GROWING UP MEDICATED: THE SEXUAL HEALTH CONSEQUENCES OF PSYCHIATRIC DRUGS IN YOUNG MEN

Rising Use of Psychiatric Medications in Youth

In recent years, there has been a significant increase in the use of medications to treat conditions like attention-deficit/hyperactivity disorder (ADHD), depression, anxiety, and impulsivity in children and adolescents. As more young patients are prescribed these drugs (often in combinations), specialists in male reproductive and sexual medicine are observing more cases of sexual and reproductive side effects. It is essential for both physicians and patients (and parents) to understand what is known – and unknown – about how these medications can affect puberty, sexual function, and fertility. In this article, we take a deep dive into this topic, reviewing common medications used in youth for ADHD and other mental health conditions, their short-term and long-term impacts on sexual/reproductive health, and how to manage or avoid these side effects when possible.

Common Medications Prescribed for ADHD, Depression, and Anxiety

A wide variety of medications are now used in pediatric and adolescent populations to manage ADHD and other psychological conditions. Below is an overview of the major drug classes and examples commonly prescribed:

Stimulants for ADHD: Medications like methylphenidate (Ritalin®, Concerta®) and amphetamine mixtures(Adderall®, Vyvanse®) are first-line for ADHD. They increase dopamine/norepinephrine and help improve focus and impulse control.
Non-Stimulant ADHD Medications: These include atomoxetine (Strattera®, a selective norepinephrine reuptake inhibitor) and alpha-2 agonists such as guanfacine (Intuniv®) and clonidine (Kapvay®). They are used especially if stimulants are not tolerated or as add-on therapy.
Antidepressants (SSRIs and Others): For depression or anxiety in adolescents, selective serotonin reuptake inhibitors (SSRIs) are common (e.g. fluoxetine, sertraline, escitalopram). Some serotonin-norepinephrine reuptake inhibitors (SNRIs) (like venlafaxine or duloxetine) or atypical antidepressants like bupropion (which also can help ADHD) and mirtazapine are used in certain cases.
Anxiolytic and Other Psychiatric Medications: To manage severe anxiety or impulsive aggression, doctors may use buspirone (for anxiety), or short-term benzodiazepines (with caution, in older teens). For explosive behavioral issues or autism-related irritability, atypical antipsychotics such as risperidone or aripiprazole can be prescribed. Mood stabilizers like lithium or valproate may be used for bipolar disorder or impulsive aggression.

Polypharmacy (using multiple medications) is not uncommon – for example, an adolescent with ADHD and depression might be on a stimulant plus an SSRI. With each added medication, the risk of side effects can accumulate. Among the side effects most concerning to patients and parents are those affecting growth, puberty, sexual function, and future fertility, which historically have not been discussed as openly in pediatric care. Below, we examine what research tells us about these effects for each medication class.

Sexual and Reproductive Side Effects: What is Known?

ADHD Stimulants and Puberty Development

Stimulant medications (methylphenidate and amphetamines) are highly effective for ADHD, but they can have physical developmental effects. Growth suppression (slowed weight and height gain) in children on stimulants is well documented. More recently, studies have asked whether long-term stimulant use might also delay puberty.

A 2013 longitudinal study of boys on stimulants for >3 years found a slower rate of pubertal development compared to peers. By ages 14–16, boys treated long-term had a slightly delayed average sexual maturity rating (Tanner stage 3.6 vs 4.0 in controls of the same age). Higher stimulant doses correlated with slower growth in height during puberty, suggesting an effect on the timing of puberty.
Another analysis from a large ADHD treatment study did not find significant differences in puberty onset between medicated vs. unmedicated boys over a 3-year span. However, it did note a trend toward delayed pubertal initiation in those on stimulants, hinting that subtle delays might occur before ultimately catching up.
Clinically, the consensus is that any stimulant-related growth or pubertal delays are mild and often transient. Children with ADHD generally reach full sexual maturity, but prolonged high-dose use may shift the timing slightly. Physicians often try to use the lowest effective dose to mitigate growth/puberty suppression. “Drug holidays” (breaks from medication on weekends or summers) have been used to allow for catch-up growth, although evidence for their benefit is mixed.

ADHD Stimulants and Sexual Function

In addition to growth effects, stimulants can directly impact sexual function due to their pharmacology (increasing catecholamines like norepinephrine and dopamine). Most data here come from adolescents or adults with ADHD:

Some patients (especially adults or older teens) report erectile dysfunction or reduced sexual desire when on stimulant medication. Amphetamine (Adderall) is a vasoconstrictor and can reduce penile blood flow – men have indeed attributed difficulties in achieving an erection to Adderall use. Methylphenidate has similarly been linked to episodes of decreased libido and trouble with ejaculation. These side effects appear to be dose-dependent and may improve as the body adjusts or if the dose is lowered.
Paradoxically, other patients experience the opposite: enhanced arousal or improved sexual performance on a low dose of stimulants. Because dopamine is pivotal for libido, a stimulant can sometimes relieve sexual dysfunction caused by other factors (for example, aiding sexual function in a person who had antidepressant-related dysfunction). The net effect of stimulants on sexuality is thus complex and individualized.
Case reports highlight some rare but serious sexual side effects of stimulants. Priapism (a prolonged, painful erection) has been reported in young patients on methylphenidate – for instance, a 4-year-old boy developed priapism that resolved after the drug was stopped. Another report described a 16-year-old boy on methylphenidate experiencing spontaneous, non-arousal-related ejaculations alongside intense anxiety; his symptoms disappeared after discontinuing the stimulant. Such cases are uncommon but illustrate the stimulant’s potential to disrupt normal sexual mechanisms via norepinephrine pathways.
Effects on fertility: Research in this area is still emerging. Animal studies have found that chronic methylphenidate exposure can damage testicular tissue and reduce sperm count/motility. In humans, there are a few reports of young men who used ADHD stimulants from childhood and later developed azoospermia (no sperm) or low sperm counts. It is not proven that stimulants caused this, but a 2014 case report did raise concern about possible testicular failure associated with long-term methylphenidate use. Additionally, stimulant use may decrease semen volume and alter ejaculation by desensitizing adrenergic receptors involved in emission. These changes might go unnoticed in a healthy individual, but for someone already at risk for subfertility, they could be significant.
Overall, the long-term impact of ADHD stimulants on male fertility remains uncertain. Current data are limited, and no definitive link to lasting infertility has been proven. Researchers emphasize that decisions about continuing stimulant treatment should be individualized, weighing the clear benefits for ADHD symptoms against any potential reproductive risks. Clinicians are advised to monitor adolescent patients for pubertal progress and sexual side effects as part of routine ADHD care.

Non-Stimulant ADHD Medications (Atomoxetine, Guanfacine, Clonidine)

Non-stimulant treatments are generally considered to have a lower side effect profile for growth and sexual function, but they are not entirely free of impact:

Atomoxetine (Strattera): As a selective norepinephrine reuptake inhibitor (NRI), atomoxetine can cause some similar adrenergic side effects to stimulants. In adults, sexual side effects are reported in a subset of users – including erectile dysfunction, reduced libido, and occasionally delayed ejaculation. The manufacturer’s trials found erectile dysfunction in up to about 5–10% of adult male patients on atomoxetine, and rare cases of priapism have been noted (though causality is hard to confirm). In adolescents, there is less systematic data, but clinicians do see occasional complaints of difficulty with erection or genital numbness in older teens taking atomoxetine. A published case described an adolescent boy who developed spontaneous ejaculation after starting atomoxetine, mirroring the type of effect seen with stimulants (likely due to elevated norepinephrine tone).
On growth and puberty, atomoxetine does not seem to cause the appetite suppression that stimulants do, so impact on pubertal timing is minimal according to clinical trials. Any reports of delayed puberty on atomoxetine are sparse.
Guanfacine and Clonidine (Alpha-2 Agonists): These medications work by reducing sympathetic nerve firing and are often used for ADHD-related impulsivity or tics, and to aid sleep. Their side effects include sedation, low blood pressure, and dizziness. In adult men (for whom clonidine was historically a blood-pressure medication), sexual dysfunction is a known side effect – specifically, alpha-2 agonists can cause decreased libido and impotence by dampening the sympathetic signals involved in arousal. Clonidine in particular has been shown to suppress erectile reflexes in animal models and can inhibit arousal responses in humans. In adolescent boys, these drugs might similarly blunt sexual response, though this may go unrecognized due to limited discussion. The frequency of sexual side effects in teens on guanfacine/clonidine is not well-studied, but one can infer that an older teen might notice erectile difficulties or reduced sexual interest, especially at higher doses.
Importantly, clonidine and guanfacine do not appear to affect puberty or hormone levels significantly. Any sexual side effects they cause are pharmacologic (happening while the drug is active) and are expected to resolve once the medication is stopped.

Antidepressants (SSRIs/SNRIs) and Sexual Function in Adolescents

Selective Serotonin Reuptake Inhibitors (SSRIs) – such as Prozac® (fluoxetine), Zoloft® (sertraline), Lexapro® (escitalopram), and others – are widely used to treat adolescent depression and anxiety. It is well established in adults that SSRIs commonly cause sexual side effects (including decreased libido, erectile dysfunction, delayed ejaculation, and anorgasmia). However, this issue historically received little attention in younger patients. Key points include:

Prevalence in teens: Although large pediatric trials did not initially assess sexual side effects, clinical experience and smaller studies show that teens do experience SSRI-induced sexual dysfunction. One chart review found an incidence of about 23% for SSRI-related sexual side effects in adolescents, even though this was likely underreported. Experts suspect the true rate could be comparable to adults (where 30–50% or more report sexual issues on SSRIs). Adolescents may be less likely to volunteer such problems, so doctors have to ask proactively. As Columbia University psychiatrist Dr. Amir Levine noted, “if you don’t ask about it, especially with adolescents, they are not going to tell you,” emphasizing that sexual side effects are “very prevalent” with SSRIs.
Types of dysfunction: Teen males on SSRIs might report loss of libido (diminished sexual thoughts and interest), difficulty getting or maintaining erections, or delayed/absent orgasm when masturbating or during sexual activity. One young patient described in therapy that after starting an SSRI, his previously frequent sexual thoughts “had disappeared,” causing him to worry he’d “never have sex” – he had essentially lost all desire until the medication was adjusted. These effects can be distressing, especially as adolescents are just developing their sexual identity.
Hormonal and pubertal effects: There is emerging evidence that SSRIs can influence the hormonal axis. An analysis of a large database in 2023 found that children on SSRIs for depression or anxiety had a significantly higher risk of delayed puberty (as defined by delayed sexual maturation signs) compared to matched children not on SSRIs. The overall incidence was low (about 0.18% vs 0.13%), but an SSRI was associated with a 44% increased odds of a puberty delay diagnosis. This suggests SSRIs might, in some cases, slow the activation of the hypothalamic-pituitary-gonadal (HPG) axis, possibly by altering serotonin’s modulation of GnRH (gonadotropin-releasing hormone) or through elevating prolactin levels. Indeed, SSRIs have been noted to occasionally cause hyperprolactinemia (high prolactin), a hormone that can suppress sex hormones. More research is needed, but clinicians are advised to monitor pubertal development in adolescents on SSRIs, especially if they have been on them for multiple years.
Duration and reversibility: Most SSRI sexual side effects are reversible upon stopping the medication. A teen who has reduced libido on an SSRI will often regain normal sexual interest within weeks to months after discontinuation. However, a serious phenomenon called Post-SSRI Sexual Dysfunction (PSSD) has been recognized in some individuals. PSSD is characterized by persistent sexual symptoms (such as genital numbness, erectile dysfunction, or lack of libido) that continue for months or years after SSRIs are discontinued. It appears to be rare, but cases have been documented even in young patients. The exact incidence is unknown due to underreporting, and it’s unclear why it happens to certain people. The existence of PSSD means that for a subset of patients, an SSRI could potentially cause long-lasting changes in sexual function. Teens (and parents) should be informed of this possibility, albeit an uncommon one, when starting SSRIs.
From a practical standpoint, adolescents may not initially notice SSRI sexual side effects if they are not yet sexually active or have no point of comparison. This makes it crucial for healthcare providers to discuss and normalize questions about sexual health. Open communication can prevent misattribution (for instance, a teen might think “this is just how I am” rather than recognizing a medication effect). If unaddressed, these side effects can lead to non-adherence – young patients might quietly stop their antidepressant because they feel “numb” sexually, thereby risking relapse of depression. Doctors are encouraged to ask questions like, “Have you noticed any changes in your body or feelings, such as your interest in sex or ability to orgasm, since starting this medication?” Making it a routine part of review can help adolescents feel that it’s a normal health topic, not something taboo.

Other Antidepressants: SNRIs and Bupropion

Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor®) or duloxetine (Cymbalta®), are less commonly used in younger patients but share many of the same sexual side effects as SSRIs. Increased serotonin, whether via SSRI or SNRI, tends to dampen sexual function. Some clinicians observe that venlafaxine can be as problematic, if not more, than SSRIs for causing anorgasmia or ED, especially at higher doses. There is little pediatric-specific data, but one can extrapolate from adult data when these are prescribed to teens.

Bupropion (Wellbutrin®) is an atypical antidepressant that does not act on serotonin – it primarily affects dopamine and norepinephrine. Notably, bupropion is often considered sexual-function friendly: it tends to have minimal sexual side effects and in some cases can even improve sexual response (due to its dopaminergic action). For an adolescent who cannot tolerate SSRI side effects, bupropion is sometimes used off-label for depression or ADHD. It has the added benefit of not causing weight gain or sedation. However, bupropion can have other side effects (like decreased appetite, insomnia, or at higher doses a risk of seizures), so it’s not a panacea. Still, the option of bupropion is valuable – clinicians have used it as a strategy to mitigate SSRI-induced sexual dysfunction, either by switching to bupropion alone or adding low-dose bupropion to an SSRI regimen. This combination can counteract sexual side effects in some cases. (Any such approach should be done under close medical supervision.)

Antipsychotics (e.g. Risperidone) and Sexual/Reproductive Effects

Atypical antipsychotics are increasingly prescribed in child and adolescent psychiatry – for example, risperidone is approved for irritability in autism and is used off-label for severe ADHD aggression or conduct problems. These medications primarily affect dopamine pathways and can profoundly impact hormonal balance, especially through prolactin elevation:

Hyperprolactinemia: Drugs like risperidone and its cousin paliperidone block dopamine D2 receptors in the pituitary, which leads to increased secretion of prolactin. Elevated prolactin can cause a host of reproductive issues. In a study of boys (ages 10–20) with autism or behavior disorders on long-term risperidone, 47% had hyperprolactinemia (versus only 2% of a comparison group not on antipsychotics). Moreover, about 43% of the boys on risperidone developed gynecomastia (breast tissue growth) and 14% reported sexual dysfunction symptoms, compared to 0% sexual complaints in the unmedicated group. Sexual dysfunction in this context often meant things like erectile difficulties or low libido, which are unusual to report in early- to mid-adolescent boys unless specifically queried. These findings demonstrate that young males on risperidone are at risk for significant sexual side effects.
Pubertal delay and HPG axis suppression: Chronic high prolactin can suppress the gonadotropin hormones (LH and FSH) that drive testicular function and puberty. Clinical reports and expert reviews have noted instances of delayed sexual maturation in adolescents on long-term risperidone, presumably due to this mechanism. For example, a boy on risperidone might experience late onset of puberty (testicular enlargement and growth of genitalia might lag behind peers) or even incomplete development if prolactin remains very high. Some youths have also had halted progression of puberty or reduced testicular size on these medications. In addition, bone mineral density can suffer, since testosterone is important for bone accrual in puberty.
The good news is that these effects are usually reversible if the drug is stopped or switched. Because prolactin levels will normalize once the dopamine blockade is removed, the HPG axis can resume normal function. In practice, when a patient on risperidone shows signs of pubertal delay or significant sexual side effects, doctors may choose to:

Lower the dose of the antipsychotic, if possible, to see if prolactin levels improve.
Switch to a different antipsychotic that has less effect on prolactin. For instance, aripiprazole is often substituted or added; it can actually reduce prolactin and has a lower risk of sexual side effects. Quetiapine or olanzapine are other options with milder prolactin elevation (though olanzapine has its own metabolic side effects).
In some cases, add a low dose of aripiprazole to a regimen of risperidone. This trick exploits aripiprazole’s partial dopamine agonist effect to bring prolactin down while continuing behavioral control. Studies have shown this can reverse hyperprolactinemia and even help resume pubertal progression.

Other antipsychotics: Not all atypical antipsychotics raise prolactin. For example, olanzapine and quetiapinetend to cause transient or minimal prolactin spikes. Aripiprazole often lowers prolactin. However, sexual dysfunction can still occur via other pathways (sedation, weight gain leading to low energy/libido, etc.). In adults, antipsychotics commonly cause sexual side effects (estimated in 30–60% of patients, depending on the drug), including problems with arousal and orgasm. For adolescents, aside from prolactin-related issues, such side effects are less charted but likely under-recognized. A teen on olanzapine, for instance, might have a normal testosterone level but feel too sluggish or emotionally flat, which can dampen sexual interest.

In summary, antipsychotic medications – especially risperidone – can significantly interfere with normal sexual development and function in young males. These drugs should be used judiciously in youth, balancing psychiatric benefit against these potential effects. Families should be informed about signs of puberty delay (lack of testicular growth, lack of spontaneous erections or morning erections, etc.) and monitored regularly. If problems arise, endocrine evaluation may be warranted. Often, switching medications or reducing dose will improve the situation: one study noted that many boys on risperidone had asymptomatic hyperprolactinemia, meaning no obvious sexual symptoms, but some did have reduced sexual function that improved after changes in therapy.

Mood Stabilizers (Lithium, Valproate) and Other Medications

Mood stabilizing medications are less commonly used in adolescents than the above classes, but they are important to mention:

Lithium: Used for bipolar disorder down to adolescent ages, lithium can cause reduced libido, erectile dysfunction, and anorgasmia in some patients. The mechanism isn’t fully clear, but lithium’s impacts on thyroid function and neurotransmitters may play a role. If an adolescent male on lithium reports new-onset sexual difficulties, clinicians might check thyroid hormone levels (since hypothyroidism can dampen libido) and consider lithium as a contributor. Managing this might involve dose reduction or adding thyroid supplementation if needed.
Valproate (Divalproex Sodium): Valproate is an anticonvulsant mood stabilizer sometimes used in adolescent bipolar or aggression. It has well-known effects on the reproductive system, particularly in females (contributing to polycystic ovarian syndrome). In males, valproate can disrupt reproductive hormones and sperm. Research shows that men on valproate tend to have abnormal androgen levels, decreased sperm motility, and even erectile dysfunction more frequently than those on other medications. Valproate appears to suppress LH and FSH release from the pituitary and can also cause weight gain and insulin resistance, which indirectly lower testosterone. In pubertal boys, valproate might elevate “female” hormones (some studies noted increased estrogen levels or markers of reduced Sertoli cell function). The net result can be a form of hypogonadism: low bioavailable testosterone, leading to low sex drive or poor erections. These side effects might be subtle, but over time they raise concerns about fertility – indeed, sperm analyses of men on long-term valproate have shown reduced counts and motility in some cases. Fortunately, many of these effects are at least partly reversible after stopping valproate. A re-analysis by the UK regulatory agency noted that some cases of valproate-associated male infertility did reverse within a few months of discontinuation. Nonetheless, the recommendation is to use the lowest effective dose and periodically monitor hormonal and semen parameters in males on valproate, especially if they will be on it for years.
Other anticonvulsants (e.g. carbamazepine, oxcarbazepine, lamotrigine): These are less implicated in sexual side effects. Carbamazepine can lower testosterone levels slightly in males, but it also increases the breakdown of hormones (as an enzyme inducer). Lamotrigine is generally thought to have a neutral sexual side effect profile. Each case may vary, and data in adolescents are sparse.
Benzodiazepines: Chronic use of anti-anxiety benzodiazepines (like clonazepam or alprazolam) can cause some dampening of sexual interest due to sedation and CNS depression. They are rarely used long-term in youth, but anecdotally a teenage boy taking nightly clonazepam for panic attacks might feel reduced morning erections or delayed ejaculation. The main risk with benzodiazepines is dependency; any sexual side effect is reversible and usually overshadowed by other issues.

Symptoms and Presentations in Young Male Patients

When children, adolescents, or young adults experience sexual or reproductive side effects from their medications, the presentation can vary by age group and the specific issue. Here are some common symptoms and complaints that have been observed:

Delayed or Absent Puberty: Perhaps the most alarming sign for parents is when a boy fails to show expected pubertal changes. For example, a 14 or 15-year-old on long-term ADHD medication or risperidone might still have a childlike body habitus – minimal facial/body hair, high-pitched voice, small testes, and lack of penile growth. Peers may have hit growth spurts and voice changes, but he lags behind. This could be due to medication-related hormone suppression. Delayed puberty is typically defined in boys as no testicular enlargement by age 14. If a medication is contributing, one might also notice things like lack of spontaneous erections (no erections in the morning or during the day, which are normal in puberty due to surges in testosterone).
Gynecomastia and Breast Development: Boys on risperidone, for instance, may develop breast tissue swelling. A young adolescent might complain of tender nipples or visible breast enlargement. This is directly related to high prolactin and low testosterone, and it often accompanies other signs of hypogonadism. Gynecomastia can be very distressing for a teen boy.
Low Sexual Desire (Libido): An older adolescent (16–18 years) or a young adult male who recently started an SSRI might report that he “just doesn’t feel interested in sex” anymore. He might recognize that previously he had frequent sexual thoughts or urges, and now they are markedly diminished. In someone who has a partner, this can manifest as avoidance of sexual opportunities or indifference to sexual stimuli that used to be exciting. Low libido in a teenager is a red flag if it emerges after a medication change, given that this age typically coincides with peak sexual interest.
Erectile Dysfunction: Some young men present with the inability to get or keep an erection sufficient for sexual activity (or even for masturbation). They might describe weak erections, erections that don’t last, or a complete failure to erect even when mentally aroused. This can occur with stimulant use (due to vasoconstriction), SSRIs (due to blunted neurological arousal), or antihypertensives like clonidine. In adolescents who are not sexually active with a partner, ED may come to light as difficulty with masturbation or noticing that they no longer get morning erections.
Orgasm and Ejaculation Problems: Delayed ejaculation or anorgasmia (inability to climax) is very common with SSRIs. A young man might say that no matter how long he stimulates himself, he cannot reach orgasm or that it’s greatly delayed and less pleasurable. In some cases, retrograde ejaculation (semen going backward into the bladder) can happen due to medications with alpha-adrenergic effects (like stimulants or atomoxetine); he might note a “dry orgasm” or very low semen volume output. On the flip side, as noted, a few have experienced inappropriate spontaneous ejaculations on stimulants – essentially the ejaculatory reflex firing without sexual context, which is disconcerting and can be embarrassing.
Mood and Self-Esteem Impact: Along with these direct symptoms, many young patients experience psychological distress from sexual side effects. An adolescent may feel anxiety, shame, or confusion (“Am I normal?”). For example, a teen who cannot orgasm might start to avoid intimacy out of fear of embarrassment or might develop low self-esteem, thinking something is permanently wrong with him. It’s important to recognize these emotional sequelae; sometimes addressing the sexual side effect can dramatically improve a young person’s overall outlook and adherence to treatment.

Importantly, distinguishing medication side effects from the symptoms of the underlying condition is crucial. Depression itself can cause low libido or erectile issues; anxiety can lead to sexual performance problems. A careful history helps: if the problem started or worsened after a medication change, that is a big clue the drug is contributing. For instance, a boy with ADHD might have been perfectly fine sexually, then after increasing his stimulant dose he notices erectile trouble – pointing to the medication rather than ADHD itself (ADHD usually does not cause ED; if anything, it might cause impulsive sexual behavior instead).

Managing and Mitigating Sexual Side Effects

When a young patient develops sexual or reproductive side effects from a psychiatric medication, clinicians must navigate how to treat the side effect without sacrificing the patient’s mental health stability. Management strategies typically include:

1. Open Discussion and Reassurance: The first step is to have an honest, supportive conversation with the patient (and parents, if appropriate) about the issue. Normalize the topic – explain that these side effects are medical in nature and not the patient’s fault. Many adolescents feel relieved to learn that others have experienced similar issues on these medications and that solutions exist. Reassure them that in most cases, the side effects are reversible or manageable. It’s also critical to assess how bothersome the symptom is to the patient. For some teens, a mild decrease in libido might be tolerable if their depression is much better, whereas for others even a moderate change in sexual function is unacceptable. Patient preference should guide the approach.

2. Dose Reduction (“Using the lowest effective dose”): If clinically feasible, lowering the dosage of the offending medication can markedly improve sexual side effects. Many side effects are dose-dependent. For example, an SSRI that causes anorgasmia at 40 mg might be tolerable at 20 mg. With stimulants, a slight dose reduction or switching from a long-acting to a lower dose short-acting formulation might restore erectile function. Any dose change should be done carefully with the doctor’s supervision, as under-treating the primary condition can lead to relapse of ADHD symptoms or depression. But often there is a middle ground where symptoms are controlled and side effects are minimized.

3. Drug Holidays or Timing Adjustments: In some scenarios, patients might skip or time doses to reduce impact on sexual activity. Adult patients on SSRIs sometimes use the “weekend holiday” approach (omitting a dose on the day they plan sexual activity) to improve function – however, this is not always reliable and could risk a recurrence of depressive symptoms or withdrawal effects. In adolescents, formal drug holidays are more commonly used with stimulants (taking summers off ADHD meds to allow growth and puberty to proceed). If a stimulant is causing significant appetite suppression and growth delay, a physician might recommend pausing it during school breaks. When it comes to sexual side effects, timing daily doses differently may help in some cases; e.g., if a teenager takes his stimulant early in the morning, its effects (including on blood flow) may wear off by late afternoon or evening, which could be timed for sexual activity later in the day. Again, these approaches should be individualized and discussed openly.

4. Switching Medications: Often the most effective remedy for a persistent side effect is to switch to an alternative medication for the condition. Examples include:

Switching an adolescent from an SSRI that’s causing sexual dysfunction to another antidepressant with a lower incidence of such effects (such as bupropion or mirtazapine). Bupropion does not cause sexual inhibition and can sometimes even improve sexual desire. If appropriate for the patient’s psychiatric condition, this switch can be a win-win: resolving sexual side effects and maintaining mood control.
If an anxiety disorder is being treated with an SSRI that causes problems, consider buspirone, a non-SSRI anxiolytic that has virtually no sexual side effects. It might not be as potent for severe anxiety, but for some patients buspirone monotherapy or combination therapy can manage anxiety without the sexual toll.
Changing an ADHD medication: for instance, if a patient has ED on an amphetamine, trying methylphenidate instead (or vice versa) might make a difference, as individual reactions vary. Or moving from a stimulant to atomoxetine or vice versa if one or the other is better tolerated sexually. In some cases, adding a medication like buspirone or sildenafil alongside the stimulant has been tried in adults to counteract stimulant-induced sexual side effects (though this is not standard in adolescents).
For antipsychotic-related issues, as discussed, switching from risperidone to aripiprazole or another agent can often reverse hyperprolactinemia and restore normal pubertal progression and sexual function. This switch is commonly done if prolactin-related side effects (like gynecomastia or amenorrhea in females) appear. Aripiprazole has even been added to ongoing risperidone treatment in low dose to specifically address prolactin elevation, with good success in lowering prolactin and alleviating symptoms.
If a mood stabilizer is the culprit (e.g., valproate causing hormone issues), switching to another (like lamotrigine or lithium) could be considered, provided it still suits the psychiatric need.

5. Treating the Side Effect Itself: In some instances, rather than removing the offending drug, doctors will opt to treat the side effect with an additional medication. This is more common in adults but may be used in older adolescents on a case-by-case basis:

For SSRI-induced erectile dysfunction, a physician might prescribe a phosphodiesterase type 5 inhibitor, such as sildenafil (Viagra®) or tadalafil, to be used as needed. There is evidence in adult men that this can counteract SSRI-related ED and improve the ability to have intercourse. In a mature adolescent (e.g., 17–18 years old) in a stable relationship, this could be a consideration, with appropriate education and dosing.
For SSRI-induced anorgasmia in males or females, some clinicians add low-dose cyproheptadine or amantadine, or even buspirone, which have shown modest benefit anecdotally to reverse sexual side effects. These approaches have varying success and again are more experimental in youth.
If hyperprolactinemia from an antipsychotic is severe and switching is not possible, occasionally dopamine agonist medications like cabergoline have been used to lower prolactin. However, this is rarely done in children due to risk of exacerbating the underlying disorder (e.g., it could worsen psychosis by counteracting the antipsychotic). Usually switching the antipsychotic is preferred.
For hormonally mediated issues like delayed puberty or hypogonadism, an endocrinologist might intervene. In extreme cases of pubertal delay, testosterone replacement therapy could be considered to jump-start puberty if the benefits outweigh risks. One of the risks of testosterone therapy is the adverse effect on sperm production. But if a medication is causing the delay, the first step is to remove or replace that medication. Short-term hormonal therapy is seldom needed once the offending drug is stopped, as natural puberty will resume, but it can be an option if there’s concern about timing (for psychosocial reasons, for instance).

6. Behavioral and Supportive Interventions: Beyond pharmacologic changes, addressing the sexual side effect may involve some counseling or behavioral tweaks. For example, a therapist or doctor can work with the young patient on anxiety reduction techniques around sexual performance, if anxiety about the side effect is compounding the issue. Education about healthy sexuality, use of lubrication for genital numbness, or scheduling sexual activity for times of day when medication levels are lowest – these are all practical measures. In cases where the patient is comfortable, involving their partner in discussions (for late-teens or young adults) can be helpful so the partner understands what’s happening and can provide support rather than feeling rejected.

7. Monitoring and Follow-Up: Once any strategy is implemented – be it dose change, switch, or add-on – close follow-up is essential. The clinician will monitor both the psychiatric condition (to ensure it remains controlled) and the sexual/reproductive symptoms for improvement. Objective measures like growth charts, Tanner staging, or lab tests (hormone levels, prolactin, etc.) may be used to track recovery of normal physiology. It’s also important to continue checking in about sexual side effects at each visit, since these issues can evolve (for instance, a boy might start puberty normally but then stall, or an initial improvement in libido after a change might later plateau). Ongoing dialogue keeps the treatment on track and the patient engaged.

Alternatives to Medication: Behavioral Therapies and Other Approaches

Given the concerns about how medications can impact development and sexual health, families and clinicians often wonder about non-pharmacological or alternative treatments for these mental health conditions. While medication is very effective for many, a comprehensive approach can sometimes reduce the needed doses or avoid medications altogether, thus avoiding side effects. Here we outline some alternatives and adjuncts:

Behavioral Therapy for ADHD: For younger children (especially prepubescent boys with ADHD), behavioral interventions are recommended as first-line or adjunct therapy. This can include parent training programs (to help manage behavior with consistent routines and reinforcement), classroom modifications (like specialized education plans, extra breaks, seating arrangements), and behavior therapy with a psychologist. While these methods may not eliminate core symptoms for moderate-to-severe ADHD, they can significantly improve functioning and may allow a lower dose of medication. Exercise and sports can also be beneficial – regular physical activity has been shown to boost concentration and reduce hyperactivity in ADHD, potentially lessening reliance on high medication doses.
Psychotherapy for Anxiety and Depression: Cognitive Behavioral Therapy (CBT) is a highly effective treatment for anxiety and mild-to-moderate depression in adolescents. CBT and related therapies (like interpersonal therapy for depression) can sometimes obviate the need for medication or allow for a lower dose. For example, a teen with anxiety might learn CBT techniques to manage panic attacks or obsessive thoughts, thus not needing as high a dose of SSRI (or possibly none at all). Exposure therapy for phobias or OCD can be very successful without medication. Using therapy as a frontline approach, particularly for mild cases, can spare an adolescent from SSRI side effects altogether. Even for those on medication, therapy is a useful adjunct to build coping skills and address any self-esteem issues that arise from side effects.
Nutraceuticals and Supplements: There is interest in dietary supplements as alternative or complementary treatments. For ADHD, certain omega-3 fatty acid supplements (fish oil rich in EPA/DHA) have shown a small benefit in improving attention in youth with ADHD. Omega-3s are generally safe and have other health benefits; while they are not as potent as stimulants, they can be part of a holistic plan. Iron and zinc supplementation may help if a child is deficient, as low levels of these minerals have been linked to worse ADHD symptoms. Zinc, in some studies, modestly improved hyperactivity and impulsivity when given alongside traditional treatment. For depression, omega-3 supplements have some evidence of mood improvement as well. Additionally, ensuring adequate Vitamin D levels is important (low Vitamin D is common in teens and is associated with mood disorders). Correcting a deficiency could help mood and overall health.
Other nutraceutical approaches include herbal remedies like St. John’s Wort for depression (not usually recommended in adolescents due to drug interactions and variable potency) or valerian and chamomile for anxiety (for their calming effects). Caution is warranted with supplements, as their quality and safety in youth aren’t as regulated; however, some families choose them when prescription meds cause issues. It is important that any nutraceutical use is discussed with the healthcare provider to avoid interactions and to set realistic expectations.
Lifestyle and Holistic Approaches: Encouraging healthy lifestyle habits can indirectly improve mental health symptoms and reduce the required medication burden. Regular exercise has robust evidence for reducing depression and anxiety and improving ADHD symptoms (exercise increases neurotransmitters like dopamine and serotonin naturally). Adolescents should be guided to engage in sports, running, swimming, or even daily brisk walks – this can also boost self-confidence and counteract any medication-related weight changes that might be affecting hormone levels or body image. Sleep optimization is crucial: inadequate sleep can exacerbate ADHD and mood issues. Sometimes, addressing sleep (through better sleep hygiene or treating insomnia with melatonin or behavioral strategies) will reduce ADHD symptom severity and improve medication response. Good sleep is also vital for proper puberty progression and hormonal balance.
Mindfulness and Meditation: Mindfulness-based cognitive therapy and meditation practices have shown promise in helping adolescents manage anxiety and mood swings. These techniques teach the young person to tolerate distress and refocus attention, which can complement or reduce the need for medication. While not a direct treatment for sexual side effects, mindfulness can help a teen cope with frustration or anxiety about those side effects and reduce performance anxiety.
Off-Label Pharmacological Alternatives: In cases where standard medications cause unacceptable side effects, clinicians sometimes turn to less common pharmacological options:

For ADHD: Modafinil (Provigil®) is a wakefulness-promoting agent occasionally used off-label in ADHD. It is not a classic stimulant and has a different mechanism (influencing hypothalamic arousal circuits); it has less impact on appetite and growth than amphetamines. Some small studies found it effective for ADHD, but it’s not widely approved for pediatric use. Modafinil’s effect on sexual function isn’t well studied, but it’s thought to be minimal – in adults it’s generally neutral or mildly pro-sexual (since it can increase dopamine). This could be an option for older teens in certain cases.
For depression: Vilazodone (Viibryd®) and Vortioxetine (Trintellix®) are newer antidepressants (not yet typically first-line in adolescents, and not formally approved for teens in most places). They are touted to have fewer sexual side effects than traditional SSRIs. Vilazodone is an SSRI with partial serotonin agonist properties, and vortioxetine is a multimodal serotonergic agent. Some studies in adults showed a lower incidence of sexual dysfunction with these medications, though not zero. If an adolescent has refractory depression and cannot tolerate SSRIs due to sexual dysfunction, a psychiatrist might consider one of these, off-label, after weighing risks.
For anxiety: Beta-blockers like propranolol can be used situationally for performance anxiety (say, public speaking fears in a socially anxious teen). They help with the physical symptoms of anxiety (racing heart, tremor) and typically don’t cause sexual side effects (although non-selective beta blockers in adult men have been associated with ED in some cases). Using a low dose propranolol sparingly is unlikely to have any lasting sexual impact and might allow a teen to avoid daily SSRIs for mild anxiety.

Collaboration with Specialists: For managing complex cases, a team approach is beneficial. Pediatric endocrinologists can be consulted if there are significant puberty or hormone concerns (they can help measure hormone levels, bone age, etc., and guide whether intervention is needed). A pediatric urologist or adolescent medicine specialist can help evaluate persistent erectile or genital issues. Involving a mental health therapist alongside the prescribing physician ensures that non-medication strategies are maximized. And importantly, educating the patient and family about these side effects empowers them to be part of the decision-making – some families may opt to try a period of therapy or school accommodations before medication, once they understand the possible trade-offs.

Conclusion

The intersection of psychotropic medications with sexual and reproductive health is an important and evolving field, especially as we prescribe these drugs to ever-younger populations. We have learned that medications for ADHD, depression, anxiety, and related conditions – while often highly beneficial for mental health – can have meaningful side effects on puberty timing, sexual function, and fertility in males. Some effects are relatively common (like SSRI-related libido loss or stimulant-related erection problems), whereas others are rare (like stimulant-induced priapism or long-term fertility impacts). There remain many unknowns. For example, will an 11-year-old boy who stays on fluoxetine through high school have any lasting sexual development differences by age 20? Research is only beginning to answer such questions, and the data so far indicate a need for caution but not alarm.

What we do know is that most side effects are reversible and that by staying vigilant, healthcare providers can take steps to minimize harm. It starts with awareness: physicians should routinely monitor growth and pubertal signs in their young patients on these medications and inquire about sexual health in an age-appropriate way. For patients and parents, being informed that these side effects can happen removes stigma and encourages reporting problems early. No teenager should suffer in silence or feel embarrassed to mention sexual difficulties – these are medical issues that deserve attention just like any other side effect.

From a treatment perspective, the approach should be holistic and individualized. Often a balance can be struck: continuing the medication at a carefully managed dose, or switching to a different therapy, can often improve the sexual side effects without sacrificing mental health stability. In some cases, adding adjunct treatments (whether it’s a small dose of another medication, or therapy, or a supplement) can significantly ameliorate the situation. And in all cases, involving the patient in decisions – discussing the pros and cons of, say, staying on an SSRI versus trying therapy alone – is key, as it is ultimately about their quality of life both mentally and physically.

Finally, this is a field where more research is needed. Long-term studies following adolescents into adulthood will help clarify any persistent effects of early medication use on fertility and sexual function. Until then, clinicians are advised to “think in the long term” when treating young patients. That means using medications only as long as necessary, at the lowest effective doses, and being prepared to adjust as the child grows. The encouraging reality is that many youth will not experience significant sexual or reproductive side effects – but for those who do, we now have a better understanding and toolkit to address them.

Both physicians and patients (and their families) should feel empowered to discuss these issues frankly. When addressed properly, mental health treatment and healthy sexual development need not be mutually exclusive. With careful management, young males can continue to thrive psychologically and physically, ensuring that as they enter adulthood, they enjoy not only wellness of mind but also a healthy sexual and reproductive life.

References:

Poulton AS, et al. Medical Journal of Australia. 2013;198(1):29-32. – Long-term stimulant treatment and pubertal development (found delayed pubertal progression in adolescent boys on ADHD medication >3 years, recommending lowest effective dose).
Bieś R, et al. Pharmaceuticals (Basel). 2025;18(5):718. – Systematic review of methylphenidate’s effects on sexual function (reported both decreased libido/ejaculatory disorders in some patients and improved sexual function in others; also discusses semen parameters and rare cases like priapism and spontaneous ejaculation).
Ramasamy R, et al. F1000Research. 2014;3:207. – Case report: Testicular failure possibly associated with chronic methylphenidate use (documented a young male with idiopathic testicular failure after long-term Ritalin, suggesting a potential link).
Morjig S. Report at American Academy of Child & Adolescent Psychiatry (AACAP) Annual Meeting 2023. (Summary in Psychiatry Advisor, Oct 31, 2023) – SSRI treatment during childhood linked to delayed puberty (Large database study: SSRIs associated with higher odds of delayed puberty in children with depression/anxiety).
Rapaport L. “Antidepressants have sexual side effects in teens, too.” Reuters Health News. March 23, 2015. – Article highlighting prevalence of SSRI sexual side effects in adolescents (emphasizes that such side effects are common and often unaddressed, possibly similar in frequency to adults).
Levine A & McGlinchey E. Pediatrics. 2015;135(3):e journ. – Perspective on assessing sexual side effects in SSRI-treated teens (noted ~23% prevalence in a clinic sample, likely underreported, and urged routine assessment and strategies like dose reduction or switching to bupropion).
Roke Y, et al. J. Child Adolesc. Psychopharmacol. 2012;22(6):432-9. – Study of prolactin and sexual side effects in boys (10–20) on risperidone (found 47% had elevated prolactin; 43% with gynecomastia and 14% with sexual dysfunction on risperidone vs 0% sexual complaints in controls).
Ali J, et al. Current Psychiatry. 2008 Nov;7(11):64-72. – Review: Hyperprolactinemia in children on risperidone (discusses how sustained high prolactin from risperidone can cause delayed sexual maturation and growth suppression via HPG axis dysfunction, and management steps).
Verrotti A, et al. Curr Drug Metab. 2016;17(6):573-581. – Review of valproic acid’s impact on sexual function(summarizes that valproate is associated with endocrine disturbances: in men, abnormal androgen levels, diminished sperm parameters, and erectile issues, especially when begun in pubertal age).
SingleCare Staff. “Clonidine side effects and how to avoid them.” SingleCare (singlecare.com), 2020. – Consumer drug info (notes that clonidine can interfere with sexual function in men, commonly causing decreased libido and erectile dysfunction).
Healy D, Mangin D. Epidemiology and Psychiatric Sciences. 2024;33:e40. – Review: Post-SSRI Sexual Dysfunction (PSSD) (confirms that some patients have enduring sexual dysfunction after stopping SSRIs, characterized by genital numbness, weak or pleasureless orgasm, low libido, and ED; discusses challenges in determining prevalence).