Lasting sexual side effects: not just SSRIs

Lasting sexual problems after stopping a medicine are best known with SSRIs, finasteride and isotretinoin. People have also reported them after spironolactone, some antipsychotics and supplements such as saw palmetto. These post-drug syndromes can last after stopping, and they are barely studied.

They are often more than sexual. The 2022 criteria describe PSSD as a lasting change in genital sensation, often numbness, with emotional numbing and problems with thinking. For post-finasteride syndrome they add depression and suicidality, which can happen with or without sexual problems.

If your medicine isn’t one of the well-known three, your doctor may never have heard of this. That doesn’t make it less real, and your report still counts.

Jade was prescribed spironolactone for hair loss. Her interview with Moral Medicine, a channel that films patients, shows how symptoms well beyond sex built up after a common tablet.

Play video: Jade's story, spironolactone for hair loss

Her story page describes physical, neurological and sexual symptoms that haven’t gone away.

Which other medicines have people reported?

Very few have a published record, and the clearest is a medical paper. In 2022 a group of doctors and researchers wrote diagnostic criteria for lasting problems after antidepressants, finasteride and isotretinoin. Near the end they added a short section on other drugs.

It notes reports of a state like PSSD after two psychiatric medicines that aren’t SSRIs: mirtazapine and aripiprazole, an antipsychotic. The authors say there isn’t enough data to know whether it’s a related condition or a different one. They also mention online reports after some newer blood thinners, with no published research yet.

Antipsychotics can affect sex while you take them. The NHS page on olanzapine names lower libido and erection problems, and our list of medicines with sexual side effects has more. The 2022 paper says these problems may last, but counts them as something other than PSSD.

Matt took Rexulti, another antipsychotic. His story page describes years of emotional numbness since, along with sexual problems and constant tiredness. Our article on emotional numbness from medicine covers that side of it.

That’s all the record there is: an expert consensus, a few case reports and patients’ own stories. Nobody has followed people up to count.

Can spironolactone’s side effects last after stopping?

We found no study of it, and the leaflet doesn’t say. The UK leaflet for Aldactone, a brand of spironolactone, lists a “change in sex drive for both men and women”. It gives the frequency as not known, and has no line about what happens after the last tablet.

Spironolactone is a water tablet. Its leaflet lists heart failure and fluid build-up as its uses. Hair loss isn’t on that list, though it’s what Jade took it for.

Moral Medicine says what Jade describes is close to post-finasteride syndrome. That’s the channel’s comparison, and no study has tested it. Our page on what PFS feels like lets you see the overlap for yourself.

Can a supplement like Lion’s Mane or saw palmetto do this?

There are reports, and almost no research. Lion’s Mane is a mushroom sold as a supplement for focus, so it has no patient leaflet listing side effects at all.

Ryan took it for about two weeks. His interview is worth watching for how fast it started, and for how little of it was about sex.

Play video: Ryan's story, two weeks of Lion's Mane

His story page describes panic attacks, severe insomnia, brain fog and a loss of libido and genital sensation that carried on long after he stopped. Moral Medicine says the cause isn’t clear.

Saw palmetto, which Imraan took in a multivitamin, works on the same hormone pathway as finasteride. In a 2026 case series from Florence, symptoms had lasted nearly five years on average (study).

What can I do?

These medicines help many people. If you have side effects, that’s a decision for you and your prescriber. Don’t stop a prescribed medicine suddenly, and follow what its leaflet says.

Many people say it took time to be taken seriously. Bring your dates and the leaflet line, if there is one. You can report it without a doctor agreeing.

Report it: it helps everyone

A doctor’s note helps you. A report to the medicines regulator helps everyone else: it is how patterns get noticed.

• No proof needed. A suspicion is enough, even years after stopping.
• Where: the Yellow Card scheme in the UK, MedWatch in the US. Yellow Card also takes reports on herbal medicines.
• Use the right words. There’s no medical term yet for lasting problems after most of these medicines, so say the symptoms continued after stopping. For saw palmetto, which works like finasteride, you could add Post 5-alpha-reductase inhibitor syndrome (MedDRA 10082430).

Our reporting guide walks you through it

What else do people ask?

Is it the same as PSSD or PFS? Nobody knows yet. For mirtazapine and aripiprazole, the 2022 criteria say there’s too little data to tell. Read about PSSD, PFS and PAS to compare.

How often does this happen? Nobody has counted for these medicines, and no reliable figure exists even for the best-known three. Trials rarely check sex after people stop, so patients’ reports are often the first record. Our page on side effects that last after stopping shows which leaflets already warn about it.

Can it be permanent? For some people it has lasted years after stopping. Nobody knows yet who will be affected, or whether it will ease. Our article on lasting erection problems after a medicine goes through what has been studied.

Jade’s medicine had no warning about after stopping. If yours didn’t either, you can still report what happened.

Sources

1. Healy D, Bahrick A, Bak M and colleagues. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med 2022;33(1):65-76. Read in full via Europe PMC. Section 3 describes PSSD as a lasting change in genital sensation, often numbness, alongside emotional numbing and problems with thinking. Section 5: for finasteride, cognitive impairment, depression and suicidality can occur with or without sexual difficulties. Section 8, “Other drugs”: “There are reports of a persistent sexual dysfunction that resembles PSSD after other psychotropic drugs that are not SRIs including mirtazapine and aripiprazole. There is insufficient data to know whether these states form a related or different syndrome”. Novel oral anticoagulants such as rivaroxaban and dabigatran “also appear to have produced clinical pictures that resemble PSSD and PFS. There are online reports but no peer reviewed literature about this”. “In contrast, antipsychotics cause sexual difficulties including a loss of sexual desire, erectile dysfunction, retrograde ejaculation and other problems. These states may endure, but they are not PSSD”. Section 5: “Finasteride, dutasteride and saw palmetto are 5 alpha-reductase inhibitors that can trigger an enduring sexual dysfunction with a very similar profile to PSSD.” “The incidence of these conditions is unknown.” “Clinical trials do not routinely include follow-up” of sexual side effects. An expert consensus, not a follow-up study.
2. Aldactone (spironolactone) 25 mg, 50 mg and 100 mg film-coated tablets, patient leaflet, Electronic Medicines Compendium (EMC 1619), leaflet last revised June 2025. Section 4, frequency not known: “Change in sex drive for both men and women”. Uncommon: “Menstrual problems in women”. The leaflet does not say whether side effects can continue after stopping. Section 1 lists congestive heart failure, nephrotic syndrome, ascites and oedema, malignant ascites and primary aldosteronism; hair loss is not listed.
3. Firenzuoli F, Firenzuoli B, Mascherini V and colleagues. Can we identify a post-Serenoa syndrome (PSS)? A case series on sexual and psychiatric side effects of Serenoa repens. Br J Clin Pharmacol 2026;92(4):1237-1246. Cases came from self-reports on an Italian post-finasteride syndrome forum, each followed by a clinical evaluation at the CERFIT centre in Florence. Symptoms were “severe and persistent (mean duration 4.7 years), with complete remission in only three patients”. Causality was rated “probable” in about half of reports on the Naranjo scale. Some cases had also taken finasteride. Read from the abstract (via Europe PMC; the PubMed page would not open); the number of patients is not given there.
4. Moral Medicine, interview with Jade, posted 20 May 2024 (17 minutes 37 seconds). The channel’s description says the condition is “very similar to Post-Finasteride Syndrome”. Jade is the first woman the channel featured.
5. Moral Medicine, interview with Ryan (27 minutes 35 seconds). The symptoms in the text follow our story page, which is based on the channel’s summary of the interview. The channel’s description says the mechanisms “remain unclear” and more research is needed to determine whether and how these conditions may be related.
6. Moral Medicine, interview with Matt, posted 14 July 2025 (58 minutes 15 seconds). Not embedded here. The channel files it with its PSSD material.
7. Moral Medicine, interview with Imraan. Moral Medicine says his symptoms overlap with those of post-finasteride syndrome.
8. MHRA, Yellow Card, as read on 21 October 2026. Reports can be made for suspected side effects to all medicines, “including vaccines, blood factors and immunoglobulins, herbal medicines and homeopathic remedies”.
9. NHS, Side effects of olanzapine, page last reviewed 19 February 2025. “See your doctor if you have sexual problems such as lower libido in men or women, or problems getting an erection.”