Stress and anxiety are unwelcome yet prevalent companions in our daily lives. Most of us can probably list a handful of things triggering mental distress right now.
According to data from the early 2000s, about a third of American adults experience an anxiety disorder at some time in their lives — a number that’s likely higher today.
As a result, many people are desperately searching for solutions. A growing number of men are seeking mental health support in the form of therapy and prescription medications — which we celebrate.
For example, Xanax® (a widely prescribed medication for anxiety and panic disorders) has become a household name for its calming effect. Take your pick of TV sitcoms with a character so stressed out they need to take a Xanax for their nerves.
Pop culture aside, Xanax can be a very effective drug for mental health when used as prescribed. However, it affects your body and brain in ways that may also negatively impact your sex life.
We’re here to break down how Xanax could be a bummer in the bedroom and — most importantly — what you can do about it.
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Xanax is the brand name for alprazolam. This medication is commonly prescribed to help manage the symptoms of anxiety and panic disorders for individuals 18 and older. It may also be used for depression and fear of open spaces.
Xanax is one of the most widely prescribed benzodiazepines for generalized anxiety disorder (GAD) and panic disorders. This class of drugs also includes diazepam (generic Valium®) and lorazepam (Ativan®), among others.
Benzodiazepines are often considered instant anxiety relief medications because they’re so quickly absorbed by the body, allowing them to get right to work. Xanax starts doing its thing almost immediately after taking it and reaches peak concentration within one to two hours.
Xanax works as an anxiety medication by reducing abnormal amounts of excitement in your brain. In this context, “excitement” isn’t referring to joy and happiness but a high level of emotion (like anxiousness) that interferes with daily life.
This prescription drug amplifies the effects of the brain chemical gamma-aminobutyric acid (GABA) to relax muscles, promote sedation and alleviate irrational fears.
The result? A sense of calmness when you’re struggling with anxiousness or similar emotions disruptive to your quality of life.
For this reason, many people assume they could benefit from Xanax for sleep. However, this medication can actually reduce the amount of deep, restorative shut-eye you get — not to mention it can become addictive or tolerant, making it difficult to doze off without it. (Certain other benzodiazepines may be a better fit for treating insomnia.)
When used as directed, Xanax is usually an effective treatment for anxiety and panic disorders — but it does come with its share of potential side effects.
Xanax works directly on your brain chemicals and can impact your sex life in ways you may not appreciate. It prevents the release of dopamine — (the “feel-good” hormone) and triggers the release of GABA neurotransmitters to reduce brain excitability.
For these reasons, it’s not uncommon for sex drive to decline or to experience other obstacles in the bedroom when Xanax is in the mix.
Sexual dysfunction isn’t a widely accepted or understood side effect of Xanax. But some smaller studies suggest that sexual dysfunction effects aren’t uncommon.
Direct data on Xanax and certain sexual side effects like erectile dysfunction (ED) are limited. However, we know many men experience them.
Erectile dysfunction, the inability to achieve or maintain an erection during sex
Anorgasmia, the inability to achieve orgasm during sex or masturbation
Undesired sexual urges
Delayed ejaculation, meaning it takes longer than normal to reach orgasm
Retrograde ejaculation, when semen travels backward into the bladder rather than forward through the urethra
Low libido, also known as reduced sex drive
Not everyone will experience every possible side effect of a drug, but it’s good to be aware of what’s been reported.
Research has found that taking Xanax may lead to a decline in sexual functioning. Still, more targeted studies are needed on the specific sexual side effects of Xanax as they apply to the broader population.
You should know that Xanax doesn’t mix well with certain other medications. For instance, don’t use it with other benzodiazepines or opioid drugs.
This increases your risk of severe drowsiness and respiratory depression — when your breaths are shallow and your lungs fail to exchange carbon dioxide and oxygen efficiently, leading to carbon dioxide accumulation. Ultimately, taking Xanax with other benzos can lead to a coma or even be fatal.
Xanax also has an addictive potential, especially when used longer than recommended. This medication is considered to have a higher misuse liability, particularly among those with a history of substance abuse or excessive alcohol intake.
Listen, there’s no shame here. If you have a personal history of addictive behaviors, don’t be afraid to disclose this to your healthcare provider when discussing anxiety medication. Xanax may not be the best fit for your needs, but your provider can suggest another option.
Even if you use benzodiazepines like Xanax as they’ve been prescribed to you, you can experience physical dependence and (potentially life-threatening) withdrawal symptoms if you stop too quickly.
Always follow the directions provided, and reach out to your provider if you have questions about safely tapering off Xanax.
Experiencing sexual side effects is a mood killer, no matter the cause. If you’ve noticed new obstacles relating to your sex life since starting Xanax, there are several steps you can take to find a solution.
We get it. It’s awkward talking to anyone about performance problems — let alone a medical professional.
But just like anything else, the first step in alleviating Xanax-related sexual side effects is telling someone there’s a problem in the first place. (Remember, Xanax isn’t a drug you want to stop suddenly without an appropriate tapering plan).
What you’re experiencing could be temporary, but you won’t know until you have that conversation with a healthcare professional. If it’s unlikely to resolve on its own, your provider can walk you through your treatment options.
The typical starting dosage for Xanax when used for anxiety is 0.25 to 0.5 milligrams (mg) three times daily. It might be increased over a few days to a maximum daily dose of 4 milligrams, taken in divided doses.
A higher dose could result in more severe side effects, including sexual function issues. So lowering your dose might reduce sexual side effects for some.
Don’t adjust your dosage on your own without medical supervision. The daily dosage of Xanax shouldn’t be decreased by more than 0.5 milligrams every three days, and some people may require a slower taper.
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You might also consider using Xanax on a less frequent basis.
Your healthcare provider can help you determine whether you need to take it as often as you currently are or if your frequency could be reduced. This may help alleviate some of the sexual side effects you’re experiencing.
If all else fails — or if your provider is concerned about your safety by continuing Xanax — other medications can be just as effective for managing anxiety and panic disorders.
For instance, your provider may prescribe a different benzodiazepine or another drug class, depending on its purpose.
If Xanax remains the best option for you, improving your sexual performance might be as simple as adding an ED medication to your regimen.
There’s not a ton of evidence directly linking Xanax to the development of ED, but that doesn’t mean plenty of men aren’t experiencing it. Trouble achieving or maintaining an erection is a complaint among many guys who use Xanax.
The gold standard of ED medications is PDE5 inhibitors. They work by interfering with the activity of phosphodiesterase 5 (PDE5), an enzyme that controls the size of vessels supplying blood to the penis and other parts of the body.
Ultimately, PDE5 inhibitors increase blood flow to your penis and help you to get and stay hard during sex. Among the most widely used are:
Stendra® and its generic avanafil
Another option is to try our hard mints. These chewable ED meds contain the same active ingredients as common erectile dysfunction drugs but in personalized dosages.
Sexual difficulties are often multifactorial, meaning that there’s not always just one thing to blame. So while Xanax can contribute to sexual health problems for many men, it’s not necessarily the only culprit.
Other underlying factors that could lead to ED and other sexual function issues include:
Advanced age. Erectile dysfunction can happen to men in any season of life. However, you’re more likely to experience vascular changes that can make it difficult to stay hard during sex as you get older. ED affects an estimated 25 to 35 percent of aging men.
Lifestyle habits. Men who are sedentary, smoke cigarettes, drink alcohol in excess or use illicit drugs are more likely to struggle with sexual dysfunction.
Existing health conditions. ED is more common among men who are obese or have underlying medical issues such as diabetes, chronic kidney disease, nerve disorders or heart-related conditions like high blood pressure and atherosclerosis (buildup of fat and plaque in the arteries).
Conditions related to the penis. Having a physical deformity to the penis (like Peyronie’s disease) or experiencing prolonged, painful erections (called priapism) can lead to ED.
Use of other medications. If you’re using antidepressants, appetite suppressants, blood pressure meds or drugs for prostate cancer therapy in addition to Xanax, they could also be to blame for ED.
Low testosterone. Having abnormally low levels of this predominant male hormone can significantly impact your sex drive and contribute to erectile dysfunction.
This isn’t an exhaustive list, as ED can be triggered and worsened by many factors. Your healthcare provider is your best resource for medical advice about what may be causing your sexual woes. And they can help figure out a solution.
Mental health matters when it comes to your sex life. You might be surprised by how much the brain is involved in sexual performance. When erectile dysfunction is related to a psychological problem, it’s called psychological ED.
A multifaceted approach to treatment may provide the most effective results. If you’re already using Xanax, adding therapy is an excellent way to supplement medication for your mental health. And let’s be real: We could all use this kind of support.
Don’t have time to seek counseling in person? Try online therapy with our licensed therapists — a great option for busy men.
Nobody should have to decide between mental health and sexual health. If the medication you’ve been prescribed to help treat a psychological challenge like anxiety is also putting a damper on your sex life, it’s time to make a change.
Here’s what to remember:
Know the side effects. Xanax can be very effective in treating anxiety when used as prescribed. But it may lead to decreased libido, as well as sexual performance problems like premature ejaculation (PE) and ED. Xanax also has a higher risk for misuse and dependency, which should be taken into account if you have a history of addictive behaviors.
Know your options. If you’re unhappy with the side effects of Xanax, talk to your provider. You might be able to ride out any temporary symptoms, reduce your dosage or frequency, or find another prescription.
Consider ED medication. Adding an erectile dysfunction medication or seeking premature ejaculation treatments may also help counteract the sexual side effects of Xanax if you want to continue using it.
Know you’re not alone. Millions of men face mental health challenges like anxiety and depression. In the United States alone, 30 million adult men have ED. You’re not alone if you’re dealing with one or both of these things, and resources are available. Speak with your healthcare provider to determine the best next steps.
Whether you need guidance in the mental health or sexual health realm, we’ve got you covered. If you’re struggling with sexual performance and want to get to the bottom of it, start by taking our free quiz.
Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!
Dr. Martin Miner is the founder and former co-director of the Men’s Health Center at the Miriam Hospital in Providence, Rhode Island. He served as Chief of Family and Community Medicine for the Miriam Hospital, a teaching hospital of the Warren Alpert Medical School, from 2008 to 2018. The Men’s Health Center, under his leadership, was the first such center to open in the US. He is a clinical professor of family medicine and urology at the Warren Alpert Medical School of Brown University in Providence and has been charged with the development of a multidisciplinary Men’s Health Center within the Lifespan/Brown University system since 2008.
Dr. Miner graduated Phi Beta Kappa from Oberlin College with his AB in biology, and he received his MD from the University of Cincinnati College of Medicine. Upon receiving his MD, he completed his residency at Brown University. He practiced family medicine for 23 years, both at Harvard Pilgrim Health Care and in private practice.
Dr. Miner presently holds memberships in the American Academy of Family Physicians, the Rhode Island and Massachusetts Academy of Family Physicians, and the American Urological Association, and he is a fellow of the Sexual Medicine Society of North America. He is the former president of the American Society for Men’s Health and the current historian. He is the vice president of the Androgen Society, developed for the education of providers on the truths of testosterone therapy. Dr. Miner has served on the AUA Guideline Committees for erectile dysfunction, Peyronie’s disease, testosterone deficiency, and early screening for prostate cancer. He has served on the testosterone committees of the International Consultation on Sexual Medicine. He has presented both at the NIH and the White House on men’s health initiatives and has authored over 150 peer-reviewed publications and spoken nationally and internationally in multiple venues. He has co-chaired the Princeton III and is a steering committee member and one of the lead authors of Princeton IV, constructing guidelines for the evaluation of erectile dysfunction, the use of PDE5 inhibitors, and cardiac health and prevention.
Dr. Miner was chosen as the Brown Teacher of the Year in 2003 and 2007 and was recognized by the Massachusetts Medical Society’s Award as achieving the most significant contribution to Men’s Health: 2012.
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Miner, M., Morgentaler, A., Khera, M., & Traish, A. M. (2018). The state of testosterone therapy since the FDA's 2015 labelling changes: Indications and cardiovascular risk. Clinical endocrinology, 89(1), 3–10. https://onlinelibrary.wiley.com/doi/10.1111/cen.13589
Miner, M., Rosenberg, M. T., & Barkin, J. (2014). Erectile dysfunction in primary care: a focus on cardiometabolic risk evaluation and stratification for future cardiovascular events. The Canadian journal of urology, 21 Suppl 2, 25–38. https://www.canjurol.com/abstract.php?ArticleID=&version=1.0&PMID=24978630