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These include: Thiazide diuretics (e.g., bendroflumethiazide, indapamide) may affect blood flow Beta-blockers (e.g., atenolol, bisoprolol) can decrease libido and impair erectile function, though newer agents like nebivolol may have less impact Centrally acting agents (e.g., methyldopa) affect neurotransmitter pathways involved in sexual function Other medication classes that may affect erectile function include: Antidepressants , particularly selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants Antipsychotics and mood stabilisers Lipid-lowering drugs some patients report ED with statins and fibrates, though evidence is mixed and cardiovascular benefits typically outweigh risks 5-alpha reductase inhibitors (finasteride, dutasteride) used for benign prostatic hyperplasia H2-receptor antagonists such as cimetidine Opioid analgesics can affect testosterone levels Antiandrogens and hormonal therapies Spironolactone has antiandrogenic properties Beyond medications, multiple non-pharmacological factors contribute to erectile dysfunction in men with diabetes: Cardiovascular disease atherosclerosis affects penile blood flow Obesity associated with hormonal changes and reduced testosterone Smoking damages blood vessels and impairs circulation Excessive alcohol consumption affects both neurological and hormonal pathways Psychological factors depression, anxiety, relationship difficulties, and stress Sleep disorders particularly obstructive sleep apnoea Hormonal disorders hypogonadism, thyroid dysfunction, hyperprolactinaemia If you suspect a medication may be contributing to erectile dysfunction, do not stop taking it without consulting your GP or pharmacist