While I don’t think this article is going to be anywhere near important enough to catch the attention of pharmaceutical legal teams, let me be very clear that what I am writing about here is a combination of what clients have told me first hand, plus references from specific studies, such as this study on the negative sexual side effects of SSRIs. This article explores the relationship between ADHD medications and sexual functioning issues. The aim is to provide context on this issue and to help people work out if this is something they are struggling with.

This is a highly complex area, and the effects can vary depending on the individual, the specific medication, the dosage, and other factors. I am not a doctor nor a medical professional, and these are my experiences as an AuDHD sex therapist, working with many ADHD adults. 

Stimulant Medications (e.g., Adderall, Ritalin, Concerta, Elvanse/Vyvanse)

The key areas impacted tend to be libido, penile erectile issues, and reduced ability to orgasm, partnered or alone. Here are the key areas with a bit more detail. 

Decreased Libido
Some individuals report a decrease in libido (sexual desire) while taking stimulant medications. This is one of the more commonly reported sexual side effects.

Erectile Dysfunction (ED)
Studies show some cisgender men report experiencing difficulties achieving or maintaining an erection while on stimulants. Studies have shown a higher likelihood of ED in stimulant users compared to non-users in some populations.

Orgasm
Some individuals, of all genders, have reported difficulties reaching orgasm.

Increased Libido 
Conversely, some individuals, particularly early in treatment or at certain dosages, may experience a temporary increase in libido, as explained in this study. This might be related to the dopamine-enhancing effects of these medications.

Hyperfocus During Sex
Some individuals find that their medication actually improves their sexual experience by helping them focus and stay present during intimacy, reducing distractibility associated with ADHD.

Hypersexuality
In some anecdotal reports and some research, stimulant use has been linked to hypersexual behaviour in a subset of individuals, although this is not a typical or well-understood side effect in the context of therapeutic use for ADHD. 

Non-Stimulant Medications (e.g., Strattera, Guanfacine, Clonidine)

The second group of ADHD medications can be further divided into two groups: Atomoxetine (often sold as Strattera) and the group of Alpha-2 Agonists (such as Guanfacine, Clonidine). 

Strattera (Atomoxetine): This American study lists sexual side effects, including decreased libido, erectile dysfunction, ejaculation problems, and painful or prolonged erections (priapism). Studies suggest these occur in a small percentage of adults, and may be more linked to posology (how much you take and how often) rather than side effects of the medication itself.

Alpha-2 Agonists (Guanfacine, Clonidine): These medications are less commonly associated with direct sexual side effects compared to stimulants and Strattera. However, some individuals may experience fatigue or sedation, which could indirectly impact sexual desire or function. Impotence has been noted as a potential side effect, particularly when coupled with the serotonergic effects of some amphetamines.

What Does All That Actually Mean?

A 2020 systematic review found that individuals with ADHD report more sexual desire, more frequent masturbation, less sexual satisfaction, and more sexual dysfunctions compared to the general population, regardless of medication status. This suggests that ADHD itself plays a significant role in sexual health. The same review indicated that the rate of sexual dysfunction among adults with ADHD was over twice the level in the general population.

However, some people feel that the medication doesn't significantly worsen pre-existing sexual dysfunctions related to ADHD and might even improve some aspects by managing core ADHD symptoms like inattention and impulsivity that can interfere with intimacy. In other words, if you used to get easily distracted during sex, being able to focus on it more fully may lead to more enjoyable intimate experiences. 

So it's crucial to differentiate between the direct pharmacological effects of the medication and the impact of improved ADHD symptom management on relationships and intimacy. Better-managed ADHD symptoms can sometimes lead to improved communication and focus in relationships, indirectly benefiting sexual health. Put simply, it's often really tricky to tell whether the medication is directly or indirectly making things better. 

Co-occurring conditions like anxiety and depression, which are common in individuals with ADHD and may also be treated with medication, can also significantly impact sexual functioning. The more medication, the more challenging it can be to isolate the effects of ADHD medications alone.

Important Considerations:

In summary, there are many known possible negative side effects of ADHD medication. However, three key aspects are worth remembering: 

1. Individual Variability: Responses to ADHD medications vary greatly from person to person. Not everyone will experience sexual side effects.
2. Dosage and Timing: The dosage of the medication and when it is taken can influence side effects. Sometimes adjusting the timing of medication intake can help minimise sexual side effects.
3. Distinguishing from ADHD Symptoms: It can sometimes be difficult to determine whether sexual difficulties are a direct side effect of the medication or related to underlying ADHD symptoms, such as inattention, impulsivity, emotional dysregulation, or relationship challenges.

This is why it's super important that you communicate with your prescriber or relevant healthcare professional. It is crucial to find a way to openly discuss any changes in sexual functioning with your prescriber and/or doctor. There are many ways they can address these side effects, such as alternative medications or dosage adjustments, but they won't know this needs to happen if you don't talk to them. 

In conclusion, studies indicate that ADHD medications can have various effects on sexual functioning, with decreased libido and erectile dysfunction being among the more commonly reported side effects of stimulants and Strattera. However, ADHD itself also significantly impacts sexual health. More research is needed to fully understand these complex interactions and to develop effective strategies for managing any related difficulties.