From hyper- to hypo-: ADHD medications & sexual dysfunction.

Background: Although attention-deficit/hyperactivity disorder's (ADHD's) impact on academic and social outcomes is well documented, its influence on sexual health, especially in adolescents, remains poorly understood and adolescents with ADHD are at higher risk for high-risk sexual behaviors (HRSBs) and sexual dysfunction, which prior research has indicated may be somewhat influenced by medication.

Aim: To define the relationship between ADHD treatment and sexual dysfunction in adolescents, focusing on the effects of stimulant versus non-stimulant medications and gender differences.

Methods: Using de-identified electronic medical records from the TriNetX platform, this retrospective cohort study analyzed over 600 000 adolescents with ADHD. Patients were divided into male and female cohorts and further classified by stimulant, non-stimulant, or no medication use. Propensity score matching was applied to control for demographic factors. Sexual outcomes were identified using ICD-10 codes, including HRSBs, erectile dysfunction in males, and dyspareunia in females.

Outcomes: The primary outcomes of interest were HRSB with both opposite- and same-sex partners, paraphilia disorder, increased libido, hyper/compulsive sexual behavior, ejaculatory dysfunction, erectile dysfunction, contraception use, and dyspareunia.

Results: Stimulant medications were linked to increased libido and hypersexual behaviors, especially in males, who also reported higher rates of erectile dysfunction. Females on stimulants exhibited higher rates of contraceptive use and slightly elevated libido. Non-stimulant medications showed fewer sexual side effects.

Clinical implications: The findings underscore the need for clinicians to carefully consider the sexual side effects of ADHD medications, particularly stimulants, when developing treatment plans for adolescents, and gender differences in sexual dysfunction and high-risk sexual behaviors suggest that tailored interventions are necessary to address the unique needs of male and female patients.

Strengths and limitations: The limitations of this paper include its retrospective nature and the fact that the data collected were self-reported. Additionally, the lack of diversity in the patient population is a limitation.

Conclusions: Stimulant medications may exacerbate certain sexual dysfunctions, particularly in males, while non-stimulant treatments have milder effects; gender-specific differences suggest distinct sexual health impacts for males and females and clinicians should consider the potential sexual side effects of ADHD medications, particularly in adolescents, and further research is needed to explore the long-term effects of ADHD treatments on sexual health.