Does high-potency steroid (corticosteroid) use cause hypoactive sexual desire disorder (low libido)?

From the Guidelines

High-potency steroid use can cause hypoactive sexual desire disorder (low libido) due to its suppressive effects on natural testosterone production. According to the most recent and highest quality study available, 1, cancer treatment, including the use of high-potency steroids, can cause hypogonadism, resulting in decreased libido and sexual function. This study, published in 2024, emphasizes the importance of addressing sexual dysfunction in cancer survivors and highlights the potential benefits of testosterone therapy in relieving symptoms of erectile dysfunction, problems with ejaculation, and problems with orgasm.

The use of high-potency steroids, such as prednisone, dexamethasone, and betamethasone, can disrupt the hypothalamic-pituitary-gonadal axis, leading to a reduction in natural hormone production and decreased sex drive in both men and women. Anabolic steroids, such as testosterone derivatives used for muscle building, can initially increase libido but often cause significant libido reduction when stopped due to hormonal imbalances. Other sexual side effects may include erectile dysfunction, testicular atrophy in men, and menstrual irregularities in women.

If you're experiencing low libido while on steroid medication, it's essential to consult your healthcare provider before making any changes to your treatment. They may adjust your dosage, recommend a different medication, or suggest hormone replacement therapy to address these side effects while maintaining necessary treatment for your underlying condition. Additionally, lifestyle modifications, such as smoking cessation, weight loss, and increased physical activity, can also improve erectile and sexual function, as suggested by 1.

Key points to consider:

• High-potency steroid use can suppress natural testosterone production, leading to decreased sex drive
• Testosterone therapy may relieve symptoms of erectile dysfunction, problems with ejaculation, and problems with orgasm
• Lifestyle modifications, such as smoking cessation and increased physical activity, can improve erectile and sexual function
• Consult your healthcare provider before making any changes to your treatment if you're experiencing low libido while on steroid medication.

From the Research

High-Potency Steroid Use and Hypoactive Sexual Desire Disorder

• The relationship between high-potency steroid use and hypoactive sexual desire disorder (low libido) is complex and influenced by various factors, including organic, relational, and psychological factors 2.
• Studies have shown that anabolic androgenic steroid (AAS) use can lead to a decline in libido, particularly after discontinuation of use 3, 4.
• A systematic review and meta-analysis found that AAS use resulted in significant reductions in luteinizing hormone, follicle-stimulating hormone, and endogenous testosterone levels, which can contribute to low libido 4.
• The use of high-dose AAS has been associated with de novo symptoms, including decreased libido, particularly among those using more frequently and for longer durations 3.
• Testosterone therapy (TTh) can improve sexual function, including libido, in men with overt hypogonadism, but the relationship between low testosterone levels and low libido is not straightforward 2.

Mechanisms and Effects

• The decline in libido associated with AAS use is thought to be related to the suppression of gonadotropin and testosterone levels, which can lead to hypogonadism 4.
• The effects of AAS use on the reproductive system can be profound and prolonged, lasting for several weeks to months after withdrawal 4.
• AAS use can also affect sperm changes, testicular volume, and fertility, highlighting the potential risks of high-potency steroid use 4.

Clinical Implications

• Clinicians should be aware of the potential effects of high-potency steroid use on sexual function, including libido, and monitor patients for adverse effects 5, 2.
• The assessment of serum testosterone levels is mandatory before prescribing testosterone therapy, and clinicians should consider the potential risks and benefits of treatment 2.