“But what if they stop wanting sex!?” The alarmist media coverage of teens taking antidepressants.

Transcript Transcribed by Laura M.

Courtney: Hello everyone and welcome back. My name is Courtney. I am here with my spouse Royce and together we are The Ace Couple. And today we are wading into the waters of PSSD. This has been a topic that has fascinated and concerned me for quite some time. This is not going to be the end-all be-all definitive episode on the topic. I’m sure we’ll circle back to it in more detail at a later date. But today, it is once again on my radar thanks to a recent New York Times article entitled “More Teens Are Taking Antidepressants. It Could Disrupt Their Sex Lives for Years.” I would like everyone to keep in mind as we go through this that I am not at any point going to try to make the case that what people experiencing these symptoms, people who identify as having this disorder, are not deserving of our empathy. I am not going to claim that they are not deserving of further research or that what they are feeling is not valid. That is not the point.

Courtney: My biggest issue with any conversation about post-SSRI sexual dysfunction is the entire societal framework. I truly do think that not only is the framework of how these conversations get into the media extremely harmful – such as this article focusing so highly on the potential sexual side effects on teenagers and the scare tactics that are the language that are used – but I do believe that there’s probably an issue in the very framework for how PSSD has been named, labeled, identified. And this is very much on a large scale, a framework, our societal normativities that influence doctors, psychiatrists, patients, and any sympathetic reader of articles like this, that just really colors the way these conversations transpire.

Courtney: So quick primer on PSSD if you’ve never encountered this before. It is said to be a type of medically induced sexual dysfunction as a result of common antidepressants. Many claim that these side effects can even linger after discontinuing use of these medications. Is this and can it be an issue for some people? Sure, absolutely. And they absolutely deserve empathetic medical care. But that said, I have read articles, blogs, social media posts from patients who identify as having PSSD that is just riddled with compulsory sexuality, amatonormativity, these societal norms that frankly need to be deconstructed. I believe someone personally can be struggling and be very hurt as a result of something like this, but when individuals like that take their own hurt and amplify it in such a way as to say, “I have debilitating sexual dysfunction because I’ll never have a normal sex life, I’ll never be able to have a normal relationship, I’ll never be able to get married.”

Courtney: These are things that I have read from folks having discussions around this disorder. I’ve also seen people break out like Maslow’s Hierarchy of Needs and say like, “Look, reproduction and sex is the very base level, and this is now being deprived of me.” And Maslow’s Hierarchy of Needs is its own episode. But that is just one very clear example of how we are taught in schools, in psych courses, in general society, that sex is so important. We hear time and time again in our community that sex is what makes us human. You can’t have a normal relationship without sex. And so when major outlets like the New York Times take an article on this, I can even believe and give the author the benefit of the doubt and say that, you know, they’re truly just empathetic towards people dealing with this and they want to amplify their voices. I believe that could be true. But they’re going to make it as scare tactic as possible.

Courtney: They’re going to make it seem like big bad psychiatrists are giving people these medications that are going to ruin their lives because if they lose their libido and it never comes back, they’re not going to live a full life. These poor, poor souls. And I don’t think that helps anybody. It certainly doesn’t help folks with PSSD. It does not help us in the Asexual Aromantic Community, and it’s really not going to help trans medical care. I want you all regular listeners to think back to when we were going through so many conservative arguments as to why puberty blockers were being so rallied against by the Republicans in this country. We were reading quotes time and time again how they were saying, you know, “My – misgendered child – is never gonna be able to have a normal sex life. And that’s why these are dangerous. That’s why they should be banned.” Folks with PSSD are saying they just want more research. And I think more research is generally almost always a good thing. More research shouldn’t be harmful if–

Royce: If the people doing the research are trustworthy.

Courtney: Yeah. If they don’t have an agenda they’re trying to push. But whenever you take minors and medical care and start talking about how they are never going to have a normal sex life, that’s when people start calling for medications to be banned. We’ve seen it with trans healthcare. We’ve even seen these talking points when trying to ban trans healthcare for 20-somethings, adults. And I actually made this call years ago. Years ago, I started seeing people attacking the Asexual Community saying, you know, “You’re not asexual, that’s not a thing. You just had antidepressants prescribed to you when you were too young.” Those talking points as a means of specifically attacking the Ace Community have been around for years. And as with all things that are levied against the Ace Community, “You’re not asexual, you’re just autistic. You’re not asexual, you just have a brain tumor.” Those are sometimes hurdled at aces who haven’t ever been on antidepressants.

Courtney: But that negative stigma is already there. It has been there for years. And I said years ago that as the war on trans healthcare, as the war on healthcare and science for all children, teens, minors ramps up – mind you, we have RFK Jr. right now who is spouting anti-vaccine nonsense, which is going to affect an entire generation of children’s health, if not more – we have an attack on gender affirming care, I said years ago, people are going to try to ban antidepressants for minors, at least. And asexuality is going to be a key talking point that is likely going to work. And ever since I first said that, maybe six years ago, it’s only gotten more and more rampant. I have seen more talking points like this.

Courtney: Now, this article does not talk about asexuality, and that is maybe a good or a bad thing. I don’t necessarily trust the average writer to incorporate asexuality well, but I also think that discussions about low libido, sexual dysfunction, what constitutes a – quote – ‘normal sex life’ or a ‘normal libido’ is utterly incomplete without addressing and legitimizing asexuality. And in a case like this, it could be in contrast, even just saying, you know, this is not to be mistaken with asexuality, which there are a number of ways to do it, but we’re not seeing it. So I’m already, right off the bat, always going to go into articles like this skeptical when “Gasp! But think of the sex lives of minors,” is the focus. Because that almost never ends well. And I’m also going to be skeptical when what is very often a life-saving medication is coming under disproportionate scrutiny.

Courtney: Especially in this the year of Make America Healthy Again, when we do have RFK Jr. who has gotten it put in an executive order that we need to research the over-prescription of SSRIs, especially amongst children and adolescents. We have high-level political figures already talking about the dangers of these things. So that is very much the framework I’m going into an article like this with. So links to read the article in its entirety are going to be in the show notes on our website, in the description box on YouTube, as per the usual. But the article opens up with someone by the name of Marie who started taking fluoxetine at age 15 for an eating disorder, and she states that she was in touch with initial sparks of sexual energy at a very young age, going as far back as six or seven. But after taking this medication, she says, “I realized, ‘oh, I’m not developing new crushes.’”

Courtney: She is now 38, having been off of all psychiatric medications for six years. And did at some point in those spans of taking medications switch out to other types, Wellbutrin is mentioned here. And yet she says, “For me, it’s just an empty, dark space.There’s nothing there.”

Courtney: Now, one thing I have read time and time again from folks writing about their own experience with PSSD is that it very often isn’t just a lack of sexual desire, or in some cases, erectile dysfunction. They often report that it’s much more widespread than that. They’ll talk about brain fog. They’ll talk about a deadening of all of their emotions or a deadening of enjoyment of lots of different things. Which is always fascinating to me because I’ve read this from multiple sources writing in their own voices what their experience was. And every time I read that, I think, why is it called Post-SSRI Sexual Dysfunction? If the folks with this sexual dysfunction say, “No, that’s not the only symptom. Actually, it’s a lot of things.”

Courtney: Because while things such as depression or antidepressants are known to have a variety of potential side effects, sexual dysfunction is a weird one because people will also say that depression can lower libido, depression can remove sexual pleasure. Also, the medications that are used to treat depression can potentially do that. So where people with PSSD get frustrated is sometimes doctors might say, “Oh, it is just depression.” And this is where we fall into the pitfalls of medicalizing sexuality. I think it hurts everybody and helps exactly no one. There are earlier examples of medicalizing sexuality in the late 1800s when, you know, early, early psychologists started talking. We spoke in a recent episode about how one of the first examples of inserting narcissism as a medicalized diagnosis was about sexuality. It was considered a sexual disorder.

Courtney: Sexuality was again medicalized when homosexuality was considered a disorder. It took gay activists and a lot of protest work, public education, to get that removed. And asexuality has been medicalized on individual levels at large scale. We’ve talked about HSDD or Hypoactive Sexual Desire Disorder, which is still in the DSM. Asexual activists kind of got a little throwaway line added to it that says, you know, basically, “This is probably what you have unless you’re asexual, then maybe you’re just asexual.” So these are, this is a very brief overview of the history I’m talking about when I talk about the medicalization of sexuality. And I think we’re falling into a pitfall with things like this also. Because, do I think it can be a symptom that may be a problem and could use some type of medical intervention or research to find a solution to that someone who ordinarily did have an allosexual experience, someone with–? See, it’s so hard to even say someone with a high libido. Maybe they just had a moderate libido.

Courtney: How does one measure libido? Someone whose libido and desire was higher before they took medication and then it just went away. And can there be a grief period when anything that meant something to you is now lacking? Absolutely. Absolutely that can be a problem. But by necessity of calling something a sexual dysfunction, that necessarily implies that there is a medically correct or appropriate window of sexual function that they’re like, “This is good, this is correct, this is healthy.” And I don’t think that is ever going to be the case. It is gonna be different with every single person. Some people just as a baseline have a different libido from the next person, and that’s even true when you’re only taking the allosexual population into account.

Royce: It’s also something that’s going to change throughout a person’s life too. And some of the people mentioned in this article were on antidepressants for a lengthy period of time, to the point where you can’t really compare one-to-one their life before taking them and after them.

Courtney: Yes.

Royce: Even if you take into– even if you take issues with human memory into account, or things like the nocebo effect, which is placebo but bad. The placebo effect is when you expect something to help, and even if it is a, you know, a neutral pill, a pill with nothing in it, you experience positive effects. Nocebo is the opposite of that, where things go worse than they– than they expect. And there’s a lot of anxiety around this particular topic because of all of these social stigma.

Courtney: Yes.

Royce: And it’s also something that’s very easy to start searching for and find exaggerations, horror stories, things like that.

Courtney: Oh, absolutely. And the social component of it as well, I very vividly remember reading a blog by someone with PSSD and he specifically called out the social stigma. He said, “Because I don’t experience a libido or sexual desire now, I am socially ostracized. Therefore, we need medical intervention to give me my libido back. Pretty please.” And that is the sort of thing that when the Ace Community says, “We are socially ostracized for who we are, how we identify, a sexuality or lack thereof that we are happy and content with,” a lot of people will be like, “No, that’s not a thing. You’re not discriminated against for being asexual.” But when someone who is saying, “No, I was a sexual being and it was taken from me by big, bad pharmaceutical companies,” everyone’s like, “They must be stopped.” So it really, really is the framework. How you’re going into seeing these things.

Courtney: You know, some people really, really disagree with me when I say in most situations you should be able to substitute sex out for any other thing. As in, like, this is an activity that can mean a great deal to some people, won’t mean as much to others. Some people are perfectly fine without it. But let’s take– let’s substitute sex for someone’s, like, deepest hobby, passion. Let’s use dancing, because I am a dancer. I love dancing. It will always be my first love is dancing. Now, if I’m a depressed teenager who is still deriving joy out of dancing, but everything else in my life is so terrible, and I get prescribed an SSRI. And very shortly after taking it, all of a sudden I don’t like dancing anymore. It brings me no joy, it brings me no pleasure, it doesn’t help calm me. I just don’t even want to do it anymore. That would be really upsetting.

Courtney: That would be very upsetting to me, and I would want my doctors to take that seriously when I told them that. Does that mean that I think that symptom in isolation needs to have its own named disorder? Like PSDD? Post-SSRI Dance Dysfunction? No, I don’t think it should. But the underlying problem should still be taken seriously and doctors should work within the framework of individual patients. What they value, what their life was. Before, during, after medications. Basically, patients need to be treated as an individual with different life values and goals. And if, in the context of trying to research PSSD, some doctors, researchers, psychologists decide that they are going to define what an appropriate level of libido or sexual function is, that’s going to have further ramifications that spread much wider than this diagnosis.

Courtney: So the very framework of medicalizing sexuality is an issue, but it gets more complicated with something like this too. Because, you know, desire, libido, the physical manifestations of those things that happen within the body are extraordinarily complex, and I truly do not believe that scientists actually understand it very well. Because we know that there are physiological things that happen. So I don’t think that erectile dysfunction is always going to be exactly the same as a base lack of desire or very low libido. One might contribute to the other, but there are physiological components of sexuality and there are mental, emotional, psychological components as well, and different aspects of those are more important in some people than others.

Royce: And it’s well established at this point that depression, stress, anxiety, those sorts of things can be the cause of erectile dysfunction or other issues that people have where the sex isn’t doing what they want it to do. Like that whole broad category of things.

Courtney: Yes. And so it’s extraordinarily complicated to begin with. And we know it’s complicated too because of fucking Addyi, the female Viagra. I swear one of these days I’m going to do a full episode on it, but I’ve mentioned it on and off for years because it does and has gotten target-marketed to asexual people as, you know, the female Viagra. Finally! But Viagra affects the body, the blood flow. It is, “I am going to influence the blood flow so you can get it up.” Where the alleged female Viagra affects brain chemicals because they’re saying this is about the desire. It’s not about anything physiological. Which is really rich because the pharmaceutical company creating Addyi was saying they made this big push after they got rejected from the FDA because it didn’t work of how it’s actually sexist if the FDA doesn’t allow this because men have Viagra. So why don’t women have Viagra? Women deserve to have Viagra too. That’s what gender equality is.

Courtney: But like, correct me if I’m wrong, I’m pretty sure medications for, like, vaginal dryness exist. I guess I haven’t looked into how well they work, but that sounds like a thing that already exists. And so you’re already comparing apples to oranges with this actually affects physical erections versus this is influencing chemicals in the brain, and it doesn’t work. So we’ll rant about that another time. But that’s just another isolated instance of when someone is trying to cure sexual dysfunction. Sometimes it goes in weird ways. They’re saying women with a low libido should be able to raise their libido, but Viagra doesn’t raise libido. Viagra, from my understanding, you take it once when it is erection time. You have decided it is erection time, and so you take it. The alleged female Viagra, you take it more like an antidepressant. You take it every single day. Every single day to change your brain chemicals. And it doesn’t work.

Courtney: So this article even states that the statistical risk of PSSD is unclear because of the research limitations that currently exist. But one study called out here, erectile dysfunction, which affects less than 1% of former SSRI users, while another found that genital numbness numbness impacted at least 13%. I’m also gonna go out on a limb and say that those two things are different things. So not only would we necessarily have an issue defining what a medically appropriate sexual function is, sexual dysfunction seems to be itself an umbrella term for a lot of different things.

Royce: Yeah, it is. And I think that’s the case with a lot of things that are labeled as dysfunction. It’s really that someone, hopefully in most cases it is the patient, says that something is wrong and I would like it to not be that way. Sometimes it’s a medical professional saying, “You’re saying you’re fine, but I don’t believe you and I think this needs to change.”

Courtney: Yes. And so that is the problem, because even right there, erectile dysfunction and genital numbness, those are also two different– two completely different things from the original source you talked to who said she doesn’t develop crushes anymore. That’s also not the same thing as those two. Now we’re talking about three different things. So there is a line in this article that to me is indicative of my entire issue with the framing here. It says: “Full-blown PSSD might be rare, but it seemed to hint at more likely and important repercussions of reducing emergent sexuality.” And therein really does lie the issue. I do think there are people for whom sexuality is important. If someone has it and believes a medication is the sole reason that it has gone away, that can be disconcerting on an individual level.

Courtney: But what we seem to have now is a culture of medicalizing sexuality in a way that places the importance of what a correct sexuality is above all other things. Just like with trans health care. We in our community know that to very often be life-saving medical care, certainly life enhancing, but all the talking points are this is dangerous because of a normal sex life. We need these kids, these children, these teens to grow up to have a normal healthy sex life. And if we place that emphasis above other things in a case of SSRIs, we’re talking about extreme depression, anxiety, eating disorders. We’re talking about instances of self-harm, suicidal ideation. We are not far from– dare I say we are already at a point where in the popular reporting of things like this, the rare potential risk that someone will grow up to not have what is deemed to be a normal sex life is being put above immediate life-saving interventions.

Courtney: Because there very much just is an air about these conversations that seem to talk about sexual side effects as if it is a singularly horrifying side effect. When any medication has a chance for side effects, this is a well-known fact. Some of them are incredibly rare, yes. Different medications interact with people differently. For some people, common antidepressants like this don’t even work to treat their depression. Whereas others, it literally saves their lives. So there is always, in every instance where medication is being prescribed, there is always going to be a cost-benefit analysis, not only from the prescribing doctor, but from the patient. And yes, patients absolutely should be educated. But a lot of the quotes and talking points in this article and others like it are, “Yeah, I needed this prescription for a mental health disorder, but they didn’t tell me I wouldn’t want to have sex. I wish I knew about that.”

Courtney: And that’s a tricky one because as I said, on an individual level, we can certainly empathize with this. But I’ve also heard psychiatrists talking about sort of defining this disorder. How do we put the language? What do we look for when we’re writing an entry in the DSM? When we’re having these conversations, talking at conferences. There have been a number of psychiatrists who have come out and said that there is an overemphasis on sexual side effects of these things, that it is, as of now, known to be very rare. And they are afraid that there is an overemphasis in articles like this, in talking points, in attacks from sometimes people who do have a very nefarious reason for going after a variety of life-saving medications for minors, that they worry people are going to start turning down medications that very likely will help them. That very well might be life saving.

Courtney: And don’t get me wrong, I know antidepressants can be life saving, but I am no friend of the pharmaceutical industry. I have strong criticisms for how FDA approval processes even work. I have enormous criticisms on just the DSM. And the definition of various psychiatric disorders to begin with. But as someone for whom ketamine has been a life-saving treatment, as someone who has spoken to others who have used ketamine for instances like treatment-resistant depression, and have also reported that it is a life-saving medical intervention, often with few to no side effects on an individual basis, I rarely see alternatives put out in conversations like these. They seem to begin and end at, “Are SSRIs bad? Maybe we shouldn’t be giving them to so many teenagers.” And that’s paired with the fact that there are many millions of teens who are prescribed these medications, and those numbers are climbing, they are going up.

Courtney: But there are also a lot of systemic societal issues I can point to that might be contributing to that. And those also don’t tend to get brought up in these conversations either. Anecdotally, I do have some people in my life who were on SSRIs for a number of years, battling intense depression, and there are always going to be different cases, and sometimes it’s genetic, sometimes there are genetic predispositions. But I know people who said, you know, I was on SSRIs for years, but the main thing that finally cured my depression was just becoming middle class. Like when I was food insecure, housing insecure when I was living paycheck to paycheck, when I was in a lot of debt, like there was just nothing that was going to help me get my head above water. Like sure, the SSRIs, you know, took the edge off, so to speak, so that I wasn’t harming myself, but I was not happy. And so there are, I think, a number of things.

Courtney: But then you see all these silly things that are like– I read an article not too long ago that was like, oh, we learned that exercise is actually more effective than antidepressants in treating depression. And it’s like, okay, cool. The height of my depression, I was a competitive athlete. I was exercising intensely for several hours a day. Try telling depressed Courtney from yesteryear that she just needed a little more exercise. And I know I am but merely an asexual. I know a vast majority of the population is not going to understand the lens with which I view things like this. But the article also points out these drugs may avert self-harm or suicide, right? That’s huge, right? Like we want people alive long enough to treat them and to give people a higher quality of life. That is a good thing. But they followed up with a but. These drugs may prevent suicide, but! Some clinicians believe it seems probable that with SSRIs, something sexually disruptive may also happen.

Royce: That’s a lot of maybe if’s.

Courtney: [laughs] I mean, it is.

Royce: But also? Dying really disrupts sexual activity.

Courtney: Permanently. Like, yeah, I cannot see those as in any way equal. And usually I try to see things from another point of view. In this case, I think I refuse. And then we have this: “One of the most haunting accounts I heard of PSSD came from a parent. Ruth told me that a couple of decades ago, her daughter was prescribed Zoloft, an SSRI, at 11 by a psychiatrist after a humiliating incident at school left her feeling out of sorts and anxious. About the prescription, Ruth said, ‘I guess I thought that was a good thing.’ She spoke of her naivete at the time and blind trust in psychiatry. Her daughter wound up staying on the drug for a decade until 2011. Over the past few years, has Ruth learned from her daughter about the sexual side effects she still lives with and about her grief? ‘Her erogenous zones don’t work,’ Ruth said. ‘It makes me deeply sad because our sexuality, the pleasure we get from our bodies and our intimacy with another person, it’s such a beautiful experience. It helps us to feel not alone.’ Thinking back, Ruth says, ‘I have huge, terrible regret about allowing her child to be medicated. I can’t believe I so easily said yes.’”

Courtney: I’m sorry, Ruth. I don’t think you should be in this article. Does your daughter feel the same way? I don’t even know! I don’t even know. Does your daughter think she needed that medication for that decade? Did it actually help her continue with schooling and socialization in a way that she would not have been able to do otherwise? And is her erogenous zones not working actually a problem for her? Maybe it is. Maybe her daughter’s venting to her mom saying, “How dare you, Mom, why did you let them put me on this medication?” I don’t know. Could be. But I’ve also seen instances of parents of asexual kids and trans kids who have spoken completely out of turn, blaming medication for what is otherwise their child’s orientation. I know nothing about Ruth or her daughter, so I’m not claiming this is the case, but what if?

Courtney: What if Ruth’s daughter is asexual and happy? And is like, “Yeah, I’m asexual.” But then Ruth goes online and starts googling “asexuality is not real. Why is my daughter asexual? How did my daughter turn asexual?” Because maybe she’s grieving that she’ll never have grandkids. That’s a thing parents do a lot. And you start getting all of these usually conservative leaning talking points about medication screwing up teenagers budding sexuality and all the scare tactic language that goes around with it. And she thinks, “Oh, my gosh, my daughter was on that. That must be the reason why.” As I said, maybe it’s not the case, but even if her daughter thinks that this medication did cause it, does she regret it? I don’t know. You didn’t tell me anything about that. Maybe she’s cool with it and Ruth is just talking to this author at the New York Times with all of this weighty language about how important our intimacy is with another person and how my daughter’s never going to experience this beautiful thing that makes us all human.

Courtney: I don’t know. I don’t think parents should talk for their kids in most situations. Especially, and the author of this article too, calls it one of the most haunting accounts I heard. So you talked to a bunch of people with PSSD and a parent of someone with alleged PSSD– and the parent was the one who gave you the most haunting account? Mm… Something feels weird there. That has my alarm bells going. It goes on to talk a bit about extrapolations on research about adults and SSRIs and sexual functioning and surmises: “Though it’s unproven, it’s possible to infer that a comparable percentage of young people taking the drugs experience a dimming of their sexual selves.” And the article simultaneously critiques that perhaps psychologists and psychiatrists are not asking young patients on SSRIs about any sexual side effects. Which is to me really fascinating because in our little community, how often do asexual teenagers get told, “You’re not asexual, you’re just young, you don’t know what you are yet”?

Courtney: So that once again, just societally, proves that there is never a good faith criticism of who can and cannot know that they are asexual. There is a widely held belief that asexuality does not exist. If it’s present, it’s clearly a medical symptom. And there’s a baseline assumption that all people should fit within a certain framework of sexuality. And if you deviate from that in any one direction, that is a problem that should be solved. This comes at it from the framework essentially saying that there is a right and a wrong way to experience sexuality. And they’re saying these drugs influence people in a negative direction. And I just, I really want to go on record as saying there is not, nor should there be, any definition of a normal sexuality or a normal sex life, period. I have just never, ever seen a convincing argument where someone’s like, “This is not a normal sex life, or I want a normal sex life,! where I can agree with the very foundational premise of the argument they’re making.

Courtney: I mean, some people will still say that, you know, gay sex is deviant. That’s not a normal sex life? All right, you’re wrong. Transsexuality, that’s not normal sexuality? Okay, you’re wrong. Ace people can’t have a normal relationship without a sexual component? Okay, wrong. And I would even say that the statement of someone with PSSD will never have a normal sex life, I think is wrong because there’s no such thing as a normal sex life. There’s no such thing as it. And we need to stop trying to define it medically and socially. Hard stop. And that framework does not need to be at odds with the fact that there are cases of some people whose sexuality does seem to have changed in one way or another or in a variety of ways as a side effect of medication. That can still be true and that can still be a problem we can research. But I think any research is going to be flawed if it starts from a base assumption of what a normal sex life is, because there is no such thing as that.

Courtney: And even to my earlier point about how, quote, sexual dysfunction is being used to talk about seemingly several different things, the article kind of backs me up with that. It goes on to talk about how there is a doctor who is doing imaging studies of penile tissue, which is actually kind of interesting. Tracing specifically erectile dysfunction impotence with a group that has taken SSRIs versus a control group who trace their erectile dysfunction to things like trauma, like a physical injury. And without reading the study myself, this summarizes that with these penile imaging scans, the group that has taken SSRIs has this black tissue that indicates excess collagen, which is far more consistent with the erectile dysfunction you see due to aging and diseases. But the group that had physical injuries did not have any of those signs on their images. So that is very physical, very measurable. It’d be interesting to see more research done on that to see how and why an SSRI might cause that to happen if in fact that is the case.

Courtney: But then the article goes on to say: “Other mechanisms behind PSSD, less easy to discern, could lurk within the mysteries of the psyche and its murky relationship to the biochemistry of the brain.” And TLDR: brains are weird and complicated and even people who study them don’t know everything about them. But then to tie it back to a specific person that was interviewed for this article as having PSSD, it says there’s also a full blunting of non-sexual emotion where this patient, Cale, says, “‘I don’t feel attached to them anymore.’ He says of his parents and siblings, ‘I could go years without seeing them and I wouldn’t miss them.’” And so you now have, okay, maybe it’s causing erectile dysfunction, maybe we have scans that can show and prove that this is happening, versus this person also has PSSD, we’re calling it exactly the same thing. He doesn’t love his family anymore. But we’re calling his disorder post-SSRI sexual dysfunction. That seems like that’s not the only issue there, and maybe that’s a misnomer.

Royce: I mean, Freud might approve.

Courtney: Freud might approve! Yeah, fuck Freud, man. [laughs] So much of this is his fault. And then it jumps to another case, Sean, who says: “I had numb genitals.” Sensation on his penis, “feels like my elbow. If you touch my elbow, it’s that same kind of sensation.” But then goes on to talk about how there’s an emotional numbness that goes along with the physical. “I can’t feel any connection to you guys. I feel like my soul was ripped out of my body.” Which is really consistent with other blogs I have read by people with PSSD. I vividly remember one saying, “I feel like a lobotomized zombie. I have post-SSRI sexual dysfunction.” Why are you calling it that? Why? If anything, that sounds like a symptom of a broader thing, and it is a misnomer and shouldn’t be called that.

Courtney: But that is, again, this hyperfocus on medicalizing sexuality. That has been placed above people who say they feel like their soul has been ripped out of their body and they don’t experience other emotions. They’re like, yeah, but the sexual dysfunction part is the problem. That’s what this thing should be called. And it goes further. It goes on to say, “Another intertwined distress is the disappearance of creativity. It goes back to Marie, the very first woman we spoke to in this article who says she has no flow state. She was a musician, played a variety of instruments, and says, ‘Sometimes I feel like a robot.’” And I really just– That feels like burying the lead in an article where you’re talking about, like, SSRIs giving sexual side effects to teenagers. You open with a woman saying, like, “Yeah, I had crushes before I started taking this, and now I don’t have crushes anymore.” But then halfway through this incredibly lengthy article it’s like, also, she lost her love of playing instruments. She can’t practice her flute anymore. She says emotionally she feels like a robot.

Courtney: But the entire framework is about the sexual dysfunction. Again, just like with the, you know, preventing self-harm and suicide, those things to me are not equal. We have another story by Liz that says: “Liz told a story that interlaced the loss of Eros with other deep shifts. Like Marie’s story, Liz’s involved music.” It goes on to talk about how she used to masturbate to Jeff Goldblum. Extremely specific. But then says, “Liz said her medication snuffed out her sexual feelings. It also seemed to steal the heightened, exquisite sensitivity. The spine tingles she had always felt listening to, playing, and creating music. With that gone, her artistic determination and ingenuity disappeared.” A quote from her says, “It’s somehow tied to the sexual. Everything became robotic and formulaic. I couldn’t invent stuff on the piano.” And I would love to have a conversation with someone like Liz. Genuinely, I would. Because I want to know why it is that she thinks it is the creative passion that is tied to the sexual.

Royce: Yeah, my best guess is that it’s exactly the opposite. Whatever is causing this state of mind where you can’t enjoy things in the way you once used to, that is causing both of those effects, is what my guess would be.

Courtney: Yes. And I believe it is. And if it’s happening at the same time, and you, in your personal experience, have a very clear, “This is when it started.” So it’s easy to extrapolate that, yes, this medication is what caused both of these things to go away simultaneously. Then I’m sure there is an inciting incident that caused it all to happen. But where did the quote come from where you’re talking about your love of music and saying it’s somehow tied to the sexual. Is it because of whatever the question this interviewer asked? And I assume the interviewer was taking this from a sexual standpoint. It’s all under the umbrella of PSSD, and that is the starting point. So that’s the framework you have. It could be that. It could be the very nature that this thing is called PSSD to begin with. So there is sort of a like, this is what my diagnosis is called.

Courtney: This is the framework I’m going to approach the rest of my experience, because this is what that I have on paper, and this is what I’m being interviewed for. Or even a broader, less specific societal thing where lots of people do treat sex and sexuality as the pinnacle of human existence and do place it above all other things. So of course, if you don’t have one, you can’t have the other. That’s why so many asexual people are called robots. That’s why so many of us hear time and time again that we can’t lead meaningful lives if we don’t have, you know, a robust sexual experience either. And that is why I think an asexual framework, an asexual advocate, researcher point of view needs to be incorporated into any conversations like this. Because I don’t want people to immediately dismiss Liz and everyone like her and be like, “This is wrong, this is bad.” Because we don’t like dismissing people’s medical concerns. That’s not a thing we want to do around here.

Courtney: But what’s going to get the most clicks, what’s going to get the most outrage, and therefore the most attention, is gonna be this extremely sexual framework, this extremely allosexual lens, this extremely amatonormative lens, that is not only going to hurt the Asexual Community in the long run, but I think everybody. I also think it’s going to hurt people like this. Because if all the research they’re advocating for is being approached from this very sexual angle, I don’t want the fact that you no longer love listening to music to be an afterthought, because the only thing that’s going to get attention is like, but what about the sex lives of teenagers? To me, that is a narrow, harmful lens that will harm everybody. And, yeah, we– we just really need an asexual point of view to be incorporated into all of these.

Courtney: And this article points out, to your earlier point, Royce, that any effort to fully research PSSD will face the challenge of distinguishing between the effects of SSRIs and the impact of the depression, anxiety, or other psychological troubles. Because, yeah, a lot of these symptoms are also known symptoms of depression in some people. So is it the underlying disorder or is it the thing you’re trying to treat it? And them, right off the bat are saying this is gonna face an issue and that the problem is that patients dealing with this are going to be disregarded. And I agree the patient should not be disregarded. But I think hyper focusing on the medicalization of sexuality is going to be as much of a hindrance, if not the actual problem. Because any nuanced reading of this on an individual basis is the problem is not that you don’t have a libido, because that is not a problem for everybody. And it should never be looked at as a problem for everybody.

Courtney: The problem in these cases is: this was a thing I had and valued, I took a medication, and now it’s gone. It should be treated with a similar gravity as I lost my love of playing music. Earlier I had an example about dance. And I don’t know what a symptom would necessarily be named that is broad enough to account for whatever an individual person cherishes and values, but I think finding the answer to that and taking it very seriously and treating patients like individuals is the only way to do this correctly without inadvertently causing a lot of other medical and social issues. But yeah, the placebo and nocebo effects, like you were mentioning, is also like just a really rocky component of all of this. Because here is a psychiatrist who believes the placebo factor for SSRIs might be at roughly 35%. And his concern is if you are very forthright when prescribing, saying there might be sexual side effects, he’s concerned about it mucking up the patient’s optimism about the prescription thus losing the placebo boost.

Royce: Yeah, in skimming through some of this article, a lot of the things that people are saying about what they are calling their sexual dysfunction read to me in the same ways that cases of sexual dysfunction that have nothing to do with SSRIs. And I don’t know how to distinguish those. I don’t know if any licensed professional knows concretely 100% of the time how to distinguish those things.

Courtney: Yeah, because brains are weird, bodies are weird, psychology is weird. I mean, a lot of things about psychiatry are also just a much softer science than a lot of people give it credit for. It can be helpful, it can be harmful, it can be mostly helpful with a little bit of harm. It’s all different on a case-to-case basis, and not all psychiatrists or prescribers are even built equally. But this next story really told me the approach that the interviewer was coming in from, which also tells me that this entire article is likely quite biased. [reading] “A young man named True told me a story that was a reminder that sexual side effects can matter much less than misery.” He’s been on fluoxetine for almost 10 years, had about a year and a half break in the middle all of that. He had enormous anxiety about college entrance exams as well as mass shootings in school, because that’s a thing that students have very real anxieties about in this country.

Courtney: Again, some of those systemic issues that don’t really get brought up in conversations like this.

Courtney: But he states that, you know, his taking fluoxetine was transformative. It didn’t totally eliminate all of his troubles, but it was meaningfully protective. And it says desire for his girlfriend was depleted, erections were more tenuous, and orgasms were much tougher to reach. But he wrote this off partly to being in a long-term relationship. [reading] “When he eventually stopped taking the drug because he wanted to experiment with sorting through his anxieties unmedicated, erections rebounded and climaxing was no longer a chore. Then he gave up his medication-free experiment, the sexual troubles returned. When I asked about PSSD, he guessed that it would not become a problem given how sexuality was restored when he took a pause from fluoxetine. But as we talked, it wasn’t clear that he worried much about whatever risk he might nevertheless face as his use of the drug lengthens year by year.” That’s such a weird line to me. “As we talked, it wasn’t clear that he was worried that this might be a long-term problem.”

Courtney: It’s like you interviewed these people, assuming every single one of them was gonna be like, “Yes, it’s ruining my life because I don’t have a sexuality anymore.” And then you meet someone who says, “No, actually it was kind of worth it,” and you didn’t know what to do with it. And as, quote, “It’s sometimes hard to stay erect or get erect, and as the stars have to align a little for him to have an orgasm. For him, he said, fluoxetine works super super well. He was willing to put up with the sexual issues.”

Courtney: I don’t know, I can’t get over the “it wasn’t clear that he was worried.” Why not just say he’s not worried? Why not just say for him the trade-off is worth it?

Courtney: And this next one is odd because it says: “Like True, Sammy told a story of need, but hers was also a story of regret.” I’d be really curious to see if she actually used the word regret. Because it goes on to talk about how her history of depression goes back to age 13.

Courtney: She was self-harming and managed to pull herself out without medication before sinking into depression again in college. Nope, three years after college, she began taking Zoloft and now says that orgasms are superficial and short lived and that sex is now just generally frustrating. After six years of being off it, she says that it’s finally returning at a drips pace. And she simultaneously said, “I felt I was out of options and it really did help me.” But also, “I would have thought much harder about it,” had she known about the enduring side effects. And the couple things that are odd to me about this is that the entire framework is teenagers. Three years post-college she was no longer a teenager. The article has already said we have found that there are known sexual side effects for adults. We don’t know if they are there for teenagers or not. And just sort of said maybe, probably, it could be within the realm of possibility. Because what are teenagers but small adults? It did not say that, to be clear.

Courtney: So not only are you using a solidly adult’s case to still say, “But what if teenager?” This is someone who simultaneously says, “It did help and I was out of options, but I also would have thought about it harder.” She either did not say or was not asked if, with the gift of hindsight, if she would still do it again or not. But also her first bout of depression and self-harm was at age 13. So if the framework of this article is about teenagers taking SSRIs and causing PSSD, someone who is an adult saying, “I would have thought a lot harder about this if I knew about the sexual side effects.” What would that conversation look like with a 13 year old? I really, really want to know because that is not a thing we’re talking about. I was pretty young, I think, the first time a doctor told me that I would likely have very complicated pregnancies because of what is now called EDS. It was absolutely not called that at the time. And that was already an extremely weird, complicated thing to hear at that very young age.

Courtney: But truly, what and how, what conversation would you have and how with a 13-year-old? Like, you are harming yourself, you are depressed, this medication might help you, but maybe you won’t want to have sex when you’re older. How do you feel about that? I don’t know. I– I don’t even know how to go about starting to have that conversation. But earlier in this article, the author made the case that not enough psychologists are talking about the possible sexual side effects of this when they prescribe to people. That was something that was explicitly stated and called out. But the title of the article is More Teens Are Taking Antidepressants. It Could Disrupt Their Sex Lives For Years. Genuinely tell me, how do you propose to have that conversation with teenagers? Truly.

Courtney: The mother who was distraught, who gave you the most haunting story of all the people you talk to, said her daughter was 11 when she started taking medication. How are you going to have that conversation with an 11 year old? Please enlighten me. It’s sort of those– Like, you’re shouting about a problem that you think people are going to be afraid of without offering solutions and alternatives. I mentioned other medications. I mentioned ketamine. Like, we never talk about ketamine in these conversations about SSRIs, although I think that should also be discussed in these conversations. The reason why these SSRIs are so much more readily available is because, you know, insurance covers them. There are other treatments with studies that show that they work that aren’t covered by insurance because there’s no way to get this FDA approval, purely because of profit motives for the company, period. And those conversations don’t get put in here.

Courtney: You say it’s a problem that these people aren’t informed of possible side effects, so give us an example of how to fix that and what that should look like. There’s one case here where someone says she found herself completely de-eroticized. Quote, “I thought, ‘I have ruined my life. I have obliterated my ability to have a normal relationship’.” There we go. There’s that normal relationship quote again. And I’m– I’m trying to check myself here a little bit because I don’t want people experiencing these instances to feel shame by what I am saying. But just like I don’t think there is a normal sexual function or a normal sex life or a normal sexuality, I also don’t think there is such a thing as a normal relationship. So any quote like that at a large scale to me warrants criticism.

Courtney: She says that for the first couple of years of this, she would wake up and remember what happened to her. Quote, “That this was my reality and I would just want to go back to sleep and not wake up. I had frequent thoughts of suicide.” And when she conveyed this to doctors, doctors said that sounds like depression returning. They said, quote, “Some people might say their sexuality is less important than their mental health, and their dismissals imbued shame.” And I really, really do not want to shame people who are experiencing this. I– Truly, that is not my goal. But knowing the world we live in, the society we live in, how sex and sexuality and relationships and marriage are all made out to be a very prescriptive, normative thing, we have this woman now who’s saying, “I don’t have the capacity for romantic relationships. That’s just gone in a stark way. For me, the chemical mechanisms of romance are too deeply tied in with sexuality for the romantic to exist independently. One reason I have improved somewhat mentally is by tolerating a new normal.”

Courtney: She just had her first child, because she has no partner she used in vitro fertilization. Quote, “I want a partner, she said. ‘I want a child to grow up with their mom and dad. Your sexual life is so core when you consider that the sexual relationship is the basis for most long-term relationships’, she explained. ‘As excited as I am to be a parent, every so often I’m hit with another wave of grief that I had to resort to this, that it came to this.’” And that is how the article ends, and that’s a very bummer way to end. Especially here, hearing it coming from a community where we so often have a more expansive view of what relationships are and can be. I’m in a way kind of glad that she said, “For me, romance is so deeply tied with sexuality that I can’t feel the romance without the other.” Because I do think that is true for some people. It’s not true for everybody. And that’s most abundantly clear in our community amongst the aces and aros.

Courtney: But I want to hear more about how she came to the decision to have a child via IVF with no partner. I really genuinely am curious because she says, “I want a partner. I want my child to have two parents. But if we don’t have a sexual life, then that was core to who I am, and I don’t have that now, so I can’t have that.” And I just know so many people who do co-parent without a sexual relationship, without a romantic relationship. There are queerplatonic partnerships. There are friends who co-parent. And I don’t know if she knew all of these options and different relationship structures. It could be that she did and just decided it wasn’t for her. That’s possible. But it’s not very likely, considering on major outlets, even like the New York Times, every now and then there’s a big shock article like friends are getting married now, isn’t that silly? And I guess the reason why I do want to– Okay, so my ideal interview candidate would be someone who identifies as having PSSD but is also just socially very aware and an ally to asexuals.

Courtney: Because I really do want to dissect the differences in a way that I feel like a lot of people are not equipped to do. Because just not having a clear enough frame of reference for the other lived experiences. Because another thing that I find myself asking every time I hear these things, I have to kind of equate it to almost, in my mind, to like a disability. Because we’re talking about grieving something you had that you no longer have. And my biggest frame of reference for that is like physical capabilities. You know, even within the disability community, there are people who are born with a disability, and there are others who acquire a disability throughout their life. And those are two fundamentally different experiences, even if their symptoms are similar. And it’s a bit of a trap because sexuality should not be medicalized, but it’s really hard not for me to say, like, okay, so in some ways, someone could be born asexual, or they could become asexual. And those are going to be two fundamentally different experiences. And how do both sides reconcile it?

Courtney: Even folks I know who believed they were and have always been asexual, some of them had a much harder time coming to grips with it than I did. Some still grieve for the life that just society told them they should have, and then they learned it wasn’t a good fit, whereas others are like, “Great, I’m asexual, don’t need that in my life, we’re happy, we’re cool, we’re content with that.” The emotional responses vary widely. But when you talk about, like, desire, like, “I did desire romantic relationships, I did desire sexual relationships, and now I took this medication and I don’t desire these things anymore.” I want to hear a really in-depth, nuanced conversation with someone like that about, like, tell me more about why that is a problem. Because equating it to other activities I can get there. When I use my dance example, when I see music example, that I totally get.

Courtney: But I struggle to understand more when it’s in a context of a teenager who was not sexually active before that, which nearly every adult who is writing or reading an article like this is immediately going to be like, “That’s bad. If a teenager doesn’t want to have sex anymore, that’s a bad thing.” But if you were not sexually active, but you did have crushes, crushes are not always sexual in nature. Sometimes they can become that. But I know so many asexual people who look back at what they thought was a crush or what they perceived as a crush and realize, no, that was kind of just societal pressures on me. That was how I perceived it. Or I was trying to fit myself into a box that didn’t really fit. And some, for some people, it takes years and years and years of unpacking to understand this about themselves.

Royce: And that’s part of why this can be very difficult to pick apart or why you would need someone who was very self-aware to sit down and have an in-depth conversation. Because when you talk about struggles to exist in a relationship or a hesitancy to try to have a relationship, you know, the idea that a relationship without a sexual component can’t exist. Does that person know for a fact that that is the case for them? Or do they have a lot of deep-seated feelings of insecurity, perhaps of selfishness or guilt, because their entire life they’ve been told to be valuable or meaningful as a person in a relationship you need to bring this to the table?

Courtney: Which is something that even a lot of ace people have over the years. These are common feelings. And so on an ‘activity you enjoy’ level, I get it. If you enjoyed this and now you don’t, and you have a direct, “I think this was the cause,” that’s a problem. You deserve doctors who are going to listen to you empathetically 100%. If it is a teenager who did not have a sex life yet and is like, “I just never developed that interest, I don’t have that interest,” then any negative feelings that would come from that is to me a little less clear. Because it’s not, “I’m grieving something I had and liked that isn’t there.” It’s a very theoretical grief. It’s a, theoretically, “This is the life I thought I would have or could have.” But if you literally now, as you are, just don’t want it, there is a little part of me that always wonders and wants to ask or try to understand, like, why do you want to make yourself want it?

Courtney: And I do think that, you know, the two communities, the PSSD community and the Asexual Community, I think theoretically, with an abundance of conversation and empathy, I think could learn a lot from each other. But my suspicion is that both sides are going to see the other as, like, fundamentally incompatible towards achieving your goals. And that sucks. Because I don’t think it has to be. But in the society and structure we have, it probably does seem that way. Asexuals are trying to not be medicalized. We are famously one of the most heavily medicalized minority orientations. So a huge number of aces are going to be like, “Absolutely not, PSSD, get out of here. We are going to ignore it. We aren’t going to talk about it.” Whereas PSSD, on the other hand, I’m sure aren’t going to want to hear a bunch of asexuals be like, “Sex doesn’t matter that much. Just get used to not being sexual,” if that’s something that was meaningful and important to those people.

Courtney: I don’t think it has to be that way, but I think if done correctly, understanding the nuances of asexuality can help the PSSD community in a variety of ways. Not only from shifting the framework of research in a way that I think long term would be more meaningful, but also, while someone is grappling with these issues of I wanted this and now I don’t have it and they haven’t come up with a cure yet, maybe giving some kind of comfort about how here are the numerous ways you can have a relationship. Here is how you navigate a relationship and have conversations if you have sort of, you know, varying levels of libido, a mixed orientation. These are conversations we have all the time in the Asexual Community that could help people like this, even if they didn’t get to their point in their life the same way we did.

Courtney: And if there is someone with PSSD out there who does decide this is my new normal, this is just how I am, and they decide that asexuality does work for them as a label, I think we need to fully embrace them and allow them in. And I would be livid if and when I saw people in the Ace Community being like, “That’s not actually asexuality. You don’t count. You don’t belong here.” Because at the end of the day, there are going to be similar social issues. There are going to be similar relationship issues. And I think we can and should be able to help each other out. Like I referenced earlier with the PSSD blog I was reading, someone talking about the social ostracism being an issue. Yeah. Welcome to the club! Us too. Let’s be friends. Let’s help each other out.

Courtney: But that is necessarily going to mean that the Ace Community cannot be so quick to shun any and all concept of sexuality being fluid, being changed, being influenced by a medical history, which is something that the Ace Community sometimes does, at least certain pockets of it. And it is going to involve folks speaking about their lived experiences with PSSD not using language like any normal relationship. So I guess that’s my premise. We shouldn’t throw each other under the bus. I think we can and would be stronger together if we can figure out how to do it right. But everyone’s terrible, including but not limited to the writer of this article. And we’re a long way from it.

Courtney: So that is gonna be all for today, which means it is time for today’s featured MarketplACE vendor. Today we’re giving a big shout out to Baumaus where you can find original and fan vector art made by an agender, panromantic, asexual latine. Links to find Baumaus of course are gonna be in all of the usual places. You can purchase some ready-made artwork and poetry for wallpaper or printable files, or check out their commission page for poetry in Spanish or English, or longer original short stories or art. I think my favorite in this shop is this really beautiful rainbow flying fish file, but I do also love a good Mothman and you can find that too. As always, thank you all so much for being here and we will talk to you all next week.