Beta-Blocked Below the Belt

I’ve been having a bit of trouble with down there lately. It’s not been working properly. Mind you, I haven’t particularly minded, but there’s something about producing eunuch goo for my top to say “look what you made me do” that is kind of hot.

It is getting me worried.

I thought it might have been because I’d had a whiff of poppers, either by sniffing them directly or second-hand. But the last time, neither my top nor I used them, so I don’t think its that. Anyway, I have used poppers on and off for years without any problem.

Its more likely to be the heart medication. That’s new and its known that any one of the drugs I’m taking could cause erectile dysfunction.

Typical. I am finally getting laid after dry spell lasting several years … and the equipment is faulty!

So what could be the culprit?

Medication	Purpose	ED Risk	Comment
Aspirin 75mg	Blood thinner (antiplatelet)	Unlikely	No significant link to ED; may even slightly improve circulation by thinning the blood.
Atorvastatin 80mg	Cholesterol-lowering (statin)	Possible but uncommon	Statins sometimes reduce testosterone or libido, but can also improve blood flow. The data’s mixed — at high doses like 80mg, a few men report ED, but most don’t.
Bisoprolol 1.25mg	Beta-blocker (for heart rate/blood pressure)	Likely	Classic culprit. Even at a low dose, beta-blockers can dampen sexual arousal and cause ED by reducing adrenaline and blood flow. The effect varies a lot by person and drug; bisoprolol is among the more tolerable ones but still a strong suspect.
Candesartan 2mg	ARB (for blood pressure/migraines)	Unlikely	ARBs are actually one of the best antihypertensive classes for sexual function — sometimes even improve it, unlike beta-blockers.
Co-dydramol (10/500)	Pain relief (codeine + paracetamol)	Possible	Opioid component (codeine) can suppress testosterone and libido if used frequently or long-term. Occasional use, not a big deal; daily or heavy use, potentially yes.
Omeprazole 20mg	Acid reflux / gastric protection	Unlikely	Very little evidence it affects sexual function; rare reports, but mostly unrelated.
Testosterone gel 20mg/g	Hormone replacement	*Should improve* ED**	This one’s on your side! Assuming levels are properly monitored, it should boost libido and erectile function, not harm it.
Ticagrelor 90mg	Antiplatelet (post-heart event)	Unlikely	No known direct link to ED; could theoretically help by maintaining good blood flow.
Vortioxetine 15mg total daily	Antidepressant (serotonin modulator)	Possible to common	SSRIs and related antidepressants often reduce libido or delay orgasm. Vortioxetine is better than older SSRIs but can still cause some sexual side effects — often mild or dose-dependent.

There’s quite a lot there that could be causing a problem, and there are a few there that might counter it.

I suppose there’s no single culprit, but a few usual suspects. So what to do about it?

1. Mind the brain–penis connection

Anxiety kills erections faster than a beta-blocker ever could. Even mild worry (“will it work this time?” ) triggers the sympathetic nervous system – the exact opposite of what I need. I’ve noticed that when I start thinking about whether it’ll work, it definitely doesn’t.
Performance pressure compounds ED. When I reframe sexual contact around play, then the stress goes away because ejaculation doesn’t matter. At the other end of the sextrum, intimacy might invoke a mind connection that a hook-up just can’t create.

2. Exercise — the magic bullet

Regular aerobic exercise (running, cycling, brisk walking, etc) improves blood flow, nitric oxide levels, and testosterone sensitivity. Trouble is, I have zero get-up in the mornings, and by late afternoon I’m ready for a nap.
Strength training helps maintain healthy testosterone levels – or would if I had testicles to produce it.
But I am told that 30 minutes of brisk walking five days a week significantly improves erectile function in men on cardiac meds. The dog walk isn’t brisk though: it’s about her and she likes to smell everything on our walks, so they are quite slow.

3. Diet and supplements

Mediterranean-style diet – high in olive oil, nuts, veg, oily fish – is strongly associated with better erectile function. Hmm. Maybe that’s why Italians are such randy buggers! Anyway, I eat a lot of this kind of stuff anyway as it’s my favourite non-treat food.
Avoid restrictive low-fat diets; I need some fats for hormone synthesis. A bit of cheese with my salad? Yes please!
Supplements with modest evidence:
- L-citrulline (precursor to nitric oxide, similar mechanism to Viagra but gentler). I wonder where I can get this from … more research required!
- Ginseng and maca – mild libido enhancers for some. I am sure that Holland and Barrett will sell this, so I have added it to my shopping list.

4. Optimise timing and context

I avoid taking bisoprolol right before sexual activity. I take it of an evening before bed – and I don’t seem to have sex just before sleep anyway – I’m usually too tired: weekend sex is the best!
Whilst alcohol dulls response – and even more when combined with beta-blockers – so drink and sex are a no-no. I don’t drink often anyway – although I seem to have found a Friday social routine with Ambrosius where we have a pint and go to the pictures.
Ensure I’m warm, relaxed, and hydrated because peripheral circulation matters.

5. Consider mechanical and non-drug aids

Vacuum erection devices (VEDs) are unsexy in theory but surprisingly effective and discreet with practice. Apparently, the NHS sometimes supplies them for post-cardiac men – worth asking about! That’s hilarious: a penis pump on the NHS! I’m not going down this route.
Pelvic floor exercises (Kegels) – they’re not just for women. Strengthening the pubococcygeus muscle can significantly improve rigidity and control. Maybe.

6. Optimise your testosterone effect

I try to make sure that my testosterone gel is absorbed properly – I apply to clean, dry skin, consistent time daily (ie after my morning shower as a morning application gives more natural rhythm).
I need to make sure that blood tests happened 2–4 hours post-application to make sure that I have properly absorbed the gel..
I don’t know if oestrogen and haematocrit are monitored – both affect sexual response. Something to ask about.

7. And there’s always chop the bloody thing off!

It’s funny, really – I’ve spent my life making peace with not needing it, and now I find myself missing its cooperation. Seriously, I’m a bottom and its kinda surplus to requirements. I guess its something extra for a top to play with!