Can asthma medication cause erectile dysfunction (ED)? Common asthma inhalers are not established causes of ED. Long term systemic corticosteroids can suppress testosterone which may contribute to sexual symptoms but direct evidence about medication induced ED in men with asthma is limited. Asthma itself has also been associated with ED. So what do studies say which medicines are worth attention and what can be done?
Asthma and ED: How Strong Is the Link?
In a large Taiwanese national database study, men with asthma were diagnosed with ED about 1.9 times as often as matched men without asthma. This is an association not proof of cause.About 2.8 million people (10.8%) in Australia have asthma, according to the Australian Bureau of Statistics.
Numerous studies have tried to establish the connection between the two conditions.
Study | Who was studied | Key finding |
3,466 men aged 18 to 55 with asthma vs 13,836 matched controls, followed for about 4.5 years | ED was diagnosed in 0.98% of men with asthma vs 0.58% of controls, an association of about 1.9 fold higher risk. Men with more than 24 asthma visits a year had a 4.2 fold higher risk than those with fewer than 12 | |
40 men aged 24 to 50 with asthma vs 20 healthy controls | 57.5% of men with asthma had some degree of ED vs 20% of controls. All men with severe ED had uncontrolled asthma | |
157 men with asthma | 52.9% had some degree of ED. Long illness duration and taking multiple medicines were linked to ED |
The studies point in a similar direction: ED was more common in men with asthma and in some studies in men with poorer control. However, two of the three studies are small and all three show association not causation.
Which Asthma Medicines May Affect Erections?
Oral corticosteroids can lower testosterone in some men. For other asthma medicines, we did not find studies linking them to ED.
Medicine type | Examples | What the evidence says | Evidence strength |
Oral corticosteroids | Prednisolone and dexamethasone | A study of 36 men with COPD found lower free testosterone in men taking oral glucocorticoids. A case control study found current steroid exposure was associated with lower total & free testosterone. These studies measured testosterone not ED | Limited: studies were small and not in asthma only |
Inhaled corticosteroids | Budesonide and fluticasone | No clear link to ED found | Limited |
Reliever inhalers | Salbutamol | No study found linking them to ED | Limited |
Other preventers and add-ons | Montelukast, tiotropium and theophylline | No study found linking them to ED | Limited |
Low testosterone is one possible contributor to ED and can reduce libido, but ED has many other causes, so the effect of steroids is only one thing to consider. A study of 90 men with uncontrolled moderate or severe asthma and 35 healthy controls found lower testosterone levels and more frequent sexual dysfunction in the men with asthma.. The researchers suggested that both asthma and oral corticosteroid treatment may be related to the severity of sexual dysfunction.
Continue prescribed asthma treatment and discuss suspected side effects with your doctor. Do not stop or change treatment yourself. Good asthma control can reduce the need for oral steroids but whether better control improves erections has not been established.
Does Asthma Cause Erectile Dysfunction? Why the Two May Be Linked
The Taiwanese researchers proposed that chronic inflammation linked to asthma could be one explanation for the association but this has not been established.
The Taiwanese researchers reported that the association remained after adjusting for other factors but an observational study cannot establish that asthma causes ED (Journal of Sexual Medicine, via UroToday).
Here are possible explanations researchers have proposed. None is established.
Pathway | How it may affect erections | Evidence |
Chronic inflammation | Low grade whole body inflammation is linked to the blood vessel changes behind ED | |
Poor asthma control | Worse control was associated with more severe ED in two studies | |
Low testosterone | Androgen deficiency was more common in men with uncontrolled asthma | |
Breathlessness and worry | Sex can trigger asthma symptoms for some people which may cause avoidance and performance anxiety |
Men suffering from asthma in the Spanish case control study were found to have a lower erectile function score compared to healthy males (59.5 as opposed to 64.3 according to IIEF) and sexual dysfunction was associated with asthma symptom control in men with asthma.
The takeaway: if you have asthma and notice erection problems, mention both to your doctor. Whether better asthma control improves erections has not been established.
Who's at Higher Risk of ED With Asthma?
ED has been reported more often in men with asthma. In some studies it was more common with poorer control or more asthma visits.
Risk factor | What the research found |
Frequent asthma visits | More than 24 clinic visits a year was associated with a 4.2 fold higher ED risk than fewer than 12 |
Uncontrolled asthma | All men with severe ED in the study had uncontrolled asthma |
Long illness and multiple medicines | Both were significantly linked to ED in 157 men with asthma |
Age | Each extra year of age was linked to about 11% higher odds of reporting moderate or complete ED (men aged 45 and over) |
Diabetes | 2.66 times the odds of moderate or complete ED |
Anxiety or depression treatment | 2.36 times the odds |
Smoking over 20 a day | 1.86 times the odds |
These findings show associations. They do not show that asthma or its treatment causes ED.
When to see a doctor
a doctor if erection difficulties recur, worry you or begin after a medication change. Also speak to your doctor if:
- Your asthma symptoms are worsening
- You suffer from constant tiredness or any other negative symptoms
This has implications beyond just the bedroom. ED can sometimes be an early warning sign of cardiovascular disease (Healthy Male).
Treatment and Management: What You Can Do
ED is often treatable, and you can work with your doctor on both your breathing and your sexual health. Some steps to discuss:
- Ask about a written asthma action plan. According to ABS statistics, 33.9% of Australians with asthma used asthma medication daily, and 32.1% had a written asthma action plan. Ask your doctor whether you should have one.
- Review oral steroid use. If you have needed oral steroid courses often, ask your doctor to review your asthma action plan. Do not stop or change steroids yourself and do not stop inhaled corticosteroids without medical advice.
- Ask your doctor whether testing is appropriate. If you have low libido or ongoing fatigue, a doctor may check your testosterone. A single result doesn’t necessarily establish deficiency so your doctor may repeat the test and consider your symptoms.
- Look after your mental health. Anxiety and depression can affect sexual function. Talking with your doctor or a counsellor may help.
- Drink responsibly. Research based on Healthy Male data reveals that smoking has been associated with increased chances of developing erectile dysfunction and that more physical activity can lead to lower chances of developing ED.
ED treatment options
If erection difficulties recur, speak to your GP about possible causes (including your medications, blood pressure, blood sugar & mental health). If you are prescribed medication for erectile dysfunction, you may also be prescribed Sildenafil or Tadalafil and will require assessment by your GP.
Talk to an Australian doctor online
DirectMeds offers online consultations with AHPRA-registered doctors, subject to availability. Let the doctor know about your asthma medicines so they can take them into account. Start your online ED assessment with DirectMeds.
Frequently Asked Questions
Does asthma medication have any effect on erectile dysfunction?
Possibly for some men. Common asthma inhalers are not established causes of ED. Oral steroids can lower testosterone as shown in research in men with COPD but direct evidence of medication induced ED in men with asthma is limited. We did not find research showing that asthma inhalers cause ED.
Do asthma inhalers have any effect on erectile dysfunction?
Common asthma inhalers are not established causes of ED and we did not find research linking inhalers to ED. If you notice changes, talk to your doctor. Do not stop or change your inhalers yourself and do not stop inhaled corticosteroids without medical advice.
Do oral steroids like prednisolone cause erectile dysfunction?
Oral steroids may lower testosterone in some men which could contribute to reduced libido or erection difficulties. A case control study found that current steroid exposure was associated with lower free and total testosterone. We did not find direct evidence that oral steroids cause ED in men with asthma. If you are concerned, talk to your doctor and do not stop steroids yourself.
Can asthma itself cause ED?
Asthma has been associated with ED but it has not been shown to cause it. A Taiwanese study of 3,466 men with asthma found about a 1.9 fold higher risk of an ED diagnosis compared with matched controls.
Is it okay to take ED medication if I suffer from asthma?
You must see a doctor first. They will evaluate your medical record and all your medications including inhalers and tablets containing steroids. Always let them know about your asthma conditions and never buy ED products online without having a prescription.
Will my ED condition improve if I learn to control my asthma better?
This has not been established. The authors of the Taiwanese study noted that it remains unclear whether more aggressive asthma treatment improves ED. Some studies have linked worse asthma control with more severe ED but that is an association. Good asthma control matters for your breathing and your doctor can help with both
When should I see a specialist for ED symptoms?
When should I see a doctor about ED symptoms?” and answer “See a doctor if erection difficulties recur, worry you or begin after a medication change. Call 000 for current chest pain or severe breathlessness.