Does trazodone help erectile dysfunction? (+3 studies)

In this article, we will discuss whether trazodone helps erectile dysfunction. We will also discuss how trazodone helps with erectile dysfunction and share evidence from research and other related information. 

Does trazodone help erectile dysfunction? 

Yes, trazodone helps erectile dysfunction (ED). Trazodone has been used off-label to manage ED along with other medications (1). Trazodone’s potential to treat ED has been widely studied due to its ability to cause priapism as a side effect (2). 

Trazodone belongs to the group of antidepressants called serotonin antagonists and reuptake inhibitors (SARI). It is approved by the FDA to treat major depressive disorder (MDD). It is also used for sleep disturbances and other conditions (2). 

Erectile dysfunction, also known as impotence is a condition where the individual is unable to maintain an erection rigid enough for satisfactory sexual intercourse. This condition is common in men aged over 40 years (2). 

Priapism, an officially documented side effect of trazodone, is a painful and uncontrolled erection that can last for several hours (3). Due to this side effect, trazodone’s potential to treat ED has been explored. 

How does trazodone help erectile dysfunction? 

Trazodone has a multifaceted mechanism of action. It blocks the reuptake of serotonin to increase the serotonin levels. It is also an antagonist of some serotonin receptors, histamine (H1), and alpha-1 adrenergic receptors (2).

The potential of trazodone in treating ED lies in its action of blocking alpha-1 adrenergic receptors. Different alpha-adrenergic blockers are used in the treatment of ED (1). 

By blocking alpha-1 adrenergic receptors, trazodone interferes with the sympathetic control of the process where the penis returns to its non-erect stage (detumescence) (4). A delay in detumescence is involved in priapism (3). 

This mechanism helps treat ED and trazodone has shown effectiveness in improving ED, especially in those males where ED is due to psychological reasons (1). 

What does research suggest? 

Trazodone’s use in treating ED has been widely studied. In one study, 14 impotent patients were treated with trazodone and the incidence of nocturnal penile erections was observed. 68.6% of the patients showed an improvement in ED (5).

A systematic review and meta-analysis summarized the results of six trials conducted to study the effectiveness of trazodone in treating ED. Results revealed that trazodone is helpful for men with ED, and psychogenic ED (6). 

One review summarized the results of empirical therapy with trazodone for ED. 182 patients were included and the results revealed that trazodone is more helpful for ED in younger patients (7). 

How is trazodone used for erectile dysfunction?

Literature suggests that trazodone is effective for ED in higher doses. It can be used alone or in combination with other drugs used to treat ED (1). 

Trazodone at low doses does not exert its multifaceted effects. At low doses, it does not saturate other receptors. Therefore, trazodone only exerts sedative actions at the doses of 25-100mg. 

Thus, higher doses of trazodone are required to achieve its alpha-1 inhibitory effects. A dose of 150-200 mg is recommended to treat ED (1). 

What are other treatment options for erectile dysfunction?

Initial treatment of ED is through lifestyle modifications in which patients are advised to improve their diet, exercise,  avoid alcohol, drugs, and smoking, and control their diabetes and cholesterol (1)

Supplemental L-arginine has shown effectiveness in treating ED. Other medications used for ED include oral phosphodiesterase-5 inhibitors (PDE-5 inhibitors) which are the first line of treatment and testosterone supplementation (1). 

Other interventions like external vacuum devices and intraurethral prostaglandin E1 pellets are also employed in the management of ED. Trazodone can be used alone, or along with PDE-5 inhibitors to treat ED. 

What are some sexual side effects of trazodone? 

Trazodone is associated with some sexual side effects. It can affect your sex drive and can rarely cause priapism. One study on the effects of trazodone on the male reproductive system revealed that trazodone results in the following (8): 

• reduced sperm motility
• decreased sperm concentration
• increased serum follicle-stimulating hormone (FSH)
• increased luteinizing hormone (LH)
• increased testosterone 

What to do if you experience trazodone-associated sexual side effects? 

Your healthcare provider must inform you about the possible sexual side effects of trazodone before initiating the therapy. Mostly, these side effects are rare and do not impact the quality of life. 

If you experience intense sexual side effects while taking trazodone, you must inform your healthcare provider. Your healthcare provider may consider dose adjustments or switch to alternate drugs to resolve your issue. 

It is important to remember that priapism is a medical emergency and you must seek medical help if you experience this side effect. However, this side effect is rare to occur. 

In my perspective, trazodone helps with erectile dysfunction (ED). It is used off-label to treat ED either alone or along with other medications. It helps with ED due to its antagonist effects on alpha-1 adrenergic receptors. 

Trazdone’s ability to treat ED was explored due to its association with priapism as a side effect. Evidence from the literature suggests that high doses of trazodone are effective in treating ED. 

You can experience different sexual side effects while taking trazodone. You must contact your healthcare provider if you experience any intense side effects. 

References