Can Blood Pressure, Antidepressant and Other Medicines Cause Erectile Dysfunction? Medication-Related Sexual Problems
Some blood pressure, antidepressant and other medicines can affect erections, desire and ejaculation, but not in everyone, and the illness itself often plays a part. Which medicines are involved, how to tell medicine from illness, why not to stop a medicine yourself and the treatment approach are covered here.
A few weeks after starting a new blood pressure medicine or an antidepressant, many men notice that erections have weakened, sexual desire has fallen or ejaculation is delayed, yet rarely talk about it. Reading the patient leaflet, the first question that comes to mind is: is the medicine I am taking causing this? Some consider stopping the medicine on their own, yet hesitate to raise it with the prescribing doctor.
Some groups of medicines can indeed affect sexual function; however, this effect does not occur in everyone, and the condition the medicine is used for often plays a part as well. This article explains which groups of medicines have been associated with sexual problems, how medicine and illness effects are told apart, why a medicine should not be stopped on one's own, and the treatment approach.
How can medicines affect sexual function?
Sexual function is made up of three interconnected but separately regulated areas; a medicine may affect one or several of them:
- Sexual desire: Linked to chemical messengers in the brain and to hormones, particularly testosterone and prolactin.
- Erection: Requires blood vessel widening, nerve signalling and hormones working in harmony.
- Ejaculation and orgasm: A reflex governed by the nervous system; some medicines can delay it.
The effect varies with the group of medicine, the dose, the duration of use and the individual; many people taking the same medicine notice no sexual change.
Do blood pressure and heart medicines affect erections?
Among blood pressure medicines, those more often associated with erection problems are some beta blockers and some groups of diuretics (water tablets). Blood pressure medicines are not all the same, however; this effect has been reported less often with some groups.
The key point is this: high blood pressure and vascular disease are themselves causes of erectile dysfunction. In many men the problem began silently before the medicine and is attributed to it because the timing coincides. Controlling blood pressure also protects vascular health, so giving up treatment is not the answer.
Medicines for depression and anxiety
SSRI and SNRI group antidepressants are frequently associated with sexual side effects. The increased serotonin effect they produce in the brain can suppress desire, arousal and the ejaculatory reflex. Reported effects include reduced desire, delayed ejaculation or inability to reach orgasm, difficulty with erections and, in some people, reduced genital sensation.
On the other hand, depression itself disrupts sexual function: low motivation, loss of pleasure and fatigue directly affect sex life. Knowing what sexual function was like before treatment is therefore important. Fewer sexual side effects have been reported with some antidepressants acting through a different mechanism; however, the choice of medicine rests with the prescribing doctor. These effects are usually expected to resolve once the medicine is stopped; rarely, they have been reported to continue for some time.
Which other groups of medicines can affect sexual function?
Other groups asked about during assessment include:
- Some psychiatric medicines: Some that raise the hormone prolactin have been associated with low desire and erection difficulties.
- Some epilepsy medicines: These may affect hormonal balance and the amount of usable testosterone.
- Long-term opioid painkillers: These may lower testosterone by suppressing the hormonal signal from brain to testicles.
- Hormone-suppressing treatments: In prostate cancer treatment, for example, reduced desire and erections are an expected effect; planning involves the relevant specialist.
- Some hormone-acting medicines used for prostate enlargement and hair loss: Their sexual effects are covered in detail in a separate article on this site.
- Some stomach medicines: Rarely, these may affect sexual function via hormonal balance.
The list is not exhaustive; what matters most is whether the complaint is linked in time to starting a medicine or changing its dose.
Is it the medicine or the illness?
Most often there is no single cause; the medicine, the underlying illness, age and anxiety act together. These clues help to tell them apart:
- Timing: A change beginning in the weeks after a new medicine or dose increase suggests the medicine; a problem present beforehand and slowly worsening suggests the underlying illness.
- Morning erections: If preserved, they may indicate largely healthy blood vessels and nerves; however, as some medicines also affect night-time erections, this clue alone is not decisive.
- Risk factors: Older age, diabetes, smoking, excess weight and raised blood fats can affect erections independently of any medicine.
- The expectation effect: Reading about side effects can trigger the problem by creating anxiety; some studies have observed that sexual complaints were reported more often by people informed in advance. This does not mean the experience is imaginary; it shows the real effect of anxiety.
Do not stop your medicine on your own
Some people who suspect a sexual side effect quietly stop the medicine or reduce the dose; the consequences can be more serious than the sexual problem:
- Blood pressure and heart medicines: Stopping some suddenly can raise blood pressure and heart rate, cause rhythm problems and, in people with heart disease, chest pain.
- Antidepressants: Stopping suddenly can cause dizziness, disturbed sleep and restlessness; the risk of depression returning also increases.
- Epilepsy medicines: Stopping abruptly can raise the risk of seizures.
The right course is to discuss the complaint openly with the prescribing doctor; doctors encounter sexual side effects often, and there are frequently options without stopping the medicine.
How are assessment and treatment planned?
Assessment begins with a detailed, confidential consultation: all medicines taken, their start dates, dose changes, over-the-counter products and supplements are asked about. After examination, testosterone, prolactin, blood sugar and blood fats are checked where needed. The options include:
- Adjusting the medicine: A change in dose or timing, or a switch to a group with fewer reported sexual side effects, can be discussed with the prescribing doctor; the decision belongs to that doctor, and the andrology assessment informs it.
- Medicines that support erections: These can be used where needed; however, as they can cause a serious drop in blood pressure with heart medicines, particularly the nitrates used for chest pain, they are used only after a medical assessment. They can help erections but do not increase desire or correct delayed ejaculation.
- Hormonal balance: If low testosterone or raised prolactin is found, a plan addressing the cause is made with the relevant specialty.
- Lifestyle: Regular activity, stopping smoking, and weight and blood sugar control benefit both the underlying illness and erections.
- Sex therapy and couples therapy: These help to address anxiety and the expectation effect.
A change may not be possible with every medicine; sometimes treating the main illness remains the priority, and the aim is to support sex life in a way compatible with that treatment. Where needed, care is coordinated with specialties such as cardiology, psychiatry and neurology.
When should you see a doctor?
Assessment is recommended in the following situations:
- A marked change in erections, desire or ejaculation after a new medicine or a change in dose
- Considering stopping a medicine because of a sexual side effect, or having already stopped it
- Erection difficulty lasting several weeks and causing anxiety
- Complaints persisting despite a change of medicine or after stopping it
- Low desire accompanied by hormonal symptoms such as tiredness or breast tenderness
- Considering an erection medicine while taking heart medicines
Some blood pressure, antidepressant and other groups of medicines can affect sexual function; however, not everyone is affected, and the illness and anxiety often contribute too. Rather than stopping a medicine on your own, sharing the complaint with the prescribing doctor is the way to support sex life while continuing the main treatment. Assoc. Prof. Zülfü Sertkaya practises in urology and andrology in Istanbul; assessment and treatment planning for erection and sexual function problems related to medicine use are carried out with individual assessment and confidentiality.