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Clinical evidence

Beta-blockers & thiazides

Antihypertensive·Medication side-effects

Effect across the cycle

DesireInhibitory: Older beta-blockers lower testosterone and desire.
ArousalInhibitory: Reduced pelvic blood flow blunts arousal.
PerformanceInhibitory: Thiazides and older beta-blockers raise erectile-dysfunction rates.
ClimaxNeutral: No consistent direct orgasmic effect.
ExperienceInhibitory: Central sedation can dampen the experience.
MemoryNeutral: Not a memory factor.

Mechanism

Older beta-blockers (propranolol, atenolol) and thiazide diuretics (hydrochlorothiazide, chlorthalidone) carry the highest erectile risk via beta-adrenergic blockade, reduced pelvic blood flow, central sedation and lowered testosterone. ARBs (losartan, valsartan), ACE inhibitors, calcium-channel blockers and nebivolol are neutral-to-beneficial.

Pharmacokinetics
Effects develop over weeks; partly reversible with weight loss in trial data.
Reversibility
Reversible; switching drug class often resolves it.

Sex differences & notes

Atenolol lowered testosterone and reduced intercourse frequency; valsartan improved sexual desire in postmenopausal women. Spironolactone is antiandrogenic.

Key sources

  • TOMHS (Grimm 1997)
  • MRC trial (Sica 2004)
  • Fogari et al. 2002/2004
  • MR NOED (nebivolol)