Can minoxidil cause erectile dysfunction and other sexual side effects?

Minoxidil (Rogaine) is one of the most popular medications for treating hair loss, available in topical or pill form. If you’re considering a hair loss medication, you might be wondering whether minoxidil could cause erectile dysfunction (ED) — some other hair loss medications can.

ED isn’t a common side effect of minoxidil, but it has been reported in rare cases.

It is very rare for minoxidil to cause erectile dysfunction. ED doesn’t appear on the standard list of minoxidil side effects, and no studies have found a direct link between the two. Still, some men have reported ED while using minoxidil. 

From 2004 to 2014, the US Food and Drug Administration (FDA) received 92 safety reports from men using topical minoxidil. Only four of those reports mentioned erection problems. 

Because filing these reports is voluntary and the total number of minoxidil users is unknown, these numbers don’t tell us exactly how common this side effect really is — but they do show that very few people who filed reports linked minoxidil to ED.

Some research suggests that minoxidil may actually help with ED, though more studies are needed to confirm this.

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In rare cases, minoxidil has been associated with sexual side effects — however, most people do not experience them. 

Potential —though rare — sexual side effects of minoxidil may include:

• Erectile dysfunction

• Ejaculation problems, such as premature ejaculation or delayed ejaculation

• Reduced sex drive or loss of libido

• Decreased semen 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. 

From 2004 to 2014, the FDA received a total of eight reports regarding these sexual side effects. Four men reported ED, two reported a decrease in or loss of libido, and the other sexual side effects were each reported only once. In other words, out of the many thousands of men taking minoxidil each year, there were fewer than 10 reported cases of sexual side effects.

Typical (non-sexual) 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

Yes, minoxidil is less likely to cause sexual side effects than other hair loss medications such as finasteride and dutasteride. ED, decreased libido, and reduced ejaculate volume are known potential side effects of finasteride, affecting fewer than 5% of men in clinical trials. These sexual side effects are also associated with dutasteride. ED and minoxidil, on the other hand, are such a rare combination that ED isn’t even listed as a potential side effect.

Finasteride and dutasteride are more likely to cause sexual side effects because they lower levels of dihydrotestosterone (DHT), a sex hormone linked to hair loss. Lower DHT levels can lead to a range of sexual side effects. On the other hand, minoxidil doesn’t appear to block DHT, which may be why it’s less likely to cause sexual side effects. 

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

Try prescription medications

Viagra (sildenafil) and Cialis (tadalafil) are first-line treatment for ED. If you’re experiencing ED that may be related to minoxidil, these medications can help. Both Viagra and Cialis are phosphodiesterase type 5 inhibitors (PDE5 inhibitors) that can be taken on demand, about 30–60 minutes before sex. 

Cialis is also available as a daily medication for more spontaneity. 

When taken on demand, Viagra works faster but for a shorter duration (about 3–5 hours), while Cialis takes longer to take effect but can remain active in the body for up to 36 hours. 

The active ingredients in both ED pills are also available through Ro in newer formulations, such as Daily Rise Gummies and dissolvable Ro Sparks. Both are considered off-label, since they differ from the FDA-approved pill formulations. Your healthcare provider can help determine which option is the best fit if you’re experiencing sexual side effects that may be related to minoxidil.

Eat a healthy diet

ED is highly correlated with obesity and an unhealthy eating plan. A healthy diet — and weight loss for those with excess weight to lose — has been shown to improve erectile function. 

If you’re experiencing ED symptoms that may be related to minoxidil, try to focus on healthy, whole foods. No single food is a magic bullet for treating ED, but some foods that may help ED include:

• Tomatoes

• Leafy greens

• Peppers

• Oysters

• Foods rich in omega-3 fatty acids

• Nuts

• Coffee

• Dark chocolate

• Berries

 You may also want to avoid the following foods and drinks that may worsen ED symptoms:

• Alcohol

• Red meat

• Fried foods

• High sodium and processed foods

• Foods and drinks with added sugar

Exercise regularly

Increasing physical activity is recommended for men with ED, since obesity and a sedentary lifestyle are associated with the condition. Research suggests that regular physical activity may prevent and improve ED symptoms.

Whether you’re experiencing minoxidil-related ED or ED caused by another factor, exercise might help your symptoms by improving blood flow and overall health. A 2023 review and meta-analysis suggests that 30–60 minutes of aerobic exercise 3–5 times each week led to erectile improvement. 

Take care of your mental health

Stress, depression, and anxiety — including performance anxiety — can all contribute to ED. Finding healthy ways to manage stress, including through therapy, can improve how you feel about yourself and your sexual health, which may in turn help relieve ED. Some ways to support your mental health if you’re experiencing ED — whether related to minoxidil or another underlying cause — include:

• Using stress-management techniques and coping skills

• Practicing meditation and mindfulness

• Seeking individual mental health therapy or sex therapy

• Considering psychiatric medications, such as antidepressants, if your healthcare provider thinks they could be a good fit

Treat underlying health conditions

If you have other health conditions that can lead to ED, treating those underlying conditions may help relieve your symptoms. 

ED can be caused by conditions such as heart disease, high blood pressure, and others. If you haven’t seen your healthcare provider in a while, it may be worth scheduling a check up to make sure there aren’t any underlying factors contributing to your ED.

Topical minoxidil is available at pharmacies and reputable online retailers. Oral minoxidil requires a prescription, which you can get though your healthcare provider or a telehealth platform like Ro. 

No matter which form you use, it’s important to buy your medications from well-established, verified companies to ensure you’re getting authentic minoxidil with the correct concentration and safe ingredients.

Be wary of retailers making misleading claims in minoxidil advertising, and always speak with your healthcare provider if you have any questions or concerns.

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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 recognized side effect of minoxidil. Only four reports of ED were submitted to the FDA over 10 years, and clinical trials did not identify it as a risk. 

• Minoxidil has not been shown to commonly cause sexual side effects, with fewer than 10 cases reported over a decade.

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

• 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.