Pharmacological Management of Hypersexuality

Sexual Side Effects of Spironolactone

Spironolactone reliably causes decreased libido and sexual dysfunction in both men and women due to its anti-androgenic properties 1
In men, spironolactone causes gynecomastia, impotence, and decreased sexual function through decreased testosterone production and competitive inhibition of testosterone and dihydrotestosterone binding to androgen receptors 2, 1
In women, the drug causes menstrual irregularities, decreased arousal, and sexual dysfunction 1
Decreased libido occurs in more than 10% of patients treated with spironolactone 1

The American Urological Association notes that cimetidine can cause clinically significant pharmacokinetic interactions when used with serotonin reuptake inhibitors (SRIs), especially in elderly patients 3
Selective serotonin reuptake inhibitors (SSRIs) cause reduced libido as a common side effect, with rates varying by agent 4, 5
Paroxetine shows the highest rates of sexual dysfunction among SSRIs 6
Sertraline at higher doses may be associated with increased frequency of erectile dysfunction and decreased libido 4, 5

Spironolactone should not be used in pregnancy as it crosses the placenta and may cause feminization of male fetuses 7
Potassium monitoring is essential, particularly in patients with comorbidities or those taking medications affecting renal, adrenal, or hepatic function 7
The sexual side effects of spironolactone can significantly impair quality of life and may not be reversible immediately upon discontinuation 2