Propranolol 60 mg BID and Decreased Libido
Yes, propranolol 60 mg twice daily can definitely cause decreased libido and should be considered a likely culprit for your sexual dysfunction. Beta-blockers, particularly non-selective agents like propranolol, are well-established causes of sexual side effects including reduced libido and erectile dysfunction 1.
Evidence for Propranolol's Sexual Side Effects
The ACC/AHA Hypertension Guidelines explicitly state that beta-blockers and other antihypertensive drugs can have negative effects on libido and erectile function 1. This is not a rare or idiosyncratic reaction—it's a recognized class effect.
Mechanism and Specific Data
Propranolol, as a non-selective beta-blocker, significantly reduces both total and free testosterone levels, which directly impacts libido 2. This effect appears more pronounced with non-selective agents (propranolol, pindolol) compared to cardioselective beta-blockers 2.
Strong evidence exists specifically for propranolol's ability to inhibit erectile function, especially at higher doses 3. Your dose of 120 mg daily (60 mg BID) falls within the range where sexual dysfunction becomes more likely.
Propranolol inhibits both ejaculatory reflex capacity and erectile reflexes through mechanisms beyond simple beta-receptor blockade 4, meaning the sexual dysfunction involves both motivational (libido) and physical ability components 4.
Clinical Significance at Your Dose
Your current regimen of 60 mg twice daily (120 mg total daily) is a moderate-to-high dose:
Non-selective beta-blockers like propranolol are most commonly associated with sexual dysfunction among antihypertensive agents 5.
The degree of sexual dysfunction increases with increasing propranolol dose 4, and your 120 mg daily dose is well above the threshold where these effects become clinically significant.
Management Options
If Propranolol is for Hypertension or Cardiac Indications:
Consider switching to alternative antihypertensive classes with minimal sexual side effects: ACE inhibitors, ARBs (angiotensin receptor blockers), or calcium channel blockers have little adverse effect on sexual function 5.
Alpha-adrenergic blockers also have minimal impact on sexual function 5 and may even improve erectile function in some patients.
If Propranolol is for Anxiety or Other Non-Cardiac Indications:
Discuss alternative anxiolytic strategies with your prescriber, as the sexual side effects may outweigh benefits for quality of life.
Never abruptly discontinue propranolol—it must be tapered gradually over 1-3 weeks to prevent rebound hypertension, tachycardia, or angina 6, 7.
Critical Caveat
Do not stop or reduce propranolol without consulting your prescriber, especially if it was prescribed for cardiac arrhythmias, post-myocardial infarction, or heart failure, where abrupt discontinuation can be dangerous 6, 7. The sexual side effects, while significantly impacting quality of life, must be weighed against the cardiovascular benefits in your specific clinical context.
Bottom Line
Propranolol is a highly probable cause of your decreased libido 1, 2, 3. Work with your physician to either switch to a medication class with better sexual side effect profiles 5 or, if propranolol is essential for your condition, discuss adjunctive therapies. Phosphodiesterase-5 inhibitors (sildenafil, tadalafil) can be safely coadministered with propranolol to address erectile dysfunction 1, though they primarily address physical erectile function rather than libido itself.