Does Adderall (amphetamine and dextroamphetamine) affect libido?

Effects of Adderall on Libido and Sexual Function

Adderall (amphetamine and dextroamphetamine) can cause changes in libido, with the FDA drug label specifically listing "changes in libido" as a potential endocrine adverse effect.1

Primary Effects on Sexual Function

• Adderall and other amphetamine-based medications can cause both increases and decreases in libido, depending on individual factors, dosage, and duration of use 1
• The FDA drug label for amphetamines explicitly lists "changes in libido" and "impotence" among the potential endocrine-related adverse effects 1
• Sexual side effects are considered significant enough to be included in the official drug labeling, though they may not occur in all patients 1

Mechanisms of Action

• Amphetamines primarily enhance dopaminergic neurotransmission, which can potentially increase sexual drive in some individuals 2
• This contrasts with medications that primarily enhance serotonergic neurotransmission, which typically impair sexual arousal and function 2
• The sympathomimetic properties of amphetamines (increased norepinephrine) may also contribute to changes in sexual response 2

Clinical Evidence

• Research has demonstrated that pharmacological stimulation of dopaminergic neurotransmission (as with Adderall) can enhance sexual drive in some individuals 2
• A pilot study investigating amphetamine/dextroamphetamine for delayed orgasm found that it improved subjective sexual experience in 47.1% of participants 3
• Some case reports indicate that stimulant use can lead to hypersexuality and changes in sexual behavior patterns in certain individuals 4

Variability in Response

• Individual responses to Adderall's effects on libido can vary significantly based on:
  • Dosage (higher doses may have more pronounced effects) 3, 2
  • Duration of use (acute vs. chronic effects may differ) 3
  • Individual neurochemistry and baseline sexual function 3, 2
  • Presence of comorbid conditions 3

Clinical Considerations

• When prescribing Adderall, healthcare providers should:
  • Be aware that changes in libido (both increases and decreases) are possible side effects 1
  • Consider that older patients may be more sensitive to both therapeutic and adverse effects due to age-related changes in pharmacokinetics 5
  • Monitor for sexual side effects as part of regular follow-up assessments 5

Important Caveats

• While some individuals may experience increased libido on Adderall, this should not be considered a therapeutic use of the medication 1, 3
• The primary indication for Adderall remains ADHD treatment, and it should only be prescribed for approved medical conditions 5, 6
• Sexual side effects should be balanced against the therapeutic benefits of the medication for its intended use 5
• Patients experiencing problematic changes in sexual function should discuss these with their healthcare provider rather than adjusting medication on their own 5, 6

Conclusion

• Changes in libido (both increases and decreases) are recognized potential side effects of Adderall, as documented in the FDA drug labeling 1
• Individual responses vary, with some experiencing increased sexual drive while others may experience decreased libido or other sexual dysfunctions 1, 3, 2
• These effects should be monitored as part of comprehensive care when prescribing Adderall for its approved indications 5, 6