. Your team will advise you to use condoms consistently throughout your partner's pregnancy to prevent the drug in your semen from reaching them. The decision about whether and how to continue treatment is one your oncologist will make with you, weighing the cancer risk against the pregnancy risk. Do not stop or delay starting enzalutamide without that conversation first.
I found out I am pregnant while on enzalutamide. What should I do?
Call your oncology team today — do not wait for your next scheduled appointment. They need to know immediately. Do not stop taking the drug without guidance from your team, as stopping abruptly can affect your cancer treatment. Your team will coordinate with an obstetrician to assess the situation and advise on next steps. The path forward depends on how far along the pregnancy is and the nature of your cancer treatment.
Can I use the contraception I am already on, or do I need something new?
For female patients, highly effective contraception is required — methods with very low failure rates such as an intrauterine device, a hormonal implant, or oral contraception used consistently. For male patients, condoms are required during sex even if a partner is already using a reliable method, because the concern is preventing the drug in semen from reaching a partner. Confirm with your oncologist that whatever you currently use meets the requirement for your specific situation.
After the three-month period is up, is it safe to try for a baby?
The three-month washout period for male patients is stated in the Xtandi prescribing information, but whether it is safe to attempt conception after that also depends on your overall cancer treatment status, your general health, and whether any other drugs you are taking carry their own requirements. Have this conversation with your oncologist before attempting to conceive. Ask to be referred to a reproductive specialist if you want a dedicated fertility assessment at that point.
Does enzalutamide affect breastfeeding?
It is not known whether enzalutamide passes into breast milk in amounts that could harm a baby. Because this has not been established as safe, breastfeeding is not recommended while you are taking enzalutamide. If this is relevant to your situation, raise it with your oncologist before your first dose rather than after. Your team can advise on how to plan around it.
What if we decide we want children after treatment has already started?
Tell your oncology team as soon as that decision is made. Sperm banking and egg or embryo freezing are most effective before treatment starts, and some options are no longer available once treatment is under way. If you did not preserve fertility before starting and now want children in the future, ask for a referral to a reproductive specialist. Your oncology team can tell you what is still possible given where you are in treatment, but early action gives you the most options.
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Common questions
Frequently asked questions
How long after stopping enzalutamide do I need to keep using contraception?
Male patients are required to use contraception for three months after their last dose, according to the Xtandi prescribing information. Female patients are required to use contraception for one month after their last dose. These periods reflect how long the drug remains active in the body. Do not stop contraception before the period is up without first checking with your oncologist.
Is it safe to take enzalutamide if my partner is not pregnant and we use contraception?
Yes — this is the expected situation for patients on enzalutamide. Male patients are expected to use condoms plus another effective method if their partner could become pregnant, and as long as that is in place treatment can continue as planned. Tell your oncologist which contraception you are using so they can confirm it meets the requirement. Report any changes — such as a method failing — to your team straight away.
Can enzalutamide harm my partner through skin contact, not just through sex?
The concern is specifically through semen during sex, not through general physical contact such as skin contact or kissing. Enzalutamide is present in semen, which is why condoms are required for male patients during sex. Other forms of everyday contact are not the source of concern. If you have specific questions about your situation, ask your oncology team directly.
We want children after treatment is finished. What should we be planning now?
Sperm banking for men and egg or embryo freezing for women should happen before your first dose of enzalutamide, not after treatment ends. Ask your oncologist for a referral to a fertility specialist before starting treatment. If treatment has already begun, ask your team what is still possible — some options remain available in certain situations, but the earlier this is discussed, the more choices you are likely to have.
I am a woman taking enzalutamide for breast cancer. Do the same rules apply to me?
Yes. The contraception requirement applies to female patients taking enzalutamide for any reason, including breast cancer. Highly effective contraception is required during treatment and for one month after your last dose. Tell your oncologist which method you use so they can confirm it meets the requirement. If you are peri-menopausal or unsure whether you are at risk of pregnancy, discuss this directly with your team rather than assuming either way.
What counts as effective contraception on enzalutamide?
For female patients, highly effective methods are preferred — typically a hormonal intrauterine device, an implant, or oral contraception used consistently. For male patients, condoms are required during sex in addition to any contraception a partner is using. The two-method requirement for male patients is specifically because the concern is the drug in semen, not only the risk of pregnancy. Ask your oncologist to confirm that your chosen method meets the requirement for your situation.