American Thought Leaders - New Evidence Shows SSRI Antidepressants Can Cause Permanent Harm to Sexual Function | Dr. Irwin Goldstein

Episode Date: November 1, 2025

Dr. Irwin Goldstein is one of America’s leading sexual health physicians, a pioneer in the field, and the director of San Diego Sexual Medicine.In this episode, he breaks down his latest research into what’s known as post-SSRI sexual dysfunction (PSSD)—a condition that’s not uncommon but rarely discussed publicly.He’s found that a class of antidepressants known as SSRIs can cause lasting physiological damage even after patients discontinue the medication—contrary to what many patients are told.“When they stop the medicine, the usual teaching is that everyone returns to their pre-medication sexual function, and that’s not what we’re seeing in our sexual health clinic here,” Dr. Goldstein says.His recent research showed that SSRIs can cause structural damage to genital tissue as well as many other physiological problems, like genital numbness, erectile dysfunction, and loss of libido. These problems persist long-term after discontinuing SSRI antidepressants.“It’s kind of an awful thing, and it doesn’t go away,” Dr. Goldstein says. “These individuals in my clinic who have been given the medicines: Our youngest is age 11. They'll never experience what one would otherwise consider a normal sexual life.”Dr. Goldstein holds a degree in engineering from Brown University and a medical degree from McGill University in Montreal. He is credited with advancing the study and treatment of both male and female sexual dysfunctions and has authored more than 360 academic publications in the field.Views expressed in this video are opinions of the host and the guest, and do not necessarily reflect the views of The Epoch Times.

It's an awful condition causes frustration, embarrassment, humiliation, and it doesn't go away. Dr. Irwin Goldstein is one of America's leading sexual health physicians. Many young people who are prescribed SSRI antidepressants are coming to him for help, for lasting damage they've suffered. In this episode, he breaks down his latest research into what's known as post-SSRI sexual dysfunction, PSSD, a condition that's not uncommon, but rarely discussed publicly. These individuals in my clinic who have been given the medicines are youngest as age 11. They'll never experience what one would otherwise consider a normal sexual life.

This is American Thought Leaders, and I'm Yanya Kellick. Dr. Erwin Goldstein, such a pleasure to have you on American Thought Leaders. Thank you so much for having me. It's a great honor. So you've just presented some incredibly important data at a conference. You have found that in post-SSRI, sexual dysfunction, that there's actual physiological damage that's happening to people, including young people that are on these drugs. That is a true statement. So explain to me the whole picture here. What's going on? Well, SSRI's selective serotonin reuptake inhibitors are one of the most widely prescribed medications in the United States.

They decrease the suicide rate of people with major depressive disorder and other mood issues and have been found to be really life-changing by psychiatrists and individuals with mood disorders. The problem is they are recognized to raise serotonin, that's their mechanism, but serotonin is an inhibitor of sexual function. So while using the medication, it's widely appreciated that individuals will suffer sexual health concerns but what is not appreciated is when they stop the medicine the usual teaching is that everyone returns to their pre-medication sexual function and that's not what we're seeing in our sexual health clinic

here so the name of the condition is post SSRI sexual dysfunction or P.S.S.R. SSD. And it's an awful condition. It persists, causes frustration, embarrassment, humiliation. It causes erectile dysfunction in young men, libido problems, genital sensation changes, orgasmic dysfunction. It's kind of an awful thing. And it doesn't go away. And it is used in a lot of minors who aren't part of the consent process since these medications, you know, there's a recent study that looked at the date of the patient's initial prescription of the SSRI medication. And three out of four patients are between the ages of 10 and 25 in the study. That's kind of, it's just, I don't know. It's amazing.

Well, and of course it's incredibly important because even if some of these patients might actually even be pre-pubescent and so forth, like this is huge ramifications. Well, they never experienced normal sexual function. These individuals in my clinic who have been given the medicines are youngest as age 11, I mean, they'll never experience what one would otherwise consider a normal sex. sexual life. We're using the medication. I mean, it's not like they're taking poison. It's a medicine. FDA approved. And so the other part that's really important here is that many people who are prescribing these medications, you know, I said psychiatrists, but actually it's general practitioners that are prescribing these medications as well, are simply not aware that this is a phenomenon that can happen. The teaching is that this is a sexual, dysfunction that occurs only while on the medicine. There's no, there's no really understanding

of this PSSD phenomenon, but it is a very real issue, and it's very sad. Well, and so why is it that doctors might be unaware, even though obviously this must exist in the scientific literature? There's a lot of reasons. We don't like talking of sexual health problems, especially when giving consent. I mean, can you imagine if it was standard of care to say, I'm going to leave you a medicine to treat your depression. But by the way, a percentage of people will never have a normal sexual life again. And again, it's a suicide issue. We don't want people to commit suicide and these medicines have been shown to reduce suicide rate. So how do you bring in this horrible side effect that's permanent of this drug while trying

to help people with mood issues that are kind of severe? Well, explain to me now what your study found because it is actually, I think, incredibly important. It kind of, I guess, raises the level of the discussion substantially at least in my mind. Okay, so let's just start with the drug. There are SSRIs, and there's a group called SNRIs, and there's another group of other modulators of serotonin, but primarily SSRIs.

And the drugs raised serotonin. Basic science studies have shown that use of these products actually changes the structure and function of neurons and their connections called synapses in the brain. Like permanently change their structure and function. They permanently affect the neurotransmitters being released, serotonin, noradrenaline, oxytocin.

And these are not just, I'm raising serotonin while I'm on the drug. These are drugs that have the potential to literally change brain function, permanently. Individually, we have identified that independent of the brain actions, the drugs have peripheral actions, and in the penis of animals, and now we're finding in our study, that oxygen radical concentrations are increased in individuals who take these medicines. Oxygen radicals are very potent oxygen molecules that attach and kill

smooth muscle cells in the penis, leading to increased scarring in the penis. That is not a reversible concept. So we have identified in 11, 12, 15-year-old people scarring in their penises, adversely affecting function because of use of these medicines. That's the sad part. I think you've described it as being that of a 70-year-old. We took the population of PSSD patients and identified two subgroups, similar-aged people who had ED rectal dysfunction from trauma, motocross, horse riding, bicycle riding, you know, that type of thing.

And we compared to another subgroup of individuals greater than age 55 with the risk factors of hypertension, high cholesterol diabetes. And the individuals who were in their 20s had ultrasound studies that paralleled and couldn't be distinguished from the older population and way different from the similar-aged trauma group. I mean, unbelievable when you think about it. Do you have some sense of what types of people are more predisposed to having this condition? So we don't, but that would be very important to study. Why do these individuals have PSSD where the majority of people who take SSRIs don't have PSD? I mean, I presume it's some genetic issue that we don't yet understand. You know, just on the topic, you mentioned that these drugs are often prescribed to reduce suicidality,

and there's evidence that they do that. But there's also evidence that in rare cases, they actually cause suicidality, which is something that, again, from what I understand, a lot of doctors don't share. Like, people don't necessarily know they should be watching people when they're not. they get on these drugs in case they have these rare side effects. You're 100% correct. Suicidality is a complication of the acute use of the medicine. What I'm talking about when we spoke was individuals who are not really seeing psychiatrists. They may have stress or sadness after a romantic breakup.

a divorce, a death, where counseling could be performed for this situational sort of issue. Listen, you can go on the Internet and get the medicine not having really seen or being evaluated by an in-office doctor's appointment. You could do it on the Internet. And I don't know. I sit here and I see the sadness of these people. And our job was to put together a 15-year review of many, many patients. Highly select population of individuals who have sexual health issues,

but can't be explained by any other reason. None of these people had diabetes, hypertension, high cholesterol. None of these people were in car accidents, were horse riders, bicycle riders. There was no other explanation. and everyone was sexually functional in a normal way prior to taking these medicines. So this is a really highly select population. I can speak to you about some of the other biologic pathologies beyond the vascular one. Yeah, no, please do.

Tell me more about this phenomenon, about what you've discovered. So beyond the scarring of the penis, these drugs affect nerves. and synapses and neurotransmitters, synthesis, and release centrally. And what is really the saddest part of the sexual dysfunction of PSSD is the anhedonia that individuals have, the lack of pleasure.

They call it reduced genital sensation. It's not like a sensation to touch. It's a sensation that touching the penis used to be a special feeling that is different than touching your arm. And right now it's the same as touching your arm. And seeing someone outside in provocative clothing would bring an arousal to a usual individual.

But seeing a provocative situation is like looking at a car now. And this is particularly distressing to individuals with PSSD. The other thing is we've noted that they're hormones, are kind of off. These are 20-year-old men who should have upper tertile values of testosterone, and the vast majority have lower turtiles of testosterone. And again, that's all regulated through central processes, and they seem to be adversely impaired by these drugs. So there's a lot

going on here and they require, you know, intensive evaluations. A visit to our facility is a three-hour event. It's not a ten-minute thing. So we have to unravel and play detective and allow them to accept that their sexual health issues are not going away, but we can work with them and deal with it. And it's not always easy. The testosterone issue strikes me as, you know, quite significant because that has obviously a lot of second order effects beyond just the sexual dysfunction at an early age. Yeah, well, muscle strength, vim, vigor, concentration, libido, very much testosterone-related. It's not that they have a testosterone value outside low. they don't have the usual level of testosterone that someone that age would usually have.

I mean, there's even, testosterone has massive impacts across, you know, a whole range, even, you know, I think well beyond even what you described, the muscle mass and so forth, right? Well, bone health, air health, skin health, sure, goes on and on. Right. What does the literature actually tell us right now about, you know, how prevalent this PSSD is? Well, in my opinion, it's extremely prevalent. But I don't have a number, and I don't think there is a number, of the prevalence of this condition that's already published. So I think I'll do an intense literature search as we complete this manuscript.

but it's not anywhere near like 90% or 50%. It's going to be a small percentage, a single-digit percentage. But the reality is this is way more prevalent than like not existing. It's not like the rarest thing on earth. It's extremely common. We see so many people with this thing. Dr. Goldstein, why don't you tell me a little bit about your background? Because this is an unusual field of medicine that you find yourself.

in. How did you, how did you end up where you are today? Great question. So I'm a hockey playing Canadian who came to the United States to do electrical and biomedical engineering. And somewhere along the way I fell in love with medicine and especially urology. And my chairman, at the time I was training, was very involved in the placement of sexual medicine, penile prosthesis insertion. And Essentially, I've never really done anything else in my entire career. I've never really done urology. So we take care of the sexual health concerns of men and women, and it's a sexual medicine practice, and it's fascinating, and I love it,

and I should have retired a long time ago, and I can't stop doing it, because I really enjoy it. Well, and what are the typical types of scenarios that you see? other, you know, at PSSD, it seems to be like your clinic is something that focuses on that now because it's something that isn't so well understood. But what other types of scenarios do you see often? So there's other medicines that cause permanent sexual health problems. Another very frustrating, sad patient is someone who takes hair loss medicine. The medicine It's called finasteride.

And that has a lot of sexual health problems. I think this is a very important interview we're doing. I would love to get awareness out. And I want to leave the message that while my involvement with patients is extremely sad because we're dealing with a patient population who didn't expect this outcome from using this medicine. But we really help these people. I can help their erection problems.

I can help their orgasm problems. I can help their libido problem. I can help pretty much everything they have. But they have to have the expectation that's never going to be like it was where it was a spontaneous sort of healthy sex life. They will have to do things. And what's really scary is sometimes

they have to take medicines, but they are very suspect of taking medicines now. They don't want to take medicine. They'd rather take herbs, spices, things like vitamins and things that tree bark things. I'm just saying that they're very suspicious individuals going forward. Well, I mean, and probably for good reason, right? Yeah. Yeah. These are FDA-approved products that, um,

should have this warning. People I've spoken with before about this issue tell me that this is actually something that's very difficult to treat, but you're saying you're able to treat it. Can you tell me a little bit more about how that can play out? Well, it's very difficult to treat at multiple levels. I agree, but it's not that we can't help people. So I think there has to be some optimism provided. That's what we hope to provide. The most difficult is the adhedonia. We don't have a lot of understanding of how you increase pleasure in people who don't have current pleasure. But if their problem is more focused on

libido, or more focused on reduced sensation, or there's problem as more focused on erectile dysfunction, we're very good at helping people with erectile dysfunction. I mean, at the end of the day, beyond medicines, we have penile prostheses that can't be used. Again, this is a young population, and just the concept of surgery to correct an erectile dysfunction is a little aversive. But my whole point is we're not giving up on these people. We're working with them. And I have a lot of patients who have done well. And maybe the next, your podcast next, is to actually speak to some of these people, show them their concerns and show them where they are currently, having had treatment. That sounds like an amazing idea. And I absolutely will.

Again, you know, there's a whole bunch of scenarios that I've become aware of recently where there's just kind of a lack of informed consent around certain medicines. But part of the problem is that the doctors themselves don't have full understanding of the medicines. And the combination of that is something I'm just trying to tackle here. I mean, as a sexual health provider, medicines as the cause of the sexual problem is not a rare phenomenon. We talked about finasteride, there's hypertensive drugs, there's, you know, the diabetic drugs, many, many things cause sexual problems that is pharmaceutically based. In life, it's risk-benefit.

I mean, if you're going to die of hypertension or have heart attacks or strokes, then take the hypertensive medicine and let's deal with the sexual problem. I'm just saying that people ought to be given awareness that this could happen to, and the people who have this support me trying to explain to others that this could happen. because they say had they ever been told that this could happen they would have thought twice about taking this medicine again suicidality is a big issue you don't want to not take this medicine for that but situational things stressful situations at high school and college I don't know if you're ready to take on permanent erectile dysfunction and he don't orgasmic dysfunction, low libido, to help you with that stressful event. Have any risk factors been identified at this point that doctors should know about? Not that I'm aware of. I mean, we could do a deeper dive to the population,

re-interview them with a better understanding of what to ask, but to best my knowledge, my knowledge, there's no predictor of who gets the PSSD at this point. Oh, so there isn't a sense of whether maybe it's more prevalent among young people or more prevalent among older people. There isn't, that also isn't well characterized yet? Well, it isn't characterized. Like I'm saying, our publication will be one of the first on this topic. But the prevalence of the sexual problems makes it more logical to be in younger people because younger people

have healthier sexual function. It's only later on in life typically do sexual health problems occur. Well, Dr. Goldstein, you're doing some really important work here. A final thought as we finish? The true take home

message is that now that we have done work with it and understand in the past people we're saying, this is all psychological, there is nothing biologic about this, there's no way a drug could cause biologic issues. We now have evidence against that, and we're understanding the biologic issues, and we're developing strategies to help people who have PSSD with these biologic problem. We have excellent strategies for erectile dysfunction.

We're developing strategies for orgasmic dysfunction, libido dysfunction, sensation issues. And if we are working with this people and helping them. Well, Dr. Erwin Goldstein, it's such a pleasure to have had you on. Thank you so much for this opportunity. I appreciate it. Thank you all for joining Dr. Erwin Goldstein and me on this episode of American Thought Leaders. I'm your host, Janja Kellick. Thank you.