Substances and Sex: Drugs that Heighten Arousal

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David Fawcett PhD, LCSW

This post is part of an ongoing series examining the ways in which substance use impacts sexual behavior and vice versa. Previous posts have covered alcohol, opioids, meth, other amphetamines, and drugs that disinhibit and relax the user. In this week’s post, we examine drugs that heighten arousal.

Alkyl Nitrites

Alkyl Nitrites, more commonly known by their street name, poppers, have been used by gay men (and others) for decades to enhance sex. The slang name refers to various alkyl nitrites, most commonly amyl nitrite and butyl nitrite, which are inhaled and affect the smooth muscles of the body, including the sphincter muscles of the anus. The drug also relaxes blood vessels, creating the potential for a sharp drop in blood pressure. Because of this, using poppers with blood pressure medication (and perhaps erectile dysfunction drugs) is extremely dangerous. Amyl nitrite has long been used to treat angina. It is also a component in products such as room deodorizers and video head cleaners. Because poppers for human consumption are illegal without a prescription, they are usually sold in paraphernalia shops in the guise of various products such as VHS head cleaner, despite the fact that very few people continue to use VHS tapes.

The head rush associated with the drop in blood pressure is said to increase sexual pleasure and desire at the same time the anus (or the vagina in women) is relaxed. Many men believe poppers prolong orgasm. In combination with methamphetamine, poppers significantly increase the risk of acquiring HIV, as found in a study reported in the Journal of Acquired Immune Deficiency Syndromes in 2007.[i]  Researchers reported that meth users who also used poppers had a threefold increase in the risk of acquiring HIV, underscoring the synergistic impact of multiple drugs used together.

Testosterone and Anabolic Steroids

Testosterone replacement therapy, despite its well-known risks, has become increasingly common for men of all ages. The proper balance of a variety of hormones in men and women, including both testosterone and estrogen, is required for healthy sexual and emotional functioning. If testosterone levels decline in men, there will be a drop in sexual desire, levels of arousal, sexual functioning, and other aspects such as mood. Replacement therapy can help, although some people use higher doses than prescribed, often facilitated by pumps which permit them to simultaneously apply multiple doses as a way to heighten sexual arousal and drive.

Anabolic steroids are synthetic derivatives that are used for therapeutic purposes, including treating wasting syndrome and osteoporosis. They have become increasingly common among both serious bodybuilders and other men, including younger men with no hormone concerns, to build lean muscle mass. This often has more to do with correcting body image and perceived sexual appeal than medical need. Abuse of these steroids sometimes occurs in cycles as users go on and off the drugs.

Anabolic steroids and testosterone can result in lasting hormonal imbalances, including degeneration of the gonads. In other words, the body stops producing these hormones on its own. In women, excess testosterone can cause a deepening of the voice, hair growth, a reduction in breast size, and other effects. Growth may be stunted in young people taking these hormones, and serious medical consequences can occur for adults, including high cholesterol and heightened risk of cardiac events or stroke.


[i] Plankey, M. W., Ostrow, D. G., Stall, R., Cox, C., Li, X., Peck, J. A., & Jacobson, L. P. (2007). The relationship between methamphetamine and popper use and risk of HIV seroconversion in the multicenter AIDS cohort study. Journal of acquired immune deficiency syndromes (1999)45(1), 85.