Can N-Acetylcysteine (NAC) cause a decrease in sex drive?

N-Acetylcysteine (NAC) and Sexual Function

There is no strong evidence that N-Acetylcysteine (NAC) causes decreased sex drive; in fact, limited research suggests NAC may potentially improve sexual function in certain conditions through its antioxidant properties and hormonal effects.

Effects of NAC on Sexual Function

• NAC has not been identified as a cause of decreased libido or sexual dysfunction in major clinical guidelines on sexual health or medication management 1.

• Unlike selective serotonin reuptake inhibitors (SSRIs), which are well-documented to cause sexual dysfunction including decreased libido in up to 80% of patients, NAC has not been associated with similar adverse effects 2.

• In contrast to medications that negatively impact sexual function, NAC has shown potential benefits in treating certain sexual disorders, with one case series reporting improved symptoms in patients with compulsive sexual behavior disorder 3.

Potential Mechanisms of NAC on Sexual Health

• NAC functions primarily as an antioxidant and glutathione precursor, which may actually benefit sexual function by:

  • Reducing oxidative stress in reproductive tissues 4

  • Potentially improving hormonal balance in conditions like polycystic ovary syndrome (PCOS) 4

  • Ameliorating erectile dysfunction in animal models of hyperlipidemia by inhibiting oxidative stress 5

• In women with PCOS, NAC supplementation has been shown to:

  • Decrease total testosterone levels

  • Increase follicle-stimulating hormone (FSH) levels

  • Potentially increase estrogen levels after correcting for publication bias 4

Clinical Considerations

• Sexual dysfunction is multifactorial and can be influenced by:

  • Underlying medical conditions (diabetes, cardiovascular disease) 1

  • Psychological factors (depression, anxiety, stress) 1

  • Other medications (particularly antidepressants, antihypertensives) 2

• When evaluating sexual dysfunction in a patient taking NAC:

  • Consider other medications the patient may be taking that are more likely to cause sexual side effects 2

  • Assess for medical conditions that commonly affect sexual function 1

  • Evaluate psychological factors that may be contributing to sexual dysfunction 1

Monitoring and Management

• If a patient reports decreased libido while taking NAC:

  • Conduct a thorough medication review to identify other potential culprits 2

  • Consider a trial of discontinuing NAC to determine if symptoms improve

  • Evaluate for other causes of sexual dysfunction, as NAC is unlikely to be the primary cause 1

• For patients with sexual dysfunction who are taking NAC for its therapeutic benefits:

  • The benefits of NAC therapy may outweigh any potential effects on sexual function

  • Consider adjusting the dosage if temporal relationship between NAC initiation and sexual dysfunction is established

Summary

• Current evidence does not support NAC as a cause of decreased sex drive
• Limited research suggests NAC may actually have beneficial effects on sexual function through its antioxidant properties and hormonal effects
• When evaluating sexual dysfunction, consider more common causes including other medications, medical conditions, and psychological factors