Buspirone and Sexual Function
Buspirone does not cause low testosterone or erectile dysfunction; in fact, it may improve sexual function in patients with anxiety disorders. 1
Evidence on Buspirone's Effects on Sexual Function
Clinical Improvement in Sexual Function
- In patients with generalized anxiety disorder, buspirone normalized sexual function in 8 of 10 patients after 4 weeks of treatment, with 9 patients having reported decreased sexual function before starting buspirone 1
- Buspirone offers a clinical advantage over traditional anxiolytics (such as benzodiazepines), which typically impair sexual function 1
Mechanism and Preclinical Data
- Animal studies show buspirone affects sexual behavior through 5-HT1A receptor mechanisms, with effects on ejaculation latency and copulatory intervals 2
- The sexual effects in animal models were dose-dependent and occurred through both systemic and spinal mechanisms 2
Distinguishing Buspirone from Other Causes of ED
When to Consider Hypogonadism
- If a patient on buspirone develops erectile dysfunction, measure morning testosterone levels if there is clinical evidence of hypogonadism (decreased libido, loss of morning erections, fatigue) 3
- Low testosterone is present in 12.5-35% of men with ED, but this is unrelated to buspirone use 3
- Free testosterone or androgen index is preferred over total testosterone to prevent unnecessary endocrine investigation 3
First-Line Treatment for ED (Regardless of Cause)
- PDE5 inhibitors (sildenafil, vardenafil, tadalafil) are first-line pharmacologic treatment with 69% success rates versus 35% for placebo 4
- PDE5 inhibitors are contraindicated with concurrent nitrate use due to dangerous hypotension risk 4
- An adequate trial requires at least 5 separate occasions at maximum dose before considering treatment failure 4
Combination Therapy for Hypogonadal Men
- For men with confirmed low testosterone and ED, combination therapy with testosterone replacement plus PDE5 inhibitors may improve outcomes, though evidence quality is limited 3, 5
- Testosterone therapy alone is not indicated for ED in men with normal testosterone levels 3
Common Pitfall to Avoid
Do not attribute sexual dysfunction to buspirone without first considering other medications the patient may be taking. Most antidepressants (SSRIs, SNRIs) commonly cause sexual dysfunction, while buspirone does not 6. If a patient is on buspirone plus an antidepressant and develops ED, the antidepressant is the likely culprit, not buspirone 6.