The impact of medication on ED

Reviewed by Dr Bhavini Shah

Erectile dysfunction (ED), also often referred to as impotence, is when a man struggles to get or fails to sustain an erection. It is a common problem, particularly for men over the age of 40.

Although ED is usually nothing to worry about, it can have a significant impact on those experiencing it. It can affect self-esteem, cause embarrassment, and create issues in relationships.

Read on to find out more about the causes of ED, including certain medications, and what treatment options are available.

What causes erectile dysfunction? 

There are many causes of erectile dysfunction. To achieve and maintain an erection, a man needs a healthy blood supply and nervous system in addition to sexual desire. Therefore, anything that impacts these can contribute to ED.

Psychological causes are responsible for a large amount of ED cases. Psychological factors include stress, worry, depression, and trauma.

There are also physical factors that can cause ED such as nerve problems, hormonal imbalances, and narrowing of blood vessels.

Lifestyle factors can also be linked to erectile dysfunction. Smoking and alcohol use are common contributors, as are high cholesterol and being overweight. In addition, certain prescription and over-the-counter medications, and recreational drugs can cause ED.

But how many people know this? To find out, we asked 500 Brits to tell us what they think causes erectile dysfunction and if they’ve ever experienced it. 

Interestingly, 49% of those surveyed believe that low testosterone causes erectile dysfunction rather than psychological causes, with half (50%) admitting that they have experienced erectile dysfunction once or more in their lives. 

To help us find out more, Dr Bhavini Shah - GP from LloydsPharmacy Online Doctor - explains the link between mental health and erectile dysfunction.

The link between mental health and ED

Erectile dysfunction and mental health are closely linked. Often, mental health issues like stress, anxiety, or depression can contribute to ED, as these conditions may reduce sexual desire, create tension, or make it harder to relax. 

On the other hand, experiencing ED can also affect mental health, leading to feelings of low self-esteem, embarrassment, or frustration. This can create a cycle where ED worsens mental health, and mental health issues make ED more challenging.

Is erectile dysfunction physical or psychological?

“ED can have both physical and psychological causes. In most cases it is due to a reduced blood flow to the penis. However, external factors including some lifestyle choices can also cause erectile problems.

“An increased number of young men are experiencing ED, and may think physical problems such as low testosterone are the cause. However, this is rare and there are a wide range of factors that could be causing it. Relationship issues, anxiety and depression, medication, diet and not getting enough exercise can all contribute to it.

“If you’re suffering from erectile dysfunction, it’s a good idea to assess your lifestyle and any psychological factors that may be contributing. Seeking medication for ED and performance issues but not addressing the initial cause will only prolong the issue.”

ED caused by mental health issues is common

It's common for mental health issues to affect erectile dysfunction (ED). Many men experience stress, anxiety, or depression, which can make it harder to get or keep an erection. When the mind is under pressure, it can impact the body’s ability to relax and respond to sexual activity. This connection is normal and happens to many people. 

Understanding that mental health can play a big role in ED helps men feel less alone and encourages them to seek help, which can improve both their mental well-being and sexual health.

Interestingly, 15% of men surveyed admitted that they ‘often’ felt stressed or anxious about their sexual performance, with 55% stating they ‘sometimes’ feel this way. 

“Chronic stress, anxiety, depression and other mental health conditions can make it harder to get and keep an erection. When we're stressed or anxious, our body releases hormones that can affect the blood vessels responsible for erections.

“Stress and anxiety can also make us lose interest in sex and have difficulty concentrating. Plus, these negative feelings can make us turn to unhealthy habits like smoking or drinking alcohol, which can make ED worse. It's important to find healthy ways to manage stress and anxiety, like doing relaxing activities or talking to someone you trust, and seeking appropriate mental health support.”

“Many young men may find it embarrassing or uncomfortable to discuss mental health issues, therefore if ED is being caused by stress, anxiety or depression, they may be unknowingly avoiding the root cause of the problem.”

Can medication cause erectile dysfunction?

Whilst medications may treat an illness or condition, they can contribute to ED in several ways and disrupt normal erectile behaviour. They may affect your hormones, blood circulation or nervous system, for instance, or reduce your libido.

What blood pressure medications cause erectile dysfunction? 

Certain blood pressure medications can decrease blood flow to the penis, contributing to ED. Diuretics and beta-blockers are the most common medications with ED as a side effect, examples of which include hydrochlorothiazide, chlorthalidone, furosemide, atenolol and propranolol.

Do blood thinners cause erectile dysfunction?

There isn’t any up to date or reliable evidence to suggest that blood thinners cause ED or that they can make symptoms worse. Blood thinners may be prescribed alongside other medication for heart problems which can contribute to ED. If you’re taking blood thinners and experiencing erectile dysfunction speak to your doctor. 

Does prostate medication cause erectile dysfunction?

Whilst an enlarged prostate (benign prostatic hyperplasia or BPH) does not necessarily cause ED, some medications used to treat BPH can. Some prostate cancer medications also have erectile dysfunction as a side effect. Flutamide and leuprolide are examples of such medications.

Can bipolar or anxiety medication cause erectile dysfunction? 

Mental health conditions in themselves can affect your sex drive but several medications used to treat depression and anxiety can also cause ED. These include Selective Serotonin Reuptake Inhibitors (SSRIs) such as fluoxetine and sertraline, and other medications including diazepam and tranylcypromine.

Lithium, which is a common treatment option for bipolar disorder, is another medication that can cause erectile dysfunction in some men.

“Medications for bipolar disorder and anxiety can sometimes cause erectile dysfunction. These medications help manage mood and reduce anxiety by changing certain brain chemicals, like serotonin and dopamine, which control emotions. These chemicals are also important for sexual desire and arousal. 

“These medications can  impact sexual desire, and make it harder to get or keep an erection. Fatigue and other side effects from the medications can also affect interest in sex and sexual performance.”

Can diabetes medication cause erectile dysfunction?

Men with diabetes are at higher risk of ED due to high blood sugar levels, and elevated blood pressure and fats which can damage blood vessels. Medication, such as metformin, is often prescribed in the treatment of diabetes and whilst it can improve the sexual health-related symptoms of diabetes, it can also contribute to ED as it can lower testosterone and sexual drive.

Find out more about ED and diabetes here. 

What recreational drugs cause erectile dysfunction?

Illicit or recreational drugs (some of which will be illegal drugs in some countries) can alter the way your body functions, resulting in conditions such as ED. They can also impact your health, including the health of your penis. Illegal drugs can cause serious, permanent damage and have a long-lasting impact on your sex life so it is recommended that you refrain from using any illicit substances.

Marijuana and ED

Cannabis use can prevent the smooth muscle in your penis from relaxing. This results in a restricted blood flow and an inability to get an erection.
When smoking cannabis mixed with tobacco, the chances of ED are greater still as smoking damages blood vessels by restricting blood flow.

Cocaine and ED

Long-term cocaine use can have many sexual side effects due to its effect on blood vessels. It can cause ED as well as a loss of sensation during sex. Cocaine also dulls the brain’s ability to respond to sexual stimulation, causing a loss of libido and reducing feelings during intercourse.

Amphetamines and ED

Amphetamines such as ecstasy, MDMA and meth can also cause vasoconstriction, which is the narrowing of blood vessels. When blood vessels to the penis are narrowed, this can cause issues with blood flow and the ability to get or maintain an erection.

How do you fix drug induced erectile dysfunction?

Most medication-induced sexual side effects are not permanent. If you believe that the medication you are taking is affecting your erection, there are several different treatment options available.

If you have not long started taking the medication, it may just be that your body needs time to adjust. But, if you have been on the medication for some time and you feel it is contributing to your ED, you may be able to change the dose or switch to an alternative medication.

If changing your current medication is not an option, you may be able to look at treatments that specifically target the sexual side effects.

None of this should be done, however, without guidance and approval from your GP or medical practitioner.

When to seek treatment for ED

If you keep experiencing erectile dysfunction or it is affecting other aspects of your life such as your mental wellbeing or sex life, you should book an appointment to discuss it with your GP. They will be able to provide advice, carry out tests if needed, and outline treatment options for you.

Medication for ED

Viagra (sildenafil) is perhaps the most well-known treatment for ED. It is an oral tablet that works by temporarily increasing blood flow to the penis.

You don't need a prescription to get Viagra Connect, and you can buy it from a pharmacy after discussing it with the pharmacist. You can also purchase it online but be cautious and make sure you are using a reputable site.

There are other oral medications available for the treatment of ED that do require a prescription. These include Tadalafil, Vardenafil and Levitra and they work in a similar way to Viagra.

In summary, erectile dysfunction is a common problem experienced by men. There are many causes of erectile dysfunction, including a range of medications. Erectile dysfunction can often be easily treated. If you are concerned about your ability to get or keep an erection, then you should talk to your GP about treatment options.

References

https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
https://www.webmd.com/erectile-dysfunction/guide/drugs-linked-erectile-dysfunction
https://www.diabetes.org.uk/guide-to-diabetes/complications/sexual-problems-men
https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/erectile-dysfunction-impotence
https://www.health.harvard.edu/mens-health/blood-pressure-drugs-and-ed-what-you-need-to-know
https://www.health.harvard.edu/blog/sex-and-the-prostate-overcoming-erectile-dysfunction-when-you-have-prostate-disease-20090331100
https://www.medicalnewstoday.com/articles/317104
https://www.therecoveryvillage.com/cocaine-addiction/erectile-dysfunction/