Does Lithium Affect Sex Drive? What the Studies Actually Show

Lithium and sex drive show up together in study data, and the picture has soft edges. About a third of people stable on lithium score in the dysfunction range on a sexual function questionnaire. The blood level of lithium does not predict who lands there, so a normal serum level tells you nothing about your desire. The drop is smaller than the internet claims, because the illness itself and the other medicines people take do part of the work. Roughly one in seven on lithium alone reported a problem. Add a benzodiazepine and it was close to half.

Figures from Grover et al. 2014 (PMID 24781439), Aizenberg et al. 1996 (PMID 8937790) and Ghadirian et al. 1992 (PMID 1590497).

Is it the lithium, or is it me?

You type the drug into a search bar and get a wall of anecdotes. That is the wrong shape of question for this one. Lithium sits in the middle of a picture with several moving parts, and the medicine is only one of them. The illness moves desire. So does sleep, so does every other pill in the cabinet.

Bipolar disorder moves desire in both directions, flooding during the high phases and vanishing during the low ones. Lithium is prescribed to steady those phases, so the drug and the illness show up in the same conversation every time you ask what changed. Most people on lithium take something else too. Antidepressants and benzodiazepines both have their own record on desire, and a symptom shared by two pills cannot be split cleanly between them.

This page goes one drug deep, which is honest about its limits and does not promise that the pill you swallow is the whole answer. For the rest of the cabinet, start with the lamotrigine page and the Seroquel page, then read the Abilify page. Your prescriber is the one who changes your medicine. These numbers exist to make that conversation sharper, and the decision stays with the two of you.

What one in three actually means

The clinic study behind the first number followed 100 people with bipolar disorder who were stable on lithium at one clinic in Chandigarh, India. Thirty seven of them scored in the dysfunction range on the Arizona Sexual Experience Scale, which is where the one third comes from. The researchers then compared those 37 with everyone who scored normally.

The group with dysfunction was older. They scored lower on everyday functioning, averaging 81.7 against 85.5 for the rest. They reported more side effects from the lithium, 2.9 against 1.4, and they took their medicine less consistently. Side effects make people skip doses, skipped doses let the illness get louder, and a louder illness moves desire on its own. One clinic, observed at one point in time, cannot untangle that knot. The study can report an association here, and it stops short of handing you a verdict.

The second study is smaller and more personal. In Petah Tikva, Israel, 11 of 35 men taking lithium on its own reported a sexual problem, which is 31.4%. The most common changes were fewer sexual thoughts, in 23%, and losing an erection during sex, in 20%. Pleasure during sex stayed intact for almost all of them. That is a strange and useful detail: the machinery kept working while the appetite for it thinned.

The men with a problem and the men without one had serum lithium levels that did not differ, and no questionnaire score tracked their blood level. This matters more than it sounds. A normal number in your blood does not clear the drug, and it does not convict it either.

The authors added that the drop they found was not a source of distress for these men, and none of them stopped taking the medicine over it.

The blood level does not predict it

The Montreal survey of 104 people found no relationship between sexual function scores and serum lithium, and none with prolactin either. The Israeli study agreed. Chasing a number in your blood is not a route back to your desire.

The Danish dosing data makes the point again. In a group taking preventive lithium, the mean dose was 23.2 millimoles a day and the mean serum concentration 0.68 millimoles a litre, an unremarkable range. About one tenth reported psychological complaints, with lowered libido and reduced potency in a few of those cases. The authors were careful to say they were not sure the medicine caused them at all.

One review of male reproduction reports lithium raising prolactin and luteinizing hormone while lowering testosterone, on few studies. That is a plausible route. Desire does not run on hormones alone, so if your levels come back low, start with whether testosterone fixes low libido.

The drug contributes, and your blood level does not say how much. The same dose that flattens one person's desire leaves another untouched, and nobody in these papers can tell you which one you are before you change something and watch what happens.

The widest gap in this literature comes from Cagliari, Italy, where 51 clinically stable people on long-term lithium alone answered a questionnaire built for that study, alongside 176 healthy controls.

Desire came never or rarely for 37.3% of the lithium group against 9.5% of controls. The rest runs in the same direction. Pleasure during intercourse was reported by 73% of them against 91% of controls, satisfaction by 57% against 83%. Eighteen percent said their sex life got worse after their bipolar disorder began, and 30% tied their sexual problems to lithium arriving. The authors flag that the questionnaire was built for this study alone, which is the careful way of saying it is not a standard instrument. Read these gaps as direction, and treat the measuring tape itself as unproven.

Lithium alone, and lithium with company

The Montreal survey is the clearest place to start, because it separates the drug from its company. Of 104 people, 14% reported sexual difficulties on lithium alone. With a benzodiazepine added, it was 49%. Those scores showed no link to serum lithium or prolactin, so what mattered was the company the lithium kept. The amount of lithium in the blood had little to do with it.

That is an association. People prescribed a benzodiazepine are often more anxious or sleeping badly, and both of those move desire on their own. A jump from 14% to 49% is still wide enough to be worth naming out loud to your prescriber.

A study of 114 people in euthymia compared whole regimens. Anticonvulsants alone came out better for sexual function than lithium alone, and better than lithium combined with benzodiazepines. Lithium alone scored worse on desire and on physical response, while both combinations scored worse on the finishing phase. Being female and being older went with lower scores across the board. The lamotrigine page charts that regimen study in full, so it stays in words here.

A comparison of 57 people across five regimens points the other way. Women on lithium alone scored lower on the Arizona scale than women on quetiapine or olanzapine, and hormone levels showed no differences between the regimens. For those women lithium on its own was the rough one, and hormones did not explain it.

The oldest comparison gives the honest baseline: 24 people with major affective disorders against controls from a surgical clinic. About a fourth of the women and about a third of the men reported dysfunction in both groups. Of the people on lithium who noticed a change, four said it was for the better and five for the worse, and more of them than the controls were dissatisfied with their sex life.

What the older reports and the single cases add

The case reports are small, and they are the only place anyone watched the problem appear and then disappear. In 1982 two men developed sexual dysfunction on lithium; one was switched to a blind placebo and the dysfunction disappeared quickly. A later report describes one man who started finishing too fast on lithium, and it resolved when the dose came down.

A systematic search turned up 13 papers on this effect. Their picture is that lithium may reduce sexual thoughts and desire, and worsen erection function and satisfaction, with the true incidence uncertain. A separate overview argues that central and peripheral mechanisms are both involved, and that none of it is fully understood. The review covering bipolar disorder and marriage puts the share of people on lithium who are affected at one third to half.

The German surveillance figures deserve a careful read, because they are easy to overread. They compare older adults with younger adults, and they never compare lithium with no lithium. In that data the relative risk tied to lithium was 1.74, while the sexual dysfunction figure was 0.03 with an interval starting at 0.00, which is a polite way of saying the numbers are thin.

Put together, that is most of the evidence on one page. The studies are small and the signal is real enough to name, while staying too loose to predict for you specifically. If your labs come back fine and you still feel flat, the page titled numbers fine, still flat explains why the lab sheet is not the end of it.

Four decades of lithium studies, in order

Lithium has been prescribed for bipolar disorder for decades, and people on it have been asking about desire for most of that time. What survives the search is a short list of studies spread across four decades, each using a different scale and a different group. None is large. Several are men only. The oldest reports cover two men, the newest compares whole regimens in 114 people. Desire drops for some people on lithium, and the blood level does not predict who. How big the effect looks depends on who else is standing in the study.

Lithium in the studies: what each measured and found.

Study	Design	Who	Lithium finding	Caveat
Grover 2014	Cross-sectional, one clinic	100 stable people on lithium	37 in the range the scale calls a sexual problem; older, more side effects, poorer adherence	Everyone here was on lithium, so there is nothing to compare against
Aizenberg 1996	Questionnaire, men only	35 men on lithium alone	31.4% reported a problem; erection loss during sex 20%; pleasure preserved	One clinic, and no group off lithium
Ghadirian 1992	Survey, self-rated	104 people on lithium	14% on lithium alone, 49% with a benzodiazepine added	A cross-sectional survey can show the benzodiazepine association, and it stops there
Zuncheddu 2006	Cross-sectional, with controls	51 on lithium, 176 controls	Desire never or rarely in 37.3% against 9.5%	Built for that study, so the questionnaire is untested elsewhere
Saroukhani 2013	Randomized, double-blind, placebo	32 men on lithium, 30 completed	Aspirin 240 milligrams a day: 63.9% improved against 14.4%	Men only, one centre, six weeks of follow-up

What actually helps, graded honestly

The honest starting point is that this field has little to offer. One systematic search found a paucity of information about how common the effect is, what goes with it, and what to do about it. A wider review of the endocrine effects of psychotropic medicines was blunter: strategies for reducing sexual problems on these medicines remain largely unsatisfactory. Everything below is an option to raise with your psychiatrist. The decision stays theirs.

The top rung is the only randomized test that exists. Saroukhani and colleagues (2013) gave 32 men on lithium maintenance aspirin 240 milligrams a day or placebo for six weeks. Thirty finished. By week 6, 63.9% of the aspirin group had improved from baseline against 14.4% on placebo, and 80% of the men on aspirin crossed the bar for a clinically important change. The trial ran at one centre with men only.

Below that sits the dose. Almeida and colleagues (2023) describe one man who developed finishing too fast after lithium; reducing the dose cleared it rapidly, and lithium was deemed the likely cause. The authors note that changing the time of the dose, and lowering it, are both worth considering. They add that people rarely volunteer sexual side effects.

Then there is the regimen itself. García-Blanco and colleagues (2020) compared regimens in 114 stable people: anticonvulsants alone had the least negative effect on sexual function, and the lithium-containing regimens scored worse. Any switch is your psychiatrist's call, and the lamotrigine page covers that study.

Two things outside the prescription belong in the same conversation, because they flatten desire on their own: depression, covered in depression and low libido, and the ordinary male picture in low libido in men.

Does it wear off on its own?

Two case reports from 1982 point in opposite directions. Blay and colleagues described one man whose problems disappeared rapidly when his medicine was swapped for a blind placebo, and a second man with similar problems who remitted on his own while continuing lithium. A prospective cohort from Denmark adds a third answer: people started on preventive lithium were examined at intervals for up to 7 years at a mean serum concentration of 0.68 millimoles a litre, and lowered libido and potency turned up in a few cases inside the one tenth who reported psychological complaints. The authors say those complaints might have been caused by the medicine, and might not have been. Nobody has followed desire month by month on lithium, so nobody can promise you it settles.

What to bring to your psychiatrist

Most of what helps here is a better conversation, because this subject almost never comes up by itself. The authors of the case report above note that people are reluctant to report sexual side effects on their own. Bring these six things to your next appointment.

1. The timeline. What changed, and when, measured against starting lithium, a dose change, and your last mood episode.
2. A request to be asked directly: 37 of 100 stable people on lithium in one study scored in the range the scale calls a sexual problem, and people rarely raise it first.
3. Every other medicine you take, above all a benzodiazepine. In Ghadirian and colleagues (1992), 49% of people on lithium plus a benzodiazepine reported difficulties against 14% on lithium alone.
4. Your blood results, for context: the level is not the lever, since neither Aizenberg nor Ghadirian linked serum lithium to sexual function scores.
5. The aspirin trial as a question to ask out loud. Whether 240 milligrams a day for six weeks makes sense in your case is a call for the person who prescribes your lithium.
6. The supplement question, bottle in hand. Lithium is cleared by the kidneys, so anything you add belongs in the same conversation.

The everyday levers, and where a botanical fits

A word about who this section is not for. The formula below carries a label caution worth reading before you decide: "avoid use if you are on blood pressure medication, have cardiovascular, renal, or pulmonary conditions, or if you are sensitive to any of the ingredients". Lithium is cleared by the kidneys, and a kidney condition is named on that label. If that sentence is about you, stop here and ask your psychiatrist.

If it is not, the levers below are ordinary, and between them they do more work than anything you can buy.

• Keep the mood stable first. That is what the drug is for, and a relapse costs you more than a dip in desire does.
• Sleep. Lithium and bipolar disorder both disturb it, and broken sleep drags desire down with it. There is a page on sleep, libido and testosterone if you want the detail.
• Movement you can keep up. Exercise and libido explains what a regular walk buys you.
• Time with a partner, with nothing expected at the end. Pressure is its own appetite killer, and it turns sex into a test.
• A botanical supplement, as the smallest lever on this list, and the only one that is optional.

None of these asks for willpower you do not have. A couple of nights of decent sleep and one evening with no goal attached move more people than any bottle does.

NUUD is a botanical supplement built around desire in general. It does nothing for bipolar disorder, for mood, or for the side effects of lithium or any other medicine, and it has no role in managing any medical condition. The formula is anchored by the NUUD Mushroom Complex™, with Muira Puama, Boiled Rehmannia Root, Tribulus Terrestris, and Piper Nigrum for absorption, on a timeline of roughly 30 to 60 minutes. If you take blood-pressure medication or have a heart, kidney or lung condition, the label says no, and your psychiatrist decides the rest. If your psychiatrist has read that label and has no objection, that is what our women's libido gummies are for. There is a men's version.

Nothing is wrong with you

There are two useless answers here. The first is the shrug: this drug has no reputation for it, your labs look fine, blame everything else. The second is the forum certainty that lithium ends your sex life, full stop. Neither matches the numbers.

Roughly a third of stable people on lithium scored in the range the scale calls a sexual problem in one clinic study, 37 of 100. In another, 31 in 100 men on lithium alone reported a problem, and their capacity for pleasure was preserved. Where a benzodiazepine was added, 49% reported difficulties against 14% on lithium alone. The blood level predicted none of it.

So the illness, the drug and the rest of your life all take a share of the flattening, and none of them owns it alone. That beats despair, because it means there is more than one thing to try.

Keep reading

• Does lamotrigine affect sex drive?
• Does Seroquel affect sex drive?
• Does Abilify affect sex drive?
• Depression and low libido
• Low libido in men
• Why is my libido so low?

Frequently asked questions

Does lithium lower sex drive?
Yes, for some people, and the numbers are big enough to take seriously. In one clinic study 37 of 100 stable people on lithium scored in the range the scale calls a sexual problem. In another, 31.4% of men on lithium alone reported one, with fewer sexual thoughts in 23%. A third study found desire never or rarely present in 37.3% of people on long-term lithium against 9.5% of controls. A survey put difficulties at 14% on lithium alone and 49% once a benzodiazepine was added.

Does lithium cause erection problems?
Yes, it can. In a questionnaire study of 35 men on lithium alone, 20% reported loss of erection during sex and 14% reported difficulty achieving or maintaining one. The mechanisms are not fully understood; reviews point to both central and peripheral pathways. The one randomized trial here is relevant: men given aspirin 240 milligrams a day for six weeks improved on the erection domain by 85.4%, against 19.7% on placebo. That trial ran at a single centre with thirty men.

Does the lithium blood level affect sex drive?
Not in the studies that looked. Aizenberg and colleagues (1996) found no difference in serum lithium between men with and without a sexual problem, and no correlation between scores and level. Ghadirian and colleagues (1992) found no relationship to serum lithium or prolactin. The Danish cohort ran at a mean serum concentration of 0.68 millimoles a litre and found lowered libido in a few cases, with the authors unsure what caused it. So the level is not a reliable lever on desire.

Will my sex drive come back if lithium is changed?
Nobody can promise it, and only your psychiatrist changes lithium. The evidence is thin and mixed. Blay and colleagues (1982) reported one man whose problems disappeared rapidly when his medicine was swapped for a blind placebo, and a second whose problems remitted while he stayed on lithium. A 2020 comparison of regimens found that anticonvulsants alone had the least negative effect on sexual function, so a regimen change is worth discussing. Do not stop or lower lithium on your own over desire.

Can I take a botanical supplement with lithium?
Ask your psychiatrist first, every time. The NUUD label caution names renal conditions, and lithium is cleared by the kidneys, so that overlap is the reason for the conversation. There are no interaction studies for this formula and lithium. NUUD does nothing for bipolar disorder, and it does nothing for the effects of lithium. A supplement belongs in the same chat as everything else you swallow.

References

1. Grover S, Ghosh A, Sarkar S, Chakrabarti S, Avasthi A. Sexual dysfunction in clinically stable patients with bipolar disorder receiving lithium. Journal of clinical psychopharmacology. 2014;34(4):475-82. https://pubmed.ncbi.nlm.nih.gov/24781439/
2. Aizenberg D, Sigler M, Zemishlany Z, Weizman A. Lithium and male sexual function in affective patients. Clinical neuropharmacology. 1996;19(6):515-9. https://pubmed.ncbi.nlm.nih.gov/8937790/
3. Kristensen E, Jørgensen P. Sexual function in lithium-treated manic-depressive patients. Pharmacopsychiatry. 1987;20(4):165-7. https://pubmed.ncbi.nlm.nih.gov/3615573/
4. Ghadirian AM, Annable L, Bélanger MC. Lithium, benzodiazepines, and sexual function in bipolar patients. The American journal of psychiatry. 1992;149(6):801-5. https://pubmed.ncbi.nlm.nih.gov/1590497/
5. Saroukhani S, Emami-Parsa M, Modabbernia A, et al. Aspirin for treatment of lithium-associated sexual dysfunction in men: randomized double-blind placebo-controlled study. Bipolar disorders. 2013;15(6):650-6. https://pubmed.ncbi.nlm.nih.gov/23924261/
6. Kesebir S, Toprak B, Baykaran B, Hariri A, Bilici M. Comparison of Sexual Function and Hormonal Parameters Between Mood Stabilizer Treatment Modalities in Bipolar Disorder. Noro psikiyatri arsivi. 2014;51(3):242-247. https://pubmed.ncbi.nlm.nih.gov/28360633/
7. Elnazer HY, Sampson A, Baldwin D. Lithium and sexual dysfunction: an under-researched area. Human psychopharmacology. 2015;30(2):66-9. https://pubmed.ncbi.nlm.nih.gov/25619161/
8. Sheibani M, Ghasemi M, Dehpour AR. Lithium and Erectile Dysfunction: An Overview. Cells. 2022;11(1):. https://pubmed.ncbi.nlm.nih.gov/35011733/
9. García-Blanco A, García-Portilla MP, Fuente-Tomás L, et al. Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder. The journal of sexual medicine. 2020;17(5):930-940. https://pubmed.ncbi.nlm.nih.gov/32139195/
10. Zuncheddu C, Carpiniello B. [Sexual dysfunctions and bipolar disorder: a study of patients submitted to a long- term lithium treatment]. La Clinica terapeutica. 2006;157(5):419-24. https://pubmed.ncbi.nlm.nih.gov/17147049/
11. Vestergaard P, Poulstrup I, Schou M. Prospective studies on a lithium cohort. 3. Tremor, weight gain, diarrhea, psychological complaints. Acta psychiatrica Scandinavica. 1988;78(4):434-41. https://pubmed.ncbi.nlm.nih.gov/3227963/
12. Almeida PA, Caldas F, de Melo IH, Moreira AM, Santos GF. Premature Ejaculation after Lithium Treatment in a Patient with Bipolar Disorder. Case reports in psychiatry. 2023;2023:6156023. https://pubmed.ncbi.nlm.nih.gov/36655208/
13. Blay SL, Ferraz MP, Calil HM. Lithium-induced male sexual impairment: two case reports. The Journal of clinical psychiatry. 1982;43(12):497-8. https://pubmed.ncbi.nlm.nih.gov/6819290/
14. Solomon R, Shvartsur R, Azab AN. The Association Between Psychotropic Drug Use and Fertility Problems Among Male Subjects. Journal of psychiatric practice. 2019;25(1):22-33. https://pubmed.ncbi.nlm.nih.gov/30633729/
15. Seifert J, Reinhard MA, Bleich S, et al. Psychotropic drug-induced adverse drug reactions in 462,661 psychiatric inpatients in relation to age: results from a German drug surveillance program from 1993-2016. Annals of general psychiatry. 2024;23(1):47. https://pubmed.ncbi.nlm.nih.gov/39558338/
16. Bhuvaneswar CG, Baldessarini RJ, Harsh VL, Alpert JE. Adverse endocrine and metabolic effects of psychotropic drugs: selective clinical review. CNS drugs. 2009;23(12):1003-21. https://pubmed.ncbi.nlm.nih.gov/19958039/
17. Drobnis EZ, Nangia AK. Psychotropics and Male Reproduction. Advances in experimental medicine and biology. 2017;1034:63-101. https://pubmed.ncbi.nlm.nih.gov/29256128/
18. Grover S, Nehra R, Thakur A. Bipolar affective disorder and its impact on various aspects of marital relationship. Industrial psychiatry journal. 2017;26(2):114-120. https://pubmed.ncbi.nlm.nih.gov/30089956/

This article is for general education and is not medical advice. Bipolar disorder is a medical condition that only a licensed clinician can diagnose and manage, and lithium is a prescription medicine that must never be stopped or changed without a psychiatrist. NUUD is a botanical supplement and has no role in diagnosing, treating, curing, or preventing bipolar disorder, the side effects of any medication, or any other disease, and these statements have not been evaluated by the Food and Drug Administration. Talk with your doctor before starting any new supplement, and do not stop or change your medication without your doctor.