Metoprolol and Sexual Side Effects: What You Need to Know

Metoprolol can be associated with sexual side effects, including erectile dysfunction (ED) and decreased libido, although the risk appears to be modest and varies by individual. ^[1] Some official prescribing information and clinical resources list ED and reduced sexual drive as possible adverse effects of metoprolol and its combination products. ^{[2] [3]}

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How Often Does It Happen?

• Some medical references caution that men taking metoprolol may experience difficulty achieving or maintaining an erection or a lowered interest in sex. ^[1] This recognition is reflected in drug information monographs and patient counseling materials. ^[2]
• However, research suggests part of the reported ED with beta‑blockers like metoprolol may be influenced by expectation and anxiety rather than a direct drug effect. ^[4] In a randomized study of men with newly diagnosed hypertension taking metoprolol, ED occurred more often when participants were told the medication could cause ED compared with when they were not told, indicating a significant “Hawthorne/nocebo” effect. ^[4]

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Why Might Metoprolol Affect Sexual Function?

• Beta‑blockers reduce sympathetic nervous system activity, which can potentially dampen sexual arousal and performance in some people. This mechanism has long been discussed among antihypertensive agents linked to sexual side effects. ^[5]
• Changes in sex hormones have been observed with several beta‑blockers; in a controlled study, all four tested beta‑blockers (including metoprolol) showed effects on total and free testosterone, though results on erectile function were inconclusive and more pronounced with nonselective agents like propranolol than with metoprolol. ^[6]
• Hypertension itself, along with vascular disease and psychological stress, can independently cause ED and decreased libido, making it challenging to separate the impact of the drug from the underlying condition. ^[4]

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Comparison within Beta‑Blockers and Antihypertensive Classes

• Older nonselective beta‑blockers (for example, propranolol) tend to be more frequently linked to sexual problems than cardioselective agents like metoprolol, although individual responses vary. ^[6]
• Diuretics (water pills), particularly thiazides, are commonly associated with ED among blood pressure medications and may contribute to reduced penile blood flow and lower zinc levels needed for testosterone synthesis. ^{[7] [8]}
• Clinical guidance often notes that switching to a newer beta‑blocker or adjusting therapy can help when sexual side effects occur. ^[8]

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Practical Tips if You Notice Sexual Side Effects

• Do not stop metoprolol suddenly, as abrupt discontinuation can be dangerous; discuss concerns with your clinician to plan any changes safely. ^[1]
• Consider a medication review: Your clinician may adjust the dose, switch to a different beta‑blocker, or choose another antihypertensive class less likely to affect sexual function. ^[8]
• Address other contributors: Managing cardiovascular risk factors, sleep, mood, and stress can improve sexual function independent of medication changes. ^[5]
• ED treatments: When appropriate, phosphodiesterase‑5 inhibitors (such as tadalafil) are often effective for ED; in the metoprolol study, placebo and tadalafil were similarly effective among those with ED, underscoring the psychological component for some individuals. ^[4]

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Key Takeaways

• Metoprolol can cause sexual side effects like ED or reduced libido in some men, as noted in official drug references and patient guides. ^{[1] [2]}
• The true incidence is likely lower than commonly assumed, and expectations or anxiety about side effects can play a significant role. ^[4]
• If sexual side effects occur, collaborative management with your clinician ranging from dose adjustments to switching therapies or adding ED treatments can often restore sexual function while keeping blood pressure well controlled. ^{[8] [4]}

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References

• Patient and prescribing information note potential sexual side effects, including erectile dysfunction and reduced libido. ^{[1] [2] [3]}
• Diuretics and beta‑blockers are among antihypertensives most linked to sexual side effects; thiazides are frequently implicated. ^{[7] [8]}
• A randomized study found that informing patients about possible ED increased reported ED rates on metoprolol, highlighting a nocebo/Hawthorne effect. ^[4]
• Controlled trials in healthy volunteers showed beta‑blockers can affect testosterone, with more pronounced effects for nonselective agents than metoprolol, and inconclusive direct erectile outcomes. ^[6]
• Reviews summarize mechanisms and counseling strategies for antihypertensive‑related sexual dysfunction. ^[5]