Medication-Induced Low Libido

Spironolactone causes decreased libido in more than 10% of patients through its anti-androgenic properties, affecting both men and women, with men experiencing decreased testosterone production and women experiencing menstrual irregularities and decreased arousal 1, 2, 3
The European Society of Cardiology recommends considering alternative treatments in patients with pre-existing sexual dysfunction, as spironolactone caused gynecomastia in 10% of men in the RALES trial 2
Alternative diuretics such as hydrochlorothiazide or chlorthalidone lack anti-androgenic effects and should be considered when sexual function is a concern 2

Fluoxetine causes sexual dysfunction, including decreased libido, in 34-58% of patients, with rates varying depending on whether patients are directly questioned or spontaneously reporting symptoms 1, 4
The American Urological Association notes that SSRIs, including fluoxetine, are effective for treating premature ejaculation, with some patients preferring to maintain the delayed ejaculation effect 4
Among SSRIs, paroxetine shows the highest rates of sexual dysfunction, causing more delay of orgasm/ejaculation and impotence than fluoxetine, sertraline, or fluvoxamine 1, 4

Management Approach

For spironolactone, consider alternative diuretics or aldosterone antagonists without anti-androgenic effects when sexual function is a priority 2
For fluoxetine, dose reduction may help as effects are dose-related, and switching to medications with different mechanisms may result in improvement in sexual function 2, 4