"It's gone from grow to show," and other odd penis behavior...

April 17, 2012 5:28 PM

My blood pressure medication seems to be causing some not entirely undesirable side effects on my penis. Is this normal? Is there any need for concern?

I’m a male in my late 30s and for the last few months I’ve been on a prescription of Clonidine, Lisinopril and Hydrochlorothiazide to keep my blood pressure under control. It seems to be working, I check my pressure daily and it is usually around 105-110/65-70.
Now the side effects:

My daily morning erections have stopped completely, not such a bad thing. Make that morning pee a simpler affair.

My ability to maintain an erection, while still entirely manageable is somewhat diminished.

My formerly shy penis now spends all its down time hanging out about 80% of its erect length. An odd change.

So is this typical, could it be a sign of a more severe underlying problem? My next scheduled doctor visit isn’t for another couple months should I make it sooner?

posted by anonymous to health & fitness (8 answers total)

I don't know those drugs, but i can explain the phenomenon to you here.

think of your arteries like a garden hose and the water like blood. i'm going to mix up this metaphor a bit here, stay with me.

if the water is on too hard (your body is producing too much blood) or the hose diameter is skinnier (either because of plaque build-up on your arteries or the fact that they're contracted) the water will shoot out faster.

basically, your medicine is either turning down the water pressure (telling the body to produce less blood) or making the hose wider (telling the arteries to stop contracting, or telling the plaque to go away). What happens is that the water shoots out of the end less furiously.

The blood pressure is lower everywhere, including in your penis, so things are a little less, um, rigid.

If you're worried about it, i doubt you'll find anyone on mefi who tells you NOT to see a doctor, but in the absence of other signs of low blood pressure, pain, or inability to have an erection, it seems to this non-doctor that you could probably wait till your next appointment. your blood pressure seems a little low to me, i'd keep an eye on it. if it goes below 105/65 i'd want to talk to my doctor about adjusting my meds.
posted by andreapandrea at 5:58 PM on April 17, 2012

Do you have insurance? Is something weird going on with your junk?

If the answer to to both of these questions is yes, then see a doctor as soon as is convenient.
posted by pseudonick at 6:30 PM on April 17, 2012 [2 favorites]

It is well established that BP meds can mess with your mojo. I'd see about adjusting the dose or trying a different med if it's a problem.
posted by brevator at 6:32 PM on April 17, 2012

I am not a doctor, but i have a penis and high blood pressure. I'm on spirolactalone, myself. For two reasons: one, it blocks the hell out of testosterone (highly desired because I'm a transwoman). Two, it does a lot to moderate my blood pressure down from "how are you still alive" to "a little elevated" (highly desired because I like not having a heart attack or aneurysm).

My penis is distinctly uninterested in getting or maintaining an erection; it basically needs constant attention to stay up. It's also shrunk. I think it still gains the same amount of mass when erect - I was always more a grower than a shower - but I think it doesn't get as long as it used to, and instead gets somewhat thicker than it once did. I keep on meaning to see if a cock ring will serve to solve the "goes soft if ignored for five seconds" problem. I don't have a terribly active sex life right now, and when I do get laid I'm rarely the penetrator, so it's not a big priority. Ah, sorry if that was TMI.

So while I can't speak to the penis-modifying effects of your particular set of drugs, I can certainly attest that drugs can both lower your blood pressure and do things to your penis. I'd start with asking the googles about the side effects of these drugs, and to be honest I'd probably drop an e-mail to my doctor saying "hey this is going on since I started this stuff SHOULD I WORRY." And if it's impacting your sex life negatively then of course you'll probably want to do SOMETHING about it!
posted by egypturnash at 6:59 PM on April 17, 2012

Clonidine is a centrally (central nervous system) acting medication. It is thought to work two ways: first, as an agonist (which very basically mean it has an affinity for activating these neuro-receptors) on alpha-2 receptors which are found in vascular smooth muscle so that you have improved vasodilation. Second, by bonding to special receptors (imidazoline) receptors in your brain (the lizard part of your brain that operates things like blood pressure).

Vasodilation lowers your peripheral resistance, that is, the "push-back" the rest of your body exerts on your heart. Vasodilation means that there is an overall bigger and more flexible container for the same amount of blood, creating less pressure for the heart to pump against. Because your heart is in it for the long game, it is important that it doesn't have to work any harder than necessary to perfuse your organs and tissues, or like any other muscle, it will enlarge. Enlargement of the cardiac muscle is not good because a change in its morphology (shape) changes its physiology (the way it works). The heart is lousy with fibers that direct the electrical action of the heart that should not be stretched, for example.

One of the well-known side effects of Clonidine is erectile dysfunction since its action on alpha-2 receptors is not selective and there are lots of vessels in the penis--a lot of the penis is vascular tissue (and that's A LOT of tissue to become relaxed). There is typically a continuum, however, and it's possibly dose or patient dependent. Changes in any normal function once you've begun any medication is a reason to see your provider.

Lisinopril works by interfering with how the kidneys regulate our blood pressure. Your heart is basically a pump to keep blood moving through your kidneys (your kidneys are that important) and so your kidneys are exquisitely sensitive to changes in blood pressure and have hormone-regulated systems that can change your blood pressure to better perfuse the kidneys simply by changing what gets filtered in or out of your blood (like sodium). What the kidneys want, the kidneys get. Lisinopril comes in and takes over so that this system works in one direction, always favoring a loss of sodium into the urine and the prevention of converting one hormone into another that would vasoconstrict your vessels. Even if your kidneys would otherwise decide to up-regulate your BP, when Lisinopril's on board, they can't. Again, vasodilation makes a bigger, less pressured container and sodium loss from the blood means the blood itself will exert less pressure due to the hydrodynamics of fluid shifts.

Providers often combo two BP meds with completely different mechanisms of actions for greater efficacy, because with resistant hypertension there is a lot of complex feedback loops working together that keep that BP up. Lisinopril and its class of drugs does have a pretty well-known side effect profile, but Clonidine is more well known for erectile issues, in general.

Hydrochlorothiazide is a diuretic. It makes Lisinopril more effective at lower doses because the kidney can manage a lower volume of flltrate. If your BP is exerting vessel wall pressure to the level that hydrodynamics are changed, causing fluid shifts into undesirable places (like tissue, AKA edema), diuretics will encourage that extra fluid to filter out. This drug will have less effect on how vascular tissue actually behaves than Clonidine, for example.

According to normal clinical guidelines, a BP of 105-110/65-70 is absolutely within normal limits and safe. I assume your provider set up an individualized BP goal for you.

I only go through all of this because I feel like there can be a bit of confusion about why polypharmacy comes into play so often with controlling BP, and with polypharmacy there is a bigger grab bag of potential side effects. Again, changes in normal function are a reason to talk to your provider, who can determine where you're at as far as BP control versus functionality and adjust accordingly. A good provider LOVES to get frequent feedback about the effectiveness of your treatment, including where it could be refined fit your lifestyle better.

So all an internet stranger can do is really explain these meds so you can have a place to start to think about your own treatment, which only you and your provider know the true ins and outs of. I will say that you're young with receptors that probably respond very well to things that agonize them, so sometimes that can mean a little more initial drama and refinement of treatment.

This is a good question and your provider's going to be so psyched to figure out the best way to make everything work for you.
posted by rumposinc at 7:01 PM on April 17, 2012 [3 favorites]

i'd second trying to see if your doc would prescribe an alternative. in the hospital where i work clonidine is not usually prescribed as a 1st-line treatment for hypertension, but is usually reserved for patients who are not responsive to almost all the other drugs we give.

i'm not familiar with how often it's used in the outpatient setting, but it seems like most providers i know would start with a calcium channel blocker, like amlodipine, instead of an alpha agonist.
posted by doogan nash at 12:14 AM on April 18, 2012

I assume you are keeping your blood pressure down because of stroke risk? You don't say. Do you have other risk factors? Take this quiz.

I just read that atrial fibrillation can increase stroke risk by 500%. My point is - how important is your blood pressure in the big picture? Because it seems too low to me. I am not a doctor. But I do know that low pressure is not your ultimate goal - 90/60 and you might start fainting. 50/35 = coma or death. Read this chart.

If you have no other risk factors (like diabetes or pre-diabetes) you may want to talk to your doctor about keeping your blood pressure at the 120-125/ 80-85 range. Call your doctor and ask if you can take your meds every other day until you get in to an appointment. But this all depends on whether you have other risk factors.

You can also get some good information from your pharmacist. I recently got really good information from my Walmart pharmacist about what I could do to be able to get off my cholesterol meds. You don't have to talk to the pharmacist about erections - but you could ask a lot of questions about your meds to be better prepared when you go see your doctor. I'm trying to say that new, young, smart pharmacists will understand you don't want to take meds if you don't have to and if they don't understand get a new pharmacist.
posted by cda at 8:38 AM on April 18, 2012

Rethinking ‘Normal’ Blood Pressure
posted by cda at 8:53 AM on April 18, 2012