These medications cause low libido

If you’ve been feeling less than frisky lately, it’s no surprise. The coronavirus pandemic has made 27% of people feel isolated, and 14% feel depressed according to a SingleCare survey. On top of that, 10% are drinking more alcohol—and some may be social distancing separately from their significant other to avoid COVID-19. That’s not exactly a recipe for romantic fireworks. 

There are many everyday factors that affect sexual function—for men and women. Stress, alcohol consumption, and mental health conditions are obvious factors that can impact how easily you can “get in the mood.” What you may not realize is that the daily pill you take may also contribute to low libido. Over-the-counter treatments and prescriptions commonly affect sex drive. It’s natural for desire to fluctuate day-to-day, or year-to-year. But, if you’re never interested in intimacy anymore, it can mess with your self-esteem or cause problems in your relationship. If you think one of your medications could be impacting your sex life, start here. 

What is low libido?

Low libido is a decreased interest in sex, also known as diminished sex drive, impaired sexual function, or hypoactive sexual desire disorder. While it sometimes goes hand-in-hand with erectile dysfunction for men, the two are not the same thing. Leo Nissola, MD, scientist and immunology author, says there is an important distinction between wanting to have sex (desire), and the physical excitement needed to have sex (driven by blood flow and physical arousal). Most often, medications impact the physical aspect of lost libido.

Libido is a spectrum of feelings that vary person-to-person. It’s normal to be more or less turned on at different points. Though if you’ve completely lost interest in getting busy (or are much less interested in sexual activity than is normal for you), over an extended period of time it could be a sign of a problem.

What are the symptoms of low libido?

According to the Mayo Clinic, the symptoms of low libido include:

• Loss of interest in any form of sexual activity—with a partner or solo
• Lack of sexual fantasies or thoughts
• Feeling worried about your lack of sexual activity or thoughts

If you don’t fit the exact definition, but are worried about the change in your sex drive, that’s reason enough to talk to a healthcare provider about what could be causing it. What’s considered low depends on the individual. There’s no “right” amount of interest. If it’s less than what’s normal for you, it’s worth taking steps to fix it.

What causes low libido?

It can seem like low libido comes out of the blue, without warning, in an otherwise happy relationship. Yet, there’s usually an issue at the root of changes in sex drive, stemming from one of the following categories:

• Medication: Certain medications can affect hormones that help regulate desire. Others make it more difficult to achieve an erection or become physically aroused.
• Medical conditions: Recent surgery or sexual problems (like pain during sex) can contribute to low libido, but disorders not related to sexual function can also influence libido. Some medical problems linked to low libido include restless leg syndrome, diabetes, obesity, high blood pressure, high cholesterol, arthritis, cancer, heart disease, stroke, and neurological disease.
• Hormonal changes: Changes in testosterone levels or estrogen levels can impact sexual desire. It’s common for men to develop low T as they age, and for women to experience spikes and dips in estrogen during pregnancy and menopause respectively. Hormone therapy can help to resolve certain hormonal problems.
• Lifestyle causes: Drinking too much alcohol, smoking, or using illegal drugs can decrease sex drive. Too little sleep, not getting enough exercise, and eating an unhealthy diet have also been linked to sexual dysfunction. Exposure to certain chemicals may contribute to low libido.
• Psychological issues: Mental health conditions, like depression, can make it hard to find pleasure in things you once enjoyed—including sex. Outside of an official diagnosis, stress, low self-esteem, poor body image, or a history of sexual abuse can affect libido.
• Relationship problems: Feeling emotionally close to your partner is key to physical intimacy. If you’re having arguments, or lacking communication and trust in your partner, it’s likely making you less interested in sex.

Your healthcare provider can help you figure out what’s causing your low libido—usually with an exam and testing to rule out medical problems. Your primary care physician may refer to you a specialist, like a psychologist, if a mental health or relationship problem is the suspected culprit.

Medications that cause low libido

If your dip in sexual interest coincided with a new medication, that could be a clue. Changing medications or discontinuing a treatment you don’t need anymore could be an easy fix for problems in the bedroom. 

Medications impact libido in two main ways according to Dr. Nissola. Certain drugs create physical symptoms that make it difficult to have sex or enjoy sex—such as vaginal dryness or decreasing blood flow that makes it possible to sustain an erection—which indirectly impacts libido. Others affect hormones that regulate your mood and desire for sex.

“When it comes to medications, there are three categories of drugs known to have a negative effect on libido. Most of them have an effect because they impact the levels of three key hormones in the body: serotonin, prolactin, or testosterone,” agrees Christine Traxler, MD, retired family practice physician, author of I’m having a baby: What now? “The three classifications you need to think of are neurologic or psychiatric drugs, heart or cardiovascular drugs, and a few miscellaneous drugs.”

“Antidepressant medications are the most frequent medication induced cause of low libido and sexual dysfunction,” says Stephanie Redmond, Pharm.D., CDE, BC-ADM, who regularly consults with patients to review medications as a possible cause for sexual health concerns and is the co-founder of diabetesdoctor.com.

The following types of prescription medications are know to affect sex drive:

1. Anti-anxiety medications based on benzodiazepines (Xanax)
2. Anticonvulsant medications (such as, Tegretol, Phenytoin, Phenobarbital)
3. Antidepressants (including, anti-mania medications, antipsychotics, MAOIs, SSRIs, SNRIs, tricyclic antidepressants)
4. Benign prostatic hyperplasia treatments (such as Flomax, Propecia, Proscar)
5. Cancer treatments (including radiation and chemotherapy)
6. Heart and blood pressure medications (including, ACE inhibitors, a-Adrenergic blockers, b-adrenergic (beta) blockers, centrally acting agents, diuretics, thiazides, and statins)
7. Hormonal contraceptives (such as Ortho Tri-Cyclen )
8. Opioid pain relievers (such as Vicodin, Oxycontin, and Percocet)
9. Steroid medications (including anabolic steroids and corticosteroids)

Over-the-counter treatments can affect libido, too. “Being aware of what you’re taking is really important,” explains Dr. Nissola. “Because sometimes you’re taking a supplement that you don’t think is going to have any impact, and there isn’t a clear and obvious label saying this may impact your sexual life—or may affect your hormones.” Watch out for certain medications, such as:

1. Antifungals, specifically ketoconazole or fluconazole
2. Antihistamines, including Benadryl (diphenhydramine) and Chlor-Trimeton (chlorpheniramine)
3. Tagamet (cimetidine)

Alternative treatments, such as medical marijuana, can have a significant negative effect on libido for some patients, according to Dr. Nissola. Though, others experience the opposite effect. “Over-the-counter doesn’t mean that it’s safe. It doesn’t mean it’s not going to have any harmful impact on your life,” says Dr. Nissola. “There is a difference in regulation between over-the-counter and prescription drugs. Folks think that over-the-counter are harmless and safe, and that isn’t the case, sometimes.”

What to do if you have low libido

The first step is a visit to your healthcare provider to make sure it’s not a medical problem affecting your sex drive.

1. Change medication. 

Often, there’s an equivalent treatment that may not have sexual side effects. For example, “a few antidepressants, like mirtazapine, bupropion, and nefazodone, do not affect libido very much at all and can actually improve it,” according to Dr. Traxler. Or, if hormonal birth control is the issue, a nonhormonal option could work, like an IUD. Even changing the dosage can make a difference.

Until you consult with a physician, “do not just stop your medications! Having a spike in blood pressure or uncontrolled depression can arguably worsen sexual function more than any medication side effect,” says Dr. Redmond. “Start with contacting your doctor … and you don’t have to wait for your next appointment, you can always call in to speak with a nurse.” 

2. Treat the underlying condition. 

If there is a medical issue, such as low hormone levels, treating it can help to improve libido. “Men who already have low testosterone levels who receive testosterone as a replacement drug will tend to have a better sex drive,” says Dr. Traxler. 

“There is one approved drug for women who have low libido that was approved in 2019 called bremelanotide, or Vyleesi. It only works for women with a reduced sex drive who are not yet menopausal and who would not mind taking an injection before sex.” 

3. Make lifestyle changes. 

Reducing alcohol intake, increasing exercise, and eating a healthy diet can all help to restore lost libido. Quitting smoking can also help to improve circulation, which can impact sexual performance and desire.

4. Discuss supplements with your physician or pharmacist. 

“There are many [herbal aphrodisiacs] that have been found to be at least reasonably promising,” explains Dr. Traxler. “Most work by affecting testosterone levels so they tend to work better for men compared to women.”

“There are natural ingredients that have considerable evidence they can help with sexual drive, libido, and ED,” agrees Dr. Redmond. “Fenugreek, Tribulus, Eurycoma longifolia (Long Jack), and Panax Ginseng are all over-the-counter natural options to talk with your doctor about. There are impressive research studies that show improved sexual function in both men and women when they are used at the right doses.”

5. Talk to a therapist. 

Couples therapy, sex therapy, or individual psychotherapy can help to resolve mental health conditions that you might manage with medication. 

Changes in libido are challenging to deal with—emotionally and physically—and are often tricky to talk about without placing blame or hurting feelings. Don’t give up on having a healthy sex life. Most libido issues can be resolved with a little persistence. And, in the meantime, lack of desire doesn’t mean you have to sacrifice intimacy. Keep building your relationship with your partner, so you’re on solid ground when you’re ready to get busy again.