Based on PubMed | Can Atorvastatin cause erectile dysfunction, and how common is this side effect?

Atorvastatin and erectile dysfunction: what to know
Evidence suggests that erectile dysfunction (ED) can occur with atorvastatin, but it appears to be uncommon, and overall research shows statins do not usually worsen sexual function and may even improve it for many people. Post‑marketing safety reports include “inability to have or keep an erection” with atorvastatin, yet controlled trials and meta‑analyses generally show neutral or improved erectile function with statins. ^{[1] [2]}

Can atorvastatin cause ED?

• Atorvastatin’s consumer and professional drug information lists sexual side effects such as decreased libido and erectile problems reported after approval. These events come from voluntary reports, so frequency and causality are hard to pin down. ^{[1] [3]}
• A pharmacovigilance analysis (signal-detection study) using a national adverse-event database found a disproportional reporting signal linking statins including atorvastatin with ED; the adjusted reporting odds ratio for atorvastatin was elevated. More than half of reported cases improved after stopping the statin, and a few had positive rechallenge, suggesting a possible causal link in some individuals. ^[4]

How common is it?

• The official prescribing information summarizes common adverse reactions from large placebo‑controlled trials but does not list ED among events occurring in 2% or more of participants, implying ED was not a frequent trial‑captured side effect. When ED is reported in labeling, it typically appears in postmarketing sections without a precise rate. ^{[5] [6]}
• Because spontaneous reports lack a reliable denominator, we cannot calculate an exact percentage for ED with atorvastatin; real‑world cohort data using matched comparisons found no increased diagnosis risk of ED in statin users versus nonusers. ^[7]

What does the broader research show?

• Randomized trial meta‑analyses show a small but statistically significant improvement in erectile function scores with statins overall compared with control, suggesting a net benefit for many men, especially those with vascular risk. On average, erectile function (IIEF‑5) improved by about 3 points in these analyses. ^{[2] [8]}
• Mechanistically, statins can improve endothelial function and nitric oxide availability, which supports erections, although theoretical concerns exist about reduced steroid hormone synthesis due to cholesterol lowering. Clinical studies cited in labeling note atorvastatin does not impair adrenal reserve, and effects on male fertility are not well defined. ^{[9] [10]}

Possible mechanisms: why mixed signals?

• Potential pathways for benefit: improved blood vessel health and reduced inflammation can enhance penile blood flow. These vascular effects align with the improvements seen in erectile function scores in trials. ^{[2] [9]}
• Potential pathways for harm (less consistently observed): theoretical lowering of cholesterol might reduce testosterone synthesis in some individuals; however, consistent clinically meaningful testosterone reductions with atorvastatin have not been established in large trials. ^{[9] [10]}

Practical guidance

• If ED starts after beginning atorvastatin, other common causes should be considered (stress, diabetes, hypertension, smoking, alcohol, depression, sleep issues, low testosterone, and other medications such as certain beta‑blockers or antidepressants). Because ED is often vascular, ongoing statin therapy may actually protect sexual function over time by improving cardiovascular health. ^{[2] [8]}
• Do not stop atorvastatin on your own; talk with your clinician about timing of symptoms, dose, and alternatives. Options can include addressing reversible factors, optimizing cardiovascular risk, trial of a phosphodiesterase‑5 inhibitor (such as sildenafil), dose adjustment, or switching to another statin if a medication effect is suspected. ^{[2] [8]}

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Quick summary table

Topic	What the evidence shows
Listed in drug info	ED and reduced libido are listed as postmarketing adverse reactions for atorvastatin; frequency not estimable from these reports. [1] [3]
Clinical trial frequency	ED not among adverse events ≥2% in large placebo‑controlled datasets, suggesting it is not a common trial‑captured event. [5]
Signal from safety databases	Disproportionate reporting signal for ED with statins, including atorvastatin; many cases improved after withdrawal (signal suggests possibility but not incidence). [4]
Randomized trial meta‑analyses	Statins overall associated with modest improvement in erectile function scores versus control. [2] [8]
Real‑world cohort	No significant increase in diagnosed ED in statin users vs. nonusers after propensity matching. [7]
Mechanisms	Vascular/endothelial benefits may improve erections; theoretical hormonal effects are less clearly clinically significant. [9] [10]

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Bottom line

ED can occur in some people taking atorvastatin according to postmarketing reports, but it appears to be uncommon in clinical trials, and the best available randomized evidence suggests statins overall may slightly improve erectile function. If you notice new or worsening ED after starting atorvastatin, it’s reasonable to discuss it with your clinician to weigh benefits and risks and consider tailored strategies rather than stopping the medication abruptly. ^{[1] [5] [2] [8] [7] [4] [10]}