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: 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 and to help people work out if this is something they are struggling with. This is a highly complex area; effects vary depending on the individual, the medication, the dosage, and other factors. I am not a doctor, and these insights stem from 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, whether partnered or alone. Here are the primary areas of concern:

• Decreased Libido: Some individuals report a decrease in sexual desire while taking stimulants. This is one of the more commonly reported side effects.
• Erectile Dysfunction (ED): Research shows some cisgender men report 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 certain populations.
• Orgasm: Some individuals, across all genders, have reported difficulties reaching orgasm or a "delayed" or "muted" sensation.
• Increased Libido: Conversely, some individuals — particularly early in treatment — may experience a temporary increase in libido, as explained in this study. This is likely related to the dopamine-enhancing effects of the medication.
• Hyperfocus During Sex: Many find that their medication actually improves their sexual experience by helping them stay present, reducing the distractibility or "brain-hopping" associated with ADHD.
• Hypersexuality: In some research, stimulant use has been linked to hypersexual behaviour in a subset of individuals, though this is not a typical or well-understood side effect in therapeutic contexts.

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

The second group of ADHD medications can be further divided into two categories: Atomoxetine (Strattera) and Alpha-2 Agonists (Guanfacine, Clonidine).

• Strattera (Atomoxetine): American studies list sexual side effects including decreased libido, erectile dysfunction, ejaculation problems, and priapism (painful or prolonged erections). Research suggests these occur in a small percentage of adults and may be linked more to posology (dosage/frequency) than the medication itself.
• Alpha-2 Agonists (Guanfacine, Clonidine): These are less commonly associated with direct sexual side effects. However, some experience fatigue or sedation, which indirectly impacts desire. Impotence has been noted as a potential side effect 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.

It is crucial to differentiate between the direct pharmacological effects of the medication and the impact of improved symptom management. Better-managed ADHD symptoms can lead to improved communication and focus in relationships, indirectly benefiting sexual health. Conversely, co-occurring conditions like anxiety and depression — which are common in those with ADHD — can also significantly impact functioning. The more medications involved, the harder it becomes to isolate a single cause.

Important Considerations

1. Individual Variability: Responses to ADHD medications vary greatly. Not everyone will experience sexual side effects.
2. Dosage and Timing: The "when" and "how much" can influence side effects. Adjusting the timing of intake can often help minimise impact on intimacy.
3. Distinguishing from ADHD Symptoms: It can be difficult to determine whether difficulties are a side effect of medication or related to underlying ADHD traits like impulsivity, distractibility, or emotional dysregulation.

If you are struggling, please communicate with your prescriber. There are many ways to 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, while ADHD medications can have various effects on sexual functioning, ADHD itself significantly impacts sexual health. More research is needed to fully understand these complex interactions and to develop effective strategies for managing related difficulties.