Lithium and Erectile Dysfunction: Causes, Risks & Solutions

Lithium is one of the most effective mood stabilizers used for bipolar disorder, but some people notice changes in their sexual function after starting it. If you’ve ever wondered whether lithium causes erectile dysfunction, you’re not alone. Studies show that about one-third of men taking lithium experience erectile dysfunction caused by changes in brain chemistry and blood flow. The drug can lower key hormones like dopamine and testosterone while reducing blood supply to the penis, leading to lower sexual desire and difficulty maintaining an erection. In this article, we will look into whether lithium causes erectile dysfunction,  why this happens, and what you can do about it.

Does Lithium Cause Erectile Dysfunction?

Yes, research confirms that lithium can cause erectile dysfunction (ED) and other sexual side effects, often referred to as treatment-emergent sexual dysfunction. This means that these problems appear after starting medication. Clinical studies report sexual dysfunction in 25–50 percent of patients on lithium therapy. [1] Another study of 35 men taking only lithium found that about one in three experienced sexual problems, including loss of erection or difficulty maintaining it. [2] These findings suggest that ED is a recognized adverse side effect of psychotropic drugs like lithium and can significantly impact sexual health. Let's look at how lithium causes these sexual symptoms.

How Does Lithium Cause Erectile Dysfunction?

Lithium affects the brain pathways and the penile tissues that are involved in erections.

1. Affect On the Brain:

• Lithium decreases dopamine, which is a key chemical responsible for erections. It blocks dopamine receptor activity in brain areas that control sexual arousal and sexual thoughts. [2]
• It also increases serotonin, a brain chemical that helps regulate mood in bipolar disorder, but can lower sexual desire and make it harder to get or keep a penile erection. [1]
• Lithium affects hormone balance by acting on the brain areas that control hormone release. This can lower testosterone and increase prolactin levels, which reduce sexual desire. [2]
• Depressive phases of mood disorders, which Lithium is used to treat, can blunt sexual interest, making it hard to separate psychological from medication-related causes. [1]

2. Affect on Penile Tissues:

• Normal penile erection relies on the nitric oxide pathway. Lithium interferes by reducing the activity of nitric oxide synthase, the enzyme that produces nitric oxide. With less nitric oxide, the erectile tissue cannot relax properly, leading to absent or short-lived erections. [2]
• Lithium reduces certain body chemicals like cyclic AMP and GMP, which help the penis muscles relax, making it harder to get or keep an erection. [2]
• Additionally, lithium can disrupt the balance of other natural chemicals like prostaglandins that control blood flow in the penis. It may increase substances that tighten blood vessels and reduce those that help them relax. [2]

Is ED Caused by Lithium Permanent?

Lithium-induced erectile dysfunction is usually temporary and often improves once the dose is adjusted or supportive treatment begins. Most men regain normal sexual function with proper management. [1] Still, these side effects can be frustrating and sometimes lead to poor medication adherence, meaning male patients might skip doses or stop medication without guidance to avoid side effects. It’s important not tol not to stop your medication, as suddenly discontinuing lithium can trigger serious issues like mood relapse or psychotic excitement. Always talk to your doctor before making any changes to medications.

When to See a Doctor

You should talk to a healthcare professional if you notice:

• Difficulty getting or maintaining an erection for > 4 weeks
• Sudden loss of sexual desire or sexual arousal
• Less pleasure or inability to reach orgasm
• Symptoms of low testosterone (fatigue, mood changes, low drive)

If you’re noticing sexual changes after starting lithium, it doesn’t mean the medication isn’t right for you. We can often adjust the dose or timing without disrupting your mental health.

How to Manage ED Caused by Lithium

1. Medication Adjustments

Doctors can adjust the dose, change the timing of doses, or explore alternate mood stabilizers or antipsychotic medications with fewer sexual side effects. [3]

2. Medication Add-Ons

• Aspirin (240 mg daily): A study found that aspirin significantly improved erectile function in men taking lithium.
• PDE5 inhibitors (sildenafil, tadalafil): These drugs have been effective in treating lithium-related erectile dysfunction.

3. Monitor Other Drug Use

Avoid combining lithium with benzodiazepines or certain antidepressant medications like venlafaxine or paroxetine, which worsen sexual dysfunction.

4. Mental Health Support

Psychological support like hypnotherapy or CBT can help if sexual function problems also have emotional roots.

How to Prevent ED Caused by Lithium

1.  Regular medical check-ups

Routine blood tests to monitor serum lithium levels, thyroid function, and hormones (like testosterone) can help catch imbalances early and prevent complications.

2. Communicate openly

Discuss sexual symptoms honestly with your doctor. Many male patients hesitate to bring up ED, but it’s a common issue with psychotropic drugs, and doctors can help find solutions such as dose changes or adding ED medication.

3. Stay physically active

Regular exercise improves both mood and blood flow, boosting natural nitric oxide production that helps erections. Aim for at least 30 minutes of moderate activity most days.

4. Eat a balanced diet

A heart-healthy diet rich in fruits, vegetables, whole grains, and omega-3s supports both brain health and sexual function. Avoid heavy alcohol use, which can worsen both bipolar symptoms and ED.

5. Prioritize sleep

Poor sleep can destabilize mood and lower testosterone, both of which affect sexual performance. Maintain a consistent bedtime and limit screens before sleeping.

6. Manage stress

Practice relaxation techniques like deep breathing, yoga, or mindfulness. Stress releases cortisol, which can worsen both mood episodes and erectile function.

7. Consider Sex therapy

Sex therapy can help manage emotional and relationship stress linked to both bipolar disorder and ED. It encourages understanding, communication, and intimacy, and can help enhance sexual activity.

Conclusion

While lithium causes erectile dysfunction in some men, it’s rarely permanent or untreatable. The drug remains one of the most reliable options for stabilizing mood disorders like bipolar disorder, but it can affect processes related to erections, like testosterone levels and dopamine regulation. But with the right guidance, both mental health & sexual health can thrive together. If you experience ED or other sexual dysfunction while on lithium, don’t suffer in silence. Consult a qualified sex health expert or psychiatrist for personalized management. With proper support, your emotional balance & intimate life can stay equally strong.