This review discusses the complex pathophysiological changes caused by diabetes that lead to male infertility, including hyperglycemia stress, mitochondrial dysfunction, and endoplasmic reticulum (ER) stress. These mechanisms interact to cause significant damage to various organs and tissues, leading to multiple complications such as vascular disease, microangiopathy, and neuropathy. The review highlights the potential mechanisms of diabetes-induced male infertility, including endocrine imbalance, testicular dysfunction, and erectile dysfunction. It also explores potential therapeutic measures, such as drug therapy (insulin, resveratrol, metformin, pioglitazone, Chinese herbs, phosphodiesterase-5 inhibitors), gene therapy, exercise, mesenchymal stem cell therapy, and microbial therapy. While these approaches show promise, more clinical trials are needed to verify their effectiveness and safety. The review emphasizes the need for further research to develop effective treatments for diabetes-induced male infertility.This review discusses the complex pathophysiological changes caused by diabetes that lead to male infertility, including hyperglycemia stress, mitochondrial dysfunction, and endoplasmic reticulum (ER) stress. These mechanisms interact to cause significant damage to various organs and tissues, leading to multiple complications such as vascular disease, microangiopathy, and neuropathy. The review highlights the potential mechanisms of diabetes-induced male infertility, including endocrine imbalance, testicular dysfunction, and erectile dysfunction. It also explores potential therapeutic measures, such as drug therapy (insulin, resveratrol, metformin, pioglitazone, Chinese herbs, phosphodiesterase-5 inhibitors), gene therapy, exercise, mesenchymal stem cell therapy, and microbial therapy. While these approaches show promise, more clinical trials are needed to verify their effectiveness and safety. The review emphasizes the need for further research to develop effective treatments for diabetes-induced male infertility.