Does metoprolol cause erectile dysfunction and other sexual side effects?

Erectile dysfunction (ED) can have many causes, including high blood pressure and certain medications used to treat high blood pressure. So, does metoprolol cause ED? It's possible.

Read on to learn more about medically induced ED from metoprolol (also known by brand names like Lopressor or Toprol XL), including what you can do about it.

Yes, metoprolol may cause or worsen erectile dysfunction as a side effect of the medication. As is also the case with some antidepressants and anxiety medications, some people have trouble getting or keeping hard erections while taking metoprolol.

Metoprolol belongs to a class of medications known as beta-blockers, which are used to treat heart conditions, hypertension (high blood pressure), and even anxiety. Though the exact cause isn't completely understood, erectile dysfunction is a well-documented beta-blocker side effect. 

The drug labels for both of metoprolol's formulations — metoprolol tartrate (Lopressor) and metoprolol succinate (Toprol XL) — note that the medication can increase the risk of ED.

Find your starter ED treatment

Get started

How common is ED with metoprolol?

First, not everyone with a penis experiences ED while taking metoprolol. Research is mixed on how common ED is with metoprolol — and whether it's even the drug causing the issue.

Here's what the science shows:

• A review of 15 clinical trials and a total of 35,000 people found that about 21.6% of people on beta blockers had sexual side effects. But this research included all sexual side effects, from participants of all sexes, and from beta blockers in general (not just metoprolol). 

• One study comparing metoprolol with nebivolol, another beta-blocker, found that 7% of metoprolol users developed severe ED compared to 1.6% of nebivolol users. 

• Another study found that 32% of men who were aware of beta-blockers’ reputation for causing ED developed erection problems on metoprolol. Only 8% of the metoprolol users who didn’t know the name of their medication or its potential side effects developed ED. This suggests a psychological factor may be at play.

Bottom line: There's no denying that ED can develop with metoprolol, but research isn't clear on exactly what percentage of patients experience this side effect.

Does metoprolol cause ED? It seems so, but the connection isn't completely understood. 

There are a few possible reasons metoprolol and erectile dysfunction often go hand-in-hand:

• May reduce blood flow to the penis. Beta blockers like metoprolol work by slowing your heart rate. This diminishes the force of blood pumping through your veins and arteries, potentially reducing blood flow to the genitals. This may result in a softer erection. 

• May mess with testosterone. Some older research suggests that beta-blockers may temporarily lower testosterone levels. And while low T alone doesn’t typically cause ED, it is considered a contributing factor.

• May lower your energy for sex. Metoprolol side effects include fatigue, dizziness, and depression. Not exactly fuel for satisfying sexual activity. Feeling sluggish or blue on metoprolol may indirectly lead to a lower sex drive and even loss of erections during sex.

• May trigger psychological ED. Sexual function is physical and mental. And research shows that simply knowing beta blockers can cause ED may be enough to trigger ED-inducing anxiety. 

And finally, some men on metoprolol might develop ED symptoms not because of the drug but because of why they’re on this medication in the first place: High blood pressure. 

People with hypertension may have up to a 70% increased risk of developing ED. And up to 70% of patients with hypertension who experience side effects from their medications stop treatment before their blood pressure improves. 

In some cases, metoprolol-induced ED symptoms may go away on their own. In other situations, you may need to improve your lifestyle habits or talk to your healthcare provider about adjusting your dose, switching medications, or treating the ED with a different medication.

1. Give your body time to adjust

If you’ve been prescribed metoprolol for hypertension, it’s essential to understand that you already have an above-average risk of developing ED. 

High blood pressure itself can cause ED. And if sky-high BP is the root cause of your erection problems, your ED might improve on its own once your blood pressure is optimized.

Metoprolol side effects may also improve as your body adjusts to the drug. Meaning, in theory, your ED could be temporary, especially if it's an indirect result of short-term side effects like headache or fatigue. 

2. Adjust your dosage

Adjusting your metoprolol dosage with the guidance of your healthcare provider may help improve ED.

Research shows that higher doses of beta-blockers are more likely to cause adverse events. In theory, this means that decreasing your metoprolol dose could minimize the drug’s adverse effects on your sexual performance. Just make sure you never change your dosage without first consulting a healthcare professional. 

3. Switch medications

Not all drugs have sexual side effects. If you’ve developed sexual performance issues after starting metoprolol, it’s a good idea to ask your provider about switching to another medication.

Metoprolol is approved by the US Food and Drug Administration (FDA) to treat hypertension, angina pectoris, heart failure, and heart attack. It’s also prescribed off-label for several purposes, including migraine prevention, essential tremor, and anxiety. 

The best alternative to metoprolol depends on your reason for taking it. Never stop taking metoprolol without consulting your provider, and never switch medications without the guidance of a healthcare professional.

4. Improve your lifestyle habits

Making specific lifestyle changes can improve symptoms in some cases of ED. Here are some habits to incorporate:

• Eating a healthy diet. Eating a nutrient-rich diet that supports blood flow and nitric oxide synthesis can help promote healthy erections. Ideas include vegetables like leafy greens and peppers, omega-3-rich seafood, and antioxidant-packed berries and dark chocolate. 

• Regularly exercising. Physical activity is good for your health in general, but it also supports sexual function. A 2020 study found that cardiovascular exercises (jogging, biking, swimming, etc.) and weight training may improve testosterone levels and promote blood flow to the penis.

• Getting enough sleep. Inconsistent sleep habits have been linked to lots of erection-disrupting issues, including high blood pressure, depression, and obesity. Aiming for a solid 7-9 hours of quality sleep each night is good for your mind, body, and sexual health.

• Tackling stress. Stress raises cortisol levels, which in turn reduce testosterone. Supporting healthy testosterone levels through deep breathing exercises and mindfulness meditation may help lower cortisol levels, increase testosterone, and ultimately improve ED symptoms. 

5. Treat ED with another medication 

Your healthcare provider might suggest pairing metoprolol with a medication used to treat ED. The most common ED drugs belong to a group of medications called PDE5 inhibitors. 

Common prescription options include:

• Viagra (sildenafil)

• Stendra (avanafil)

• Cialis (tadalafil)

• Vardenafil 

These medications don’t trigger spontaneous erections. They help relax and widen the blood vessels in your penis so that blood can flow in more easily. This leads to strong, hard erections when you feel sexually aroused. 

Keep in mind that PDE5 inhibitors can lower blood pressure as well. So, your healthcare provider will help ensure this won’t be a harmful drug interaction.

If you don’t love swallowing pills, consider PDE5 inhibitors in other forms, such as Ro Sparks and Daily Rise Gummies. Ro Sparks contain a combination of tadalafil and sildenafil in a dissolvable lozenge that melts under your tongue. Daily Rise Gummies are fruit-flavored gummies that contain tadalafil. 

These products are not FDA-approved, but their ingredients are independently FDA-approved.

Yes, the prescribing information for metoprolol states that the drug can increase the risk of poor sperm motility. There is also some evidence that beta-blockers may cause low libido. 

Aside from the sexual side effects of ED and low sperm motility, the research is mixed on metoprolol’s potential impact on sexual health. 

Most studies suggest that beta-blockers can hurt sexual function or satisfaction. But then, some researchers suggest that the negative impact is primarily due to other factors, like having hypertension or experiencing anxiety about sexual performance because of beta-blockers’ reputation. 

If you think you’re experiencing ED or other sexual side effects of metoprolol, tell your provider. Whether the issues are physiological, psychological, or both, there’s no reason to suffer in silence. 

Your prescriber helped you find treatment for your high blood pressure (or heart condition, migraine, etc.), and they can do the same for any sexual problems that have developed since starting metoprolol.

Ro Sparks

Hard in 15 mins (on avg), ready for up to 36 hours, 2-in-1 formula

Get started

Metoprolol can be an effective medication for hypertension, heart conditions, and more. But for some people, it can also cause unwanted sexual side effects. So, does metoprolol cause ED? It can. Here’s the need-to-know.

• Metoprolol can cause ED in some people. Not everyone experiences this condition, but the medication label clearly states that metoprolol can increase the risk of erectile dysfunction and low sperm motility.

• Several factors may explain ED while on metoprolol. Beta-blockers like metoprolol may reduce blood flow to the penis, lower testosterone, and impact overall energy, which can make it challenging to maintain a firm erection for sex. Underlying anxiety about the drug’s impact on sexual function can also contribute to ED symptoms.

• There are ways to manage or treat ED while taking metoprolol. Your healthcare provider may adjust your dose, switch hypertension medications, or recommend an ED medication. Lifestyle changes such as exercise, a healthy diet, good sleep hygiene, and stress management can also help.

• You don’t need to suffer in silence. ED and other unwanted sexual side effects from medications can feel embarrassing. But drug-induced ED is a thing, and your provider can only help when they’re aware of the issue.