Can minoxidil cause erectile dysfunction and other sexual side effects?

Minoxidil (Rogaine) is the go‑to medicine for treating hair loss. Most people use it as a foam, spray, or liquid that they rub onto the scalp. There’s also a pill form (originally meant for high blood pressure) that some providers prescribe off‑label for hair regrowth. If you’re thinking about trying a medication for hair loss, you might be wondering whether minoxidil could cause erectile dysfunction (ED).

Minoxidil is not known to cause ED, but that doesn’t mean it’s not possible to experience ED on minoxidil. Read on as we explore what the research says about minoxidil and erectile dysfunction, as well as other possible sexual side effects of minoxidil.

Erectile dysfunction doesn’t show up on the usual list of minoxidil side effects, and no studies have found a direct link between the two. Still, there are some men who have reported ED while using minoxidil. 

From 2004 to 2014, the FDA received 92 safety reports from men using topical minoxidil. Only 4 of those reports mentioned erection problems. Because filing these reports is voluntary and we don’t know how many people actually use each drug, the numbers don’t reveal how common the side effect really is; they only show that very few people who filed reports linked minoxidil to ED.

Typical side effects of minoxidil include:

• Hair shedding at the start of treatment

• Skin irritation, including redness, itching, or burning on the scalp

• Scaling or seborrheic dermatitis on the scalp

• Allergic contact dermatitis or eczema

• Increased hair growth on the scalp or other areas of the body

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Minoxidil erectile dysfunction was not common in clinical trials or in subsequent randomized controlled trials of the drug. 

ED is not considered a common side effect of the hair loss medication. However, that doesn’t mean it’s not possible to experience ED while taking minoxidil. The question is whether it’s due to minoxidil or (more likely) to something else. ED is a multifactorial condition that often has more than one cause, which can range from physical to psychological. Various causes can contribute to ED, including:

• Older age

• Depression

• Diabetes

• Obesity

• Heart disease

• Sleep apnea

• Hormonal imbalances

• Traumatic injury to the pelvic area or spinal cord

• Medications

Speaking of medications, finasteride (brand name Propecia) is an oral hair loss medication that’s sometimes taken in combination with topical minoxidil. Taking minoxidil and finasteride together can be more effective at treating male pattern baldness than either minoxidil or finasteride alone. Unlike minoxidil, finasteride has been linked to an increased risk of ED. While the risk is still low—only 1.3% of men reported ED in clinical trials, compared to 0.7% taking a placebo—it occurred often enough for it to be considered a possible side effect of finasteride. 

Dutasteride (Avodart) is another oral medication that may be prescribed off-label for hair loss. It’s also a medication that can cause ED. One study found that as many as 7% of men experienced ED on dutasteride.

As of now, there is no evidence that ED can be caused by minoxidil. While the risk is still low, it’s more common to experience ED on oral finasteride and dutasteride. Not only is ED unlikely on minoxidil, there’s actually some research exploring topical minoxidil as a future treatment for ED.

Similar to ED, there is no evidence that sexual side effects are common on minoxidil, but they are possible. Some possible sexual side effects of minoxidil include a reduced libido, issues with ejaculation, and reduced ejaculate volume. These are so rare that they are not included in the list of common side effects for minoxidil, but a small number of reports have been submitted to the FDA.

While rare, sexual side effects of minoxidil may include:

• Erectile dysfunction

• Problems with ejaculation, such as premature ejaculation or delayed ejaculation

• Reduced sex drive

• Loss of libido

• Decreased semen volume

These sexual side effects are so rare that they were not considered a common side effect of minoxidil in clinical trials. From 2004 to 2014, the FDA received a total of eight reports regarding these sexual side effects. As explained earlier, four men reported ED, while the other sexual side effects were each reported only once.

If those numbers sound like a lot, let’s put them into perspective.  Since minoxidil hit pharmacy shelves in the late 1980s, millions of people have used the foam, spray, or solution. Eight sexual side-effect reports over a full decade works out to less than one report per million users—about the same odds as being struck by lightning in a given year. Because the FDA’s database is a voluntary “suggestion box,” it’s meant to surface rare signals, not measure true risk.

In other words, a few anonymous anecdotes can’t prove that minoxidil causes ED; they just remind clinicians (and users) to keep the conversation open if anything feels off.

The review of FDA reports did not mention whether these minoxidil sexual side effects were resolved. However, a separate case report of a man who experienced ED and low libido on minoxidil found that after stopping minoxidil, his erectile function and sex drive improved.

Yes, minoxidil is less likely to cause sexual side effects than other hair loss medications like finasteride and dutasteride. ED, decreased libido, and reduced ejaculate volume are all considered common side effects of finasteride, affecting less than 5% of men in clinical trials. These sexual side effects are also common with dutasteride. When it comes to minoxidil, they’re very rare and not considered common side effects. 

Why? Finasteride and dutasteride may be more likely to cause sexual side effects because they work by lowering the amount of dihydrotestosterone (DHT, a male sex hormone linked to hair loss) in the body. This reduction in DHT can lead to sexual side effects in men, including ED, low libido, and ejaculation issues. On the other hand, minoxidil doesn’t appear to block DHT, which may be why it’s less likely to cause sexual side effects. 

Another point in minoxidil’s favor is that you rub it onto your scalp instead of swallowing it. Because topical treatments work right where you apply them, their effects stay mostly local. Oral drugs like finasteride or dutasteride enter your bloodstream through your gut, circulate throughout your body, and can trigger a broader range of side effects. With minoxidil specifically, only 1.4% of minoxidil foam or liquid gets absorbed via your skin, whereas 95% of the medication would be absorbed if you took it orally. 

Whether minoxidil causes ED or not, ED itself is not uncommon, affecting at least 30–50 million American men. The good news is that ED is often treatable. If you start noticing signs of ED, consider these proven treatment options:

• Prescription medications: Oral PDE5 inhibitors such as Viagra (sildenafil) and Cialis (tadalafil) are the first-line treatment for ED, with a high success rate. Both Viagra and Cialis can be taken on demand, about 30–60 minutes before sex. Cialis can also be taken on a daily basis. When taken on demand, Viagra kicks in faster but lasts for less time (about 3–5 hours) while Cialis takes a bit longer to kick in but can last for 36 hours. The active ingredients in both ED pills are also available in newer formulations, such as Daily Rise ED Gummies and the dissolvable Ro Sparks.

• Eating a healthy diet: Unhealthy diets and obesity have been linked to an increased risk of ED, while following a healthy diet (and losing weight if you’re overweight) has been shown to improve erectile function. 

• Exercising regularly: Increasing physical activity is also recommended for men with ED, since obesity and having a sedentary lifestyle are associated with ED. According to research, regular physical activity may prevent and improve ED symptoms.

• Taking care of mental health: Stress, depression, and anxiety (including performance anxiety) can all contribute to ED. Finding healthy ways to manage your stress, including through therapy, can help you feel better about yourself and sex, which can relieve ED.

• Treating other health conditions: If you have other health conditions that can lead to ED, treating those underlying conditions may help relieve your symptoms. And if you haven’t been to the doctor in a while, it may be worth getting a check up just to make sure there isn’t anything you don’t know about contributing to your ED. 

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Minoxidil is considered a safe and effective hair loss treatment with minimal risk of sexual side effects. While there have been rare reports of erectile dysfunction and other sexual issues, these cases are not typical and may be unrelated to the medication itself.

• ED is not a known side effect of minoxidil. Only four reports of ED were submitted to the FDA over ten years, and clinical trials did not identify it as a risk. Minoxidil is not known to cause sexual side effects, with fewer than ten cases of sexual side effects reported over a decade.

• Minoxidil is less likely to cause ED and other sexual side effects than other hair loss medications. Oral drugs like finasteride and dutasteride are more likely to cause sexual side effects in men, including ED, decreased sex drive, and ejaculation problems.

• Treatment is available. If you do experience ED or other sexual side effects while using minoxidil, talk to your healthcare provider. Safe and effective treatments for ED are widely available, including oral medications, lifestyle changes, and therapy.