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Erectile Difficulties, Anxiety and Antidepressants: A Guide for Gay and Bi Men
Erection problems are common and often tied to anxiety, depression or medications. Here’s what causes them and what actually helps.
Earl Johns, MSN, PMHNP-BC
Board-certified psychiatric nurse practitioner and founder of Wellthy Psychiatry & Wellness
✓ Medically reviewed by Earl Johns, MSN, PMHNP-BC
Photos are illustrative and don’t show actual patients.
Trouble getting or keeping an erection is common, but many men feel too embarrassed to bring it up. For gay and bisexual men, it can also carry extra pressure tied to sexual roles or expectations. The good news is that it’s very treatable, and it often has a lot to do with mental health.
How anxiety plays a role
Arousal depends on your nervous system being relaxed enough to let blood flow. Anxiety triggers the opposite response. One difficult experience can start a cycle: you worry it will happen again, the worry makes it happen, and the pattern repeats. This is often called performance anxiety.
Depression and desire
Depression can dull desire and pleasure, making arousal harder. Low self-esteem and body image struggles can add to this.
Medication effects
SSRIs and SNRIs, some of the most common antidepressants, can cause sexual side effects, including delayed orgasm, lower desire and erection problems. Some other medications, like certain blood pressure drugs, can also contribute. Alcohol, cannabis, meth and frequent poppers use can affect erections too.
What helps
Talk with your prescriber. Options may include adjusting the dose, changing the timing, switching to a medication with fewer sexual side effects such as bupropion, or adding a treatment. Please don’t stop a medication on your own.
Rule out physical causes. A primary care visit can check blood pressure, blood sugar, cholesterol and hormones.
Reduce the pressure. Focusing on touch and connection rather than performance can break the anxiety cycle. Therapy, including sex therapy, can help.
Be careful mixing medications. Erectile dysfunction medications should never be combined with poppers, as this can cause a dangerous drop in blood pressure.
You’re not alone
These concerns are part of health care, not something to hide. Bringing them up early usually leads to faster solutions.
A gentle next step
Wellthy Psychiatry offers judgment-free, LGBTQ+ affirming care by telehealth across California. A free 15-minute phone consult is an easy way to see if we’re a good fit.
This article is for general education and isn’t medical advice. If you’re in crisis, call or text 988, the Suicide & Crisis Lifeline, or call 911.
About the author
Earl Johns, MSN, PMHNP-BC
Board-certified psychiatric nurse practitioner · UCSF-trained · Founder of Wellthy Psychiatry & Wellness
Earl provides LGBTQ+ and neurodivergent-affirming psychiatric care, blending medication management, therapy and whole-person approaches. His background includes inpatient psychiatry and community mental health at Glenn County Behavioral Health and Equity Health, a federally qualified health center. He sees clients in San Francisco and by telehealth across California.
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