There are many pharmacological products which are employed to treat a variety of diseases and which also produce a negative incidence over male sexual performance, they can affect the nervous system or the blood flow hindering in this way an appropriate performance of the reproductive system of a man. These pharmacological products include those medicines employed to treat high blood pressure.
The antihypertensives produce important interferences on male sexual performance with more frequency than any other drug or pharmacological group. The incidence of these disorders is particularly difficult to evaluate, however there is no doubt regarding the fact that antihypertensives increase the frequency of male sexual impotence on hypertensive patients.
Thiazides, diuretics and related
This type of medications is widely employed at the beginning of the treatment for high blood pressure, though sexual disorders produced by this group are very rare, medical literature provides abundant information and there have been reported cases of a decrement of libido and impotence. It is difficult to explain the mechanism that leads to these disorders, since the Thiazides do not have significant effects at level of the central nervous system or over the hormonal balance. Some experts assert that the impotence can emerge as a result of direct effects over the smooth muscle or as a result of a diminution of the production of testosterone.
The most famous example in this category is the spironolactone. It produces an important diminution of libido and triggers male sexual impotence among other sexual performance disorders. Due to its structural similarity with the estrogen and progesterone it produces an inhibition at the level of the receptors of dihydrotestosterone. The impotence depends on the dose of the drug.
Carbonic anhydrase inhibitors
There are some anecdotal cases on medical history which relate the acetazolamide with the impotence and diminution of libido. These alterations can be reversed by removing the medication.
This group of antihypertensives has been related with the production of low levels of libido and erectile dysfunctions. Since they do not affect to alpha receptors they do not produce alterations on the ejaculation. The mechanisms which produce these alterations include sedation and the depression of the CNS, diminution of the sympathetic outflow at CNS and an excessive alpha- sympathetic tone with the consequence of a diminution on the blood flow inside the penis. The most frequent cases are associated to the timolol, propranolol and nadolol. The disorders in this case also depend on the dose and are reversible with the removal of the medication.
Antihypertensives of central action
The clonidine and the methyldopa belong to this group and are related with the emergence of impotence, a diminution of sexual desire and alterations on the ejaculation. The mechanism of the diminution of libido and the emergence of male sexual impotence is not known with certainty, but the sympatholytic activity of these medicines seems to be responsible for the ejaculatory disorders. These effects depend on the dose and in many cases are reversible.