Does Xanax cause ED?

Xanax (alprazolam) is one of the most commonly prescribed medications for anxiety and panic disorders. It works by calming your central nervous system, soothing symptoms like racing thoughts or rapid heartbeat in as little as 30 minutes. Although it can bring quick relief, the drug can also come with side effects, including down-there difficulties.

But does Xanax cause erectile dysfunction (ED), in particular? It’s possible, though ED is less common than other side effects of Xanax.

Below, we explore the link between Xanax and ED and break down how the anti-anxiety drug can affect your libido. Plus, learn what you can do to manage Xanax’s sexual side effects while still taking care of your mental health.

Yes, Xanax can cause ED in some individuals. But it’s less common than other sexual side effects, such as changes in libido (aka sex drive). 

In clinical trials of the drug, sexual dysfunction — including ED — was reported in 7% of people (both men and women) who were prescribed Xanax for panic disorder. By comparison, only 4% of people taking a placebo also reported sexual side effects. 

Sexual dysfunction is a catch-all term that can include ED, as well as reduced sex drive and delayed ejaculation. According to research, these sexual side effects can occur with benzodiazepines in general, not just Xanax. 

It’s important to note that not everyone who takes Xanax will develop ED. Some men may even find that their sexual function improves, as Xanax can reduce their general anxiety or performance anxiety. And people taking Xanax — men and women included — are about twice as likely to experience an increase in libido as those taking a placebo. But if you didn’t experience ED before starting Xanax and you notice problems now, the drug could be playing a role.

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The connection between Xanax and ED is not fully understood. Xanax affects multiple systems in the body that can influence sexual performance. Here are the main ways researchers think Xanax may cause ED:

• Central nervous system (CNS) suppression: Xanax enhances GABA (gamma-aminobutyric acid), your brain’s main calming neurotransmitter. While this can reduce anxiety, it can also slow brain activity more generally, which can impair sexual arousal and lower erectile response.

• Lowered libido: Sedation, drowsiness, and reduced energy from Xanax use can make you less interested in sex, which may present as ED. In clinical trials, 14% of people taking Xanax reported decreased libido (8%, coincidentally, reported a boost in sex drive on the drug).

• Underlying anxiety and depression: Many people taking Xanax already struggle with anxiety and depression, both of which are linked to a higher risk of ED.

While Xanax is more often associated with decreased libido, there are cases where it seems to have the opposite effect. In clinical trials, 14% of users reported a reduced sex drive while 8% reported a boost. 

One explanation? By calming the nervous system, Xanax may reduce sexual performance anxiety. For men who struggle to get or maintain erections due to performance anxiety, treating the underlying anxiety may make sex feel less intimidating, allowing them to focus more on their desire.

In addition to ED, Xanax may cause other sexual side effects, including:

• Low libido (reduced sex drive): About 14% of people taking Xanax report decreased sex drive or a loss of interest in sex. 

• Increased libido: On the other hand, 8% of people experience a boost in their sex drive when they start taking Xanax.

• Anorgasmia (inability to orgasm): Anorgasmia can be another sexual side effect of Xanax (and benzodiazepines in general). One case study suggests that anorgasmia could be dose-dependent. The subject’s orgasms returned to normal after lowering the frequency and dosage of Xanax. Additionally, a study found that either difficulty orgasming, low libido, or ED occurred in 50% of sexual encounters. However, these effects occurred in people taking high doses of Xanax daily. 

• Delayed ejaculation: Delayed ejaculation has also been reported in benzodiazepines. Xanax can make it take longer to reach orgasm.

It’s worth noting that other side effects are much more common with Xanax, including:

• Drowsiness

• Fatigue or tiredness

• Impaired coordination

• Irritability

• Issues with memory or thinking

Other serious side effects of Xanax

Serious side effects can occur with Xanax, especially since the drug’s active ingredient, alprazolam, is a schedule IV controlled substance. This means it has the potential for abuse and dependence.

Here are some risks you should be aware of:

• Dependence and withdrawal: Even short-term use of Xanax can lead to dependence. Stopping abruptly may cause seizures, rebound anxiety, or other serious withdrawal effects. Stopping Xanax should only be done under the guidance of a healthcare provider, who can guide you on how to slowly taper off the medication.

• Dangerously slowed breathing: When combined with opioids, alcohol, or other sedatives, Xanax can cause respiratory depression, essentially decreasing the brain’s drive to breathe. This can potentially lead to coma or death.

• Cognitive impairment: Long-term use of Xanax has been linked to memory problems and slower thinking.

• Drowsiness-related accidents: The sedating effects of Xanax can increase your risk of getting injured or having a car accident, especially when combined with opioids or alcohol. Do not drive or operate heavy machinery until you know how Xanax affects you.

• Misuse, abuse, and overdose: Xanax is one of the most misused prescription drugs. Taking it with alcohol or other substances can lead to serious side effects.

You shouldn’t have to choose between your mental health and sexual health. So, if you’re experiencing signs of ED  or other sexual side effects of Xanax, reach out to your healthcare provider. They can help you figure out which of the following strategies might be a fit for you.   

Adjust your dosage (or dosing frequency) of Xanax

Some sexual side effects of Xanax may be dose-dependent, according to the aforementioned case study. Switching to a lower dose (or taking Xanax less frequently) may relieve your ED symptoms while still effectively treating your anxiety. But remember: Never change your dosage without first consulting your healthcare provider, especially since  Xanax comes with the risk of serious withdrawal symptoms.

Switch to another medication

There are several medications that treat anxiety and depression, including selective serotonin reuptake inhibitors (SSRIs), serotonin-orepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants. One of these could be an equally effective option when it comes to treating your anxiety, but without the same sexual side effects as Xanax. 

Be aware, however, that these medications can also cause ED and sexual dysfunction. Research suggests the risk is highest with SSRIs and SNRIS, but less so with tricyclic antidepressants or drugs like Wellbutrin (bupropion). 

Try prescription medication for ED

Prescription medication — namely, oral PDE5 inhibitors like Viagra (sildenafil) and Cialis (tadalafil) — are the first-line treatment for ED, and for good reason: They work. These medications are generally safe for most individuals to take, can be used daily or as-needed (at least 30 minutes before sex), and start working within 15–60 minutes. 

Today, you can find certain PDE5 inhibitors in newer formulations such as  Ro’s Daily Rise Gummies. These fruit-flavored gummies contain tadalafil (the active ingredient in Cialis) and are designed to be taken once a day, allowing you to be ready 24/7. Another option is Ro Sparks, a dissolvable lozenge that combines sildenafil and tadalafil (the active ingredients in Viagra and Cialis, respectively) for fast-acting, longer-lasting effects. 

Treat any underlying health conditions

Various conditions can contribute to and worsen ED, including (but not limited to):

• High blood pressure

• Diabetes

• Obesity

• Heart disease

• Multiple sclerosis

• Low testosterone

• Pelvic or spinal cord injury

• High cholesterol

• Stroke

• Sleep apnea

• Depression

If you think it’s possible that another health condition may be behind your ED, make an appointment with your healthcare provider. In many cases, getting treatment for the culprit can help relieve ED and other sexual dysfunction issues. 

Take care of your mental health

Since anxiety, depression, and stress can all cause or worsen ED, combining Xanax with therapy or other mental health support may improve both your mental and sexual wellbeing. Finding ways to manage day-to-day stress may also improve your experiences in the bedroom. Tactics range from deep breathing to breaking a sweat at the gym.

Make lifestyle changes

There are several things you can do to naturally improve your erections. 

• Adopt a regular exercise routine: Maintaining a consistent workout routine, especially one that includes cardio, can also improve heart health, which is linked to erectile function and wellbeing.

• Eating a balanced diet: What you eat can affect the quality of your erections. Experts generally recommend adopting a Mediterranean diet for stronger erections. 

• Lose weight, if appropriate: Heavier body weights are associated with several health conditions linked to ED, including obesity, high cholesterol, high blood pressure, and diabetes. 

• Quitting smoking: Smoking increases your risk of ED, but quitting can do wonders for your member — and overall health. Research shows that men who quit smoking can see a 25% improvement in their erections after one year.  

• Drinking less alcohol: Men who drink a lot are more likely to report ED. And alcohol should not be mixed with Xanax, anyway.

Talk to your healthcare provider

The most important part of treating ED and anxiety is remembering that you don’t have to suffer in silence. Just as you sought out treatment for your anxiety (way to go, BTW!), you can do the same for ED and other sexual side effects of Xanax. There are numerous treatments for  ED and anxiety, and your healthcare provider can help you find the right fit for you. 

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Xanax can be an effective medication for anxiety and panic disorders. But for some men, it can come with unwanted sexual side effects, including erectile dysfunction. Here’s the brass tacks on the topic:  

• Yes, Xanax can cause ED. While not everyone experiences the condition, clinical studies suggest 7% of people report sexual dysfunction on Xanax.

• Various factors may explain ED on Xanax. Xanax’s effects on your central nervous system may lead to reduced blood flow, libido, and arousal, all of which can make it tougher to get and maintain an erection. Underlying anxiety or depression can also contribute to ED.

• Other sexual side effects are possible Xanax. The most common sexual side effects of Xanax include changes in libido (both an increase and a decrease) and difficulty with orgasm or ejaculation.

• There are a number of treatment options for down-there difficulties on Xanax. Lowering your dosage of the drug, switching medications, trying prescription ED treatments, and addressing underlying health conditions can all help

Ultimately, if Xanax is affecting your sexual health, the best step is to talk to your healthcare provider. They can help you find the right balance between managing your anxiety and preserving your sex life.