Does Xanax Lower Sex Drive? What the Studies Actually Show

Xanax and sex drive do not have a clean study behind them. No randomized trial has measured desire in people taking alprazolam, so nobody can print a rate for this drug. What exists is a class signal: benzodiazepines came up linked to libido reduction across short panic trials against placebo. The numbers people quote belong to other benzodiazepines, or to combinations. The anxiety underneath is doing real work too, and it moves desire on its own. The honest shape of this evidence is thinner than most pages admit.

Figures from Fossey and Hamner 1994 (PMID 9160580), Ghadirian et al. 1992 (PMID 1590497) and Herder et al. 2023 (PMID 37279603).

Is it the Xanax, or is it me?

That question is the whole search bar. People arrive typing "does Xanax affect sex drive" wanting permission to blame the pill. Fair. Alprazolam is taken for anxiety and panic, and both of those lower desire before anyone swallows anything. A page about one drug has to keep two moving things apart, and most pages do not try.

This page goes one drug deep. It holds the drug and the anxiety in separate hands where the studies let it, and it says so plainly when a study never measured desire at all. Three figures are worth knowing before you read on. A meta-analysis of short panic trials found benzodiazepines associated with libido reduction, with no rate printed. A chart review of veterans put sexual complaints at 42.9% on clonazepam, and none among the men on alprazolam. A survey of people on lithium found sexual difficulties in 49% when a benzodiazepine was added, against 14% without one.

None of those is a Xanax rate, and two of them are not even about Xanax. For the other anxiety medicine we have covered, read the buspirone page. For what a stressed body does to wanting, read stress, cortisol and sex drive. For the drug class people take alongside or in place of a benzodiazepine, there is our guide to SSRIs and libido.

What the class evidence says

The closest thing to a verdict on the class is a meta-analysis of short randomized trials in acute panic disorder, each running 4 to 12 weeks against placebo (Quagliato and colleagues, 2019). It counted all-cause adverse events. SSRIs caused more adverse events overall than benzodiazepines did. On the SSRI side the risk factors were sweating and fatigue, plus nausea and diarrhea, with insomnia listed as well. On the benzodiazepine side the risk factors were memory problems and constipation, plus dry mouth. Both classes showed up for sleepiness.

The line that matters here: SSRIs were associated with abnormal finishing, while benzodiazepines were associated with libido reduction. Benzodiazepines came out protective against a fast heart rate and against sweating, and protective against fatigue and insomnia too. That abstract prints no trial count and no participant total. It gives no effect size and no confidence interval, and it prints no rate for the libido finding. It is an association flagged inside a safety analysis, which is where most drug-sexuality findings live.

The reviews around it are blunt about how little there is. La Torre and colleagues (2014) found that only a minority of published studies touch anti-anxiety medicines at all, that few are randomized controlled trials, and that most did not use a validated rating scale for sexual function. Their verdict was insufficient evidence. Demyttenaere and colleagues (1998) wrote that studying sexuality in people on mood stabilizers is tangled with confounders, and that only limited data are available on the sexual side effects of benzodiazepines and antipsychotics.

Mechanism is the one place the picture is not empty. A critical review (Hosseinzadeh Zoroufchi and colleagues, 2021) ties benzodiazepine-linked sexual effects to enhanced GABAA receptor function, and reports decreased desire and erection problems in people taking them. GABAA is also why these drugs quiet a racing night. The same receptor work that settles anxiety runs through the body's desire wiring, which is how a pill that helps you sleep can flatten wanting at the same time.

The numbers that exist, and whose they are

The figure people quote most is the clonazepam one. Fossey and colleagues (1994) went through the records of 100 men being treated for post-traumatic stress disorder. Forty-two had received clonazepam at some point, at a mean maximum dose of 3.4 milligrams a day. Eighteen of those 42, so 42.9%, complained of significant sexual problems, mostly erection problems. The same records showed diazepam in 84 men, at a mean maximum of 52.1 milligrams a day. Lorazepam appeared in eight at 3.8 milligrams a day. Alprazolam appeared in nine at 5.2 milligrams a day. None of the men on those three complained of sexual problems.

Read that number as what it is. It is a chart review with a mean dose and 9 men on alprazolam. Nine is not a rate. It is a small group in which nobody wrote a complaint down.

The other numbers belong to other people. Shetageri and colleagues (2016) scored women at an Indian psychiatry clinic and found sexual problems in 68.32%. A combination of an antidepressant and a benzodiazepine turned up more often than either medicine alone, and the group on each single drug was too small for a firm conclusion. Wainipitapong and colleagues (2023) found a sexual problem in 101 of 202 people at a Bangkok psychiatry clinic, exactly half, and found that antidepressant dosage and benzodiazepine dosage both tracked with it. García-Blanco and colleagues (2020) compared four mood-stabilizer regimens in 114 people with bipolar disorder: the group on lithium plus benzodiazepines scored worse on desire than the group on anticonvulsants alone.

So name each number by its owner. Clonazepam, 42.9%. Lithium plus a benzodiazepine, 49%. A clinic where half the people met the criteria for a sexual problem. Bipolar cohorts on combinations. Alprazolam on its own owns none of these. That bipolar study is charted on the lamotrigine page.

Trouble finishing, and the dose

The clearest dose story is one man's. Kaufman and colleagues (2018) published a case analysis of a 30-year-old man. His diagnoses were generalized anxiety disorder and social anxiety, plus panic disorder with agoraphobia. He also carried obsessive-compulsive disorder and depression in remission, with attention-deficit hyperactivity disorder on top. His other medicines were escitalopram at 10 milligrams a day and gabapentin at 1000 milligrams total daily. He also took lisdexamfetamine dimesylate at 70 milligrams a day. Nortriptyline was on the list as well, along with alprazolam extended-release.

At 1 milligram a day of alprazolam he reported no sexual problem. At 1 milligram twice a day, still nothing. Within a week of reaching 2.5 milligrams total daily dose he reported trouble finishing. Cutting back to 1 milligram twice a day cleared it, and the authors read that as dose-dependence. It rests on one man's own report while he took four other medicines that touch mood and desire. That makes it a signal worth watching. It is no finding.

Case reports are not the only source. Segraves (1988) reviewed sexual side effects of psychiatric medicine and stated that several benzodiazepines have been reported to interfere with finishing. That review leaned on case reports and small clinical series with no denominators at all, so it names a pattern without counting it. Pollack and colleagues (1992) worked through more than 130 articles on urinary and sexual side effects of psychotropic medicine. They write that these medicines can alter desire and erection. Finishing and climax are named too.

Length of use shows up as its own question. Lechin and colleagues (1996), reviewing benzodiazepine tolerability in older people, listed impairment of sexual function among the behavioral findings tied to chronic use. Drowsiness and fatigue sat on that list. So did dizziness, and the unsteady walking that comes with long use.

Is it the drug, or the anxiety underneath it?

Herder and colleagues (2023) ran a systematic review of sexual problems in people with psychiatric disorders who were taking no psychotropic medicine and free of somatic disease. Twenty-four studies, 1,199 people. For depressive disorders the reported prevalence of sexual problems ran 45% to 93%. For anxiety disorders it ran 33% to 75%. Obsessive-compulsive disorder came in at 25% to 81%, and schizophrenia at 25%. Desire was the most affected phase in depressive disorders and in post-traumatic stress disorder. Schizophrenia showed it too. In anxiety disorders the most common complaint was trouble finishing, at 7% to 48%. Nobody in those studies was on medicine.

Panic specifically gets the same treatment in Lo and colleagues (2020), a systematic review of six articles on people with panic disorder who were unmedicated. Sexual aversion ran 35.7% to 64%. Sex infrequency ran 36% to 44%. One cohort found untreated panic disorder carried a higher risk of erection problems than controls, and one study focused on women reported lower desire and less frequent sex. Two studies lost their effect after adjustment for confounding, which is the review's own caveat.

Now put those beside the drug numbers. Clonazepam, 42.9%. Lithium plus a benzodiazepine, 49%. Anxiety disorders off medicine, 33% to 75%. The untreated condition produces numbers as large as any drug figure on this page, in people taking nothing at all.

Which is the practical point. If your desire dropped the week you started alprazolam and nothing else in your life changed, the pill is a fair suspect. If it slid over months while your anxiety did the same, the anxiety is a suspect of equal size, and it moves with therapy and with time in ways a quieted receptor does not. If your labs came back fine and you still feel flat, numbers fine, still flat is where we have written that feeling down.

What has been counted, in order

Six papers carry most of what anyone has measured about benzodiazepines and desire. The work is spread across four decades and several designs. Case reports came first, in 1988. A survey of people on lithium followed in 1992. A chart review of veterans landed in 1994. A review of the whole literature reported in 2014 that the evidence was thin. A meta-analysis of short panic trials added a signal in 2019, and a 2023 review measured the illness with no drug in the picture. Each one counts something slightly different, in a group of its own, with a drug of its own. Read together they describe a class effect with fuzzy edges. None of them counted desire in people taking alprazolam on its own.

Benzodiazepines in the studies: what each measured, and whose number it is

Study	Design	Who	Finding	Whose number
Fossey 1994	Chart review	100 men with PTSD	42.9% of those on clonazepam reported sexual problems; none of the 9 on alprazolam did	Clonazepam's. Nine men is too few to say anything about Xanax.
Ghadirian 1992	Survey	104 people on lithium for bipolar disorder	49% with a benzodiazepine added reported sexual difficulties against 14% on lithium alone	The combination's.
Quagliato 2019	Meta-analysis of trials lasting 4 to 12 weeks	People in acute panic disorder	Benzodiazepines associated with libido reduction against placebo; the abstract prints no rate	The class's.
Shetageri 2016	Cross-sectional	Women at one psychiatry clinic	68.32% had a sexual problem, and combinations including a benzodiazepine fared worse; too few people per drug	The mix's.
Herder 2023	Systematic review	1,199 people taking no psychotropic medicine	Sexual problems in anxiety disorders ran 33% to 75%; trouble finishing was the most reported phase, 7% to 48%	The illness's.
Kaufman 2018	Case report	One 30-year-old man	Trouble finishing within a week of reaching 2.5 milligrams a day, gone after the dose came down	One person's.

What actually helps, graded honestly

No trial has tested a way to bring desire back while you stay on a benzodiazepine. The 2014 review of anti-anxiety medicine looked for one and reported that the literature offered no evidence supporting any specific strategy for sexual problems tied to these drugs. That is an honest zero, and it sets the order of everything below.

Start with the dose. The clearest data point on this page is a single man: trouble finishing appeared within a week of reaching 2.5 milligrams of alprazolam a day, and dropping back cleared it within days. A dose conversation with your prescriber is the first move, ahead of any supplement shelf.

The second fact explains why this is a shared project. In the panic trial reviewed by Rickels and colleagues, one third of the people on alprazolam could not stop after a taper to zero. Benzodiazepines are hard to leave, and leaving them fast carries dangers of its own. Anyone tempted to quit on their own should read that number twice before doing anything.

The third lever is the anxiety itself. In people with panic disorder who were taking no medicine, sexual aversion ran from 35.7% to 64% and sex infrequency from 36% to 44%. Across anxiety disorders generally, in people off medicine and free of somatic disease, reported sexual problems ran from 33% to 75%. The condition does part of this work by itself, so treating it well is part of treating the desire. A course of therapy aimed at panic, or a change of medicine, can move both at once.

Our page on libido after stopping antidepressants covers the period after a psychiatric drug stops. For the wider picture, see low libido in men and low libido in women.

Does it wear off on its own?

The one case on record says yes, and fast. Within a week of reaching 2.5 milligrams of alprazolam a day, the man in the 2018 report began having trouble finishing. Reducing to 1 milligram twice a day cleared it within days. A dose rise created the problem and a dose fall removed it.

Beyond that single case, nobody has measured desire after people stopped a benzodiazepine. There is no follow-up study saying when desire returns, or whether it returns at all.

What is documented is how hard stopping can be: in the panic trial, one third of the alprazolam group could not come off after a taper to zero. Treat this as a taper conversation with your prescriber, scheduled and slow.

What to bring to your prescriber

This is a short list, and it is meant to be handed over. The point of the appointment is to move the medicine conversation forward using facts you already own. Bring these six things.

1. The timeline: what changed and when, including every dose change. In the published case the trouble appeared within a week of a rise to 2.5 milligrams a day, so dates carry more weight than impressions.
2. The dose itself, in milligrams per day, and how long you have been on it.
3. A request to be asked directly. Chart reviews only count what got written down, and sexual complaints are the ones people skip. Say the word out loud in the room.
4. The anxiety underneath. Panic disorder with no medicine in the body goes with sexual aversion in 35.7% to 64% of people, so the condition belongs in the discussion too.
5. The other medicines in the mix. In the bipolar survey, lithium plus a benzodiazepine went with sexual difficulties in 49% against 14% on lithium alone. Combinations matter more than single bottles.
6. The supplement question, bottle in hand. Name everything you take, gummies and teas included.

The everyday levers, and where a botanical fits

This page is about a prescription medicine, so begin with the boundary around the supplement shelf. The label on our own bottle says: "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". If that sentence describes you, this section is information for a later day.

Desire sits on a stack of ordinary things, and most of them move. The free ones do more work than the internet admits, and they are worth a month before anything else.

• Sleep first. Broken sleep feeds anxiety, and anxiety feeds broken sleep. Sleep and testosterone covers what rest does to desire.
• Movement you can sustain. Walking three times a week is enough to count. Exercise and libido covers the wider picture.
• Treat the anxiety as the first lever, since it is doing part of this work on its own. Therapy aimed at panic belongs here.
• Time with a partner, with nothing expected at the end.
• A botanical supplement, if you want one, as the smallest lever on this list.

NUUD is a botanical supplement built around desire in general. It does nothing for anxiety. It does nothing for panic. It does nothing for the side effects of alprazolam or any other medication, and it is no quitting aid. The formula is anchored by the NUUD Mushroom Complex™, with Muira Puama, Boiled Rehmannia Root, Tribulus Terrestris, and Piper Nigrum for absorption. If your prescriber 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

Two useless answers float around this topic. One is a shrug: everyone is like that, it comes with age, stop thinking about it. The other is a forum certainty: Xanax kills libido, full stop, throw the bottle away. Neither fits the evidence, and neither helps a person at 11 at night trying to work out what happened to their desire.

The numbers sit in the middle, which is where real life sits. On clonazepam, 42.9% of the veterans in that chart review reported sexual problems, and that is a different drug. Among people on lithium, adding a benzodiazepine went with sexual difficulties in 49% against 14% on lithium alone. People with anxiety disorders who were taking no medicine at all reported sexual problems at rates from 33% to 75%.

So the drug is a candidate. So is the anxiety. Your sleep and your dose are candidates too. That combination is common, it is documented, and it moves. Readers keep arriving at the same phrase: they want to want it again, and they want to feel normal again. That is a reasonable target, and it is worth an appointment.

Frequently asked questions

Does Xanax lower sex drive?
No trial has measured desire in people taking alprazolam on its own, so nobody has a rate for this drug. The signal comes from the class as a whole. In short panic trials, benzodiazepines were associated with libido reduction against placebo. In a 1994 chart review of 100 veterans, none of the 9 men on alprazolam reported sexual problems. That is a group of 9, and an empty result there proves very little.

Does Xanax cause trouble finishing?
One man, and the pattern was clean. In a 2018 report, a 30-year-old man on 2.5 milligrams of alprazolam a day reported trouble finishing within a week of reaching that dose, and it cleared within days of the reduction. Earlier reviews list several benzodiazepines reported to interfere with finishing. Beyond that single case there is no rate, because no trial has counted it.

Do benzodiazepines lower libido?
The class signal is real, and the numbers belong to different drugs. In short panic trials, benzodiazepines were associated with libido reduction against placebo. In the veterans chart review, 42.9% of those on clonazepam reported sexual problems. In a bipolar survey, 49% of people on lithium plus a benzodiazepine reported sexual difficulties against 14% on lithium alone.

Is it the Xanax, or the anxiety?
Often both, and no study can separate them for one person. People with panic disorder who were taking no medicine showed sexual aversion from 35.7% to 64%. Across anxiety disorders, in people off medicine, reported sexual problems ran from 33% to 75%. Anxiety lowers desire by itself. A benzodiazepine added on top can add its own effect, so the two arrive together.

Can I take a botanical supplement with Xanax?
Ask your prescriber first. The label caution covers people on blood-pressure medication and people with kidney, heart or lung conditions, and that list overlaps with the people prescribed benzodiazepines most often. No interaction studies exist for this formula. NUUD does nothing for anxiety, does nothing for panic, and is no quitting aid.

Keep reading

• Does buspirone affect sex drive?
• Stress, cortisol and sex drive
• SSRIs and the libido drop: what helps
• Antidepressants and low libido
• Low libido in women
• Why is my libido so low?

References

1. Hosseinzadeh Zoroufchi B, Doustmohammadi H, Mokhtari T, Abdollahpour A. Benzodiazepines related sexual dysfunctions: A critical review on pharmacology and mechanism of action. Revista internacional de andrologia. 2021;19(1):62-68. https://pubmed.ncbi.nlm.nih.gov/32063496/
2. La Torre A, Giupponi G, Duffy DM, et al. Sexual dysfunction related to psychotropic drugs: a critical review. Part III: mood stabilizers and anxiolytic drugs. Pharmacopsychiatry. 2014;47(1):1-6. https://pubmed.ncbi.nlm.nih.gov/24222012/
3. Fossey MD, Hamner MB. Clonazepam-related sexual dysfunction in male veterans with PTSD. Anxiety. 1994;1(5):233-6. https://pubmed.ncbi.nlm.nih.gov/9160580/
4. Shetageri VN, Bhogale GS, Patil NM, Nayak RB, Chate SS. Sexual Dysfunction among Females Receiving Psychotropic Medication: A Hospital-based Cross-sectional Study. Indian journal of psychological medicine. 2016;38(5):447-454. https://pubmed.ncbi.nlm.nih.gov/27833229/
5. Kaufman KR, Coluccio M, Linke M, Noonan E, Babalola R, Aziz R. Alprazolam-induced dose-dependent anorgasmia: case analysis. BJPsych open. 2018;4(4):274-277. https://pubmed.ncbi.nlm.nih.gov/30083378/
6. Rickels K, Schweizer E. Panic disorder: long-term pharmacotherapy and discontinuation. Journal of clinical psychopharmacology. 1998;18(6 Suppl 2):12S-18S. https://pubmed.ncbi.nlm.nih.gov/9872708/
7. 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/
8. Wainipitapong S, Chiddaycha M, Charoenmakpol N. Sexual dysfunction and associated factors in Thai patients with psychiatric disorders. General psychiatry. 2023;36(2):e100989. https://pubmed.ncbi.nlm.nih.gov/37020844/
9. Segraves RT. Sexual side-effects of psychiatric drugs. International journal of psychiatry in medicine. 1988;18(3):243-52. https://pubmed.ncbi.nlm.nih.gov/2905696/
10. Pollack MH, Reiter S, Hammerness P. Genitourinary and sexual adverse effects of psychotropic medication. International journal of psychiatry in medicine. 1992;22(4):305-27. https://pubmed.ncbi.nlm.nih.gov/1363418/
11. Lechin F, van der Dijs B, Benaim M. Benzodiazepines: tolerability in elderly patients. Psychotherapy and psychosomatics. 1996;65(4):171-82. https://pubmed.ncbi.nlm.nih.gov/8843497/
12. Demyttenaere K, De Fruyt J, Sienaert P. Psychotropics and sexuality. International clinical psychopharmacology. 1998;13 Suppl 6:S35-41. https://pubmed.ncbi.nlm.nih.gov/9728673/
13. Mohammed SA, Abdelhamed A, El Sayed RM. Evaluation of Drug Abuse in Patients With Lifelong Premature Ejaculation: A Cross-Sectional Study. Sexual medicine. 2020;8(4):608-614. https://pubmed.ncbi.nlm.nih.gov/32994156/
14. García-Blanco A, García-Portillas 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/
15. Quagliato LA, Cosci F, Shader RI, et al. Selective serotonin reuptake inhibitors and benzodiazepines in panic disorder: A meta-analysis of common side effects in acute treatment. Journal of psychopharmacology (Oxford, England). 2019;33(11):1340-1351. https://pubmed.ncbi.nlm.nih.gov/31304840/
16. Lo YC, Chen HH, Huang SS. Panic Disorder Correlates With the Risk for Sexual Dysfunction. Journal of psychiatric practice. 2020;26(3):185-200. https://pubmed.ncbi.nlm.nih.gov/32421290/
17. Herder T, Spoelstra SK, Peters AWM, Knegtering H. Sexual dysfunction related to psychiatric disorders: a systematic review. The journal of sexual medicine. 2023;20(7):965-976. https://pubmed.ncbi.nlm.nih.gov/37279603/

This article is for general education and is not medical advice. Anxiety disorders and panic disorder are medical conditions that only a licensed clinician can diagnose and manage, and Xanax (alprazolam) is a prescription medicine that must never be stopped suddenly. NUUD is a botanical supplement and has no role in diagnosing, treating, curing, or preventing anxiety, panic, 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.