Hydrochlorothiazide Side Effects in Men: What to Know and What to Ask Your Doctor

Short answer: The most common hydrochlorothiazide side effects are frequent urination, headache, loss of appetite, diarrhea and dizziness when standing up. The ones that matter most over time are changes in blood salts (low potassium in particular), higher uric acid that can trigger gout, higher blood sugar, sun sensitivity and a small increase in non-melanoma skin cancer risk. Men also ask about erection problems: MedlinePlus lists hydrochlorothiazide among drugs that may cause them and calls thiazides the most common cause of erectile dysfunction among blood pressure medicines. If you notice any of these, talk to your doctor, and never stop or change a blood pressure medicine on your own.

Key Takeaways

• Hydrochlorothiazide (HCTZ) is a thiazide diuretic, or “water pill,” that helps the kidneys remove extra salt and water. It controls high blood pressure but does not cure it.^[1]
• Everyday side effects include frequent urination, headache, diarrhea, loss of appetite and hair loss. Thirst, muscle cramps, weakness, confusion or a fast heartbeat can signal dehydration or an electrolyte problem and need prompt medical attention.^[1]
• The prescribing label warns about low potassium, raised uric acid and gout, raised blood sugar, and higher cholesterol and triglycerides, which is why periodic blood tests are part of treatment.^[2]
• HCTZ is linked to a small increase in non-melanoma skin cancer, mainly squamous cell carcinoma, so sun protection and regular skin checks are recommended.^[2]
• Erection problems are a recognized possibility with thiazides, but high blood pressure itself, other drugs, diabetes and lifestyle also play a role. Your doctor can sort out the cause and has several options.^[3][4]
• Tell your doctor about every supplement you take. Some herbs, including Panax ginseng, may affect blood pressure or blood pressure medicines.^[5][6]

What Hydrochlorothiazide Is and How It Works

Hydrochlorothiazide belongs to the thiazide diuretic class. By making the kidneys pass more sodium and water into the urine, it lowers the volume of fluid in the blood vessels, which helps bring blood pressure down.^[1]

Doctors prescribe it for high blood pressure, alone or combined with other drugs, and for edema (fluid retention) caused by heart, kidney or liver disease. It is often taken once or twice a day and comes as tablets, capsules or a liquid. It is also built into many combination pills, such as lisinopril and hydrochlorothiazide or bisoprolol and hydrochlorothiazide, so some men take HCTZ without realizing it.^[1][2]

Because the drug works by moving salt and water, most of its side effects follow from that action: more trips to the bathroom, shifts in blood minerals, and changes in how the body handles uric acid and glucose.

Common Hydrochlorothiazide Side Effects

MedlinePlus lists the following side effects that you should report to your doctor if they are severe or do not go away:^[1]

• Frequent urination
• Diarrhea
• Loss of appetite
• Headache
• Hair loss

HCTZ can also cause dizziness or lightheadedness, especially when you stand up quickly from lying down. Getting up slowly helps. If nighttime bathroom trips bother you, ask your doctor or pharmacist what dose timing suits your prescription.^[1]

Side effects that need prompt medical care

MedlinePlus advises calling your doctor right away, or getting emergency treatment, for any of these:^[1]

• Signs of dehydration or electrolyte imbalance: dry mouth, thirst, nausea, vomiting, weakness, drowsiness, restlessness, confusion, muscle pain or cramps, fast heartbeat
• Blisters or peeling skin, hives, rash or itching
• Difficulty breathing or swallowing
• Fever, sore throat, chills or other signs of infection
• Unusual bleeding or bruising
• Ongoing stomach pain that may spread to the back
• Joint pain or swelling
• Vision changes, eye pain, or eye swelling or redness

Long-Term Effects: Electrolytes, Gout, Blood Sugar and Skin

These effects often cause no symptoms at first, which is why your doctor checks blood work while you take HCTZ.

Low potassium and other electrolyte changes

The prescribing information states that low potassium (hypokalemia) may develop, especially with brisk diuresis, severe cirrhosis, or after prolonged therapy, and it recommends periodic testing of serum electrolytes.^[2] Low potassium and other electrolyte problems can show up as weakness, muscle cramps or a fast heartbeat.^[1] Your doctor may suggest potassium-rich foods such as bananas, prunes, raisins or orange juice, a potassium supplement, or a combination pill that limits potassium loss. Follow the diet you are given exactly, and do not start potassium pills unless your doctor tells you to.^[1]

Uric acid and gout

According to the label, high uric acid may occur, or frank gout may be triggered, in some patients on thiazide therapy.^[2] MedlinePlus asks you to tell your doctor if you have ever had gout, and lists joint pain or swelling as a side effect to report right away.^[1] A man with a history of gout attacks may need a different medicine or extra monitoring.

Blood sugar and cholesterol

The label notes that high blood sugar may occur with thiazide diuretics and that people with diabetes may need their insulin or diabetes pill doses adjusted. It also states that increases in cholesterol and triglycerides may be associated with thiazide therapy.^[2] If you have diabetes or prediabetes, make sure your doctor knows, and keep up with your A1c and lipid tests. Our guide to health screenings for men explains which tests are routine.

Sun sensitivity and skin cancer warning

HCTZ can make your skin more sensitive to sunlight. The label also warns that hydrochlorothiazide is associated with an increased risk of non-melanoma skin cancer. In an FDA Sentinel System study, the extra risk was mainly for squamous cell carcinoma and mainly in white patients taking large cumulative doses. Overall, the increase was about 1 additional squamous cell carcinoma case per 16,000 patients per year; for white patients with a cumulative dose of 50,000 mg or more, it was about 1 additional case per 6,700 patients per year.^[2] For scale, 50,000 mg is reached after roughly five and a half years at 25 mg a day.

The absolute risk is small, but it is real. The label tells patients to protect their skin from the sun and to have regular skin cancer screening. MedlinePlus adds: limit sun exposure, wear protective clothing, sunglasses and sunscreen, and report any new skin change or growth to your doctor.^[1][2]

Hydrochlorothiazide Side Effects in Men: Erection and Sexual Function

This is the question many men are too embarrassed to ask at the pharmacy counter. The honest answer: it can happen, it is not guaranteed, and it is worth raising with your doctor.

The MedlinePlus Medical Encyclopedia includes hydrochlorothiazide in its list of drugs that may cause erection problems and states that thiazides are the most common cause of erectile dysfunction among the high blood pressure medicines.^[3] The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) likewise lists blood pressure medicines and diuretics among common prescription drugs that can cause erectile dysfunction.^[4] In one lisinopril and hydrochlorothiazide combination label, impotence was reported in 1.2% of patients on the combination versus 0.0% on placebo in clinical trials.^[2]

Much of the research that compares individual blood pressure drugs on sexual function dates from the 1980s and 1990s, used different doses and measured sexual function in different ways. So the published studies cannot tell you whether your own symptoms come from the pill.

Why the cause is not always the medicine

High blood pressure damages blood vessels over time, and healthy blood flow is central to erections. That means a man with hypertension can develop erection problems whether or not he takes HCTZ. Other common contributors include diabetes, smoking, heavy drinking, excess weight, poor sleep, depression, other medicines (antidepressants, some heart drugs), and low testosterone. If fatigue and low drive are part of the picture, our article on the signs of low testosterone covers what to ask about.

Timing is your best clue. If problems started within weeks of beginning HCTZ or after a dose increase, write that down. If they began long before, or came on gradually alongside weight gain or blood sugar changes, something else may be driving them.

What your doctor can do

Your doctor has several options and will weigh them against your blood pressure, kidney function and other conditions. These can include reviewing your dose, switching to a different class of blood pressure medicine, adjusting other drugs that may contribute, testing for diabetes or hormone problems, and discussing treatment for erectile dysfunction itself. None of these steps should be taken without your doctor. MedlinePlus is direct about it: never stop taking any medicine without first talking to your provider, because some medicines can cause serious reactions if you stop or change them carelessly.^[3]

Questions to Ask Your Doctor About HCTZ

• Is my current dose the right one, and how will we know it is working?
• Which blood tests do I need (potassium, sodium, kidney function, uric acid, glucose, lipids), and how often?
• Could this medicine be behind my symptoms (cramps, fatigue, joint pain, erection changes), or is something else more likely?
• If HCTZ is the problem, what are my other options for controlling blood pressure?
• Should I be screened for skin cancer, and how often?
• Do any of my other medicines or supplements interact with HCTZ? MedlinePlus notes that pain relievers such as ibuprofen and naproxen may interact with it.^[1]

A simple log helps: write down your home blood pressure readings, when symptoms started, and anything that changed around the same time (new medicine, dose change, weight, sleep, alcohol). Bring it to your appointment.

Supplements and Blood Pressure Medicines: Tell Your Doctor Everything

Many men with high blood pressure also take vitamins, herbs or “vitality” products. The National Center for Complementary and Integrative Health (NCCIH) states that no dietary supplement has been shown to have effects comparable to those of drugs used to treat hypertension, that some supplements may raise blood pressure, and that some may interact in harmful ways with blood pressure medicines. It also advises against replacing prescribed care with an unproven product.^[6] Mayo Clinic lists arnica, ephedra, ginseng (Panax quinquefolius, Panax ginseng), guarana and licorice among herbal supplements that may affect blood pressure or blood pressure medicines.^[5]

That is why you should tell your doctor about all supplements, including ones with Panax ginseng such as Ultra Bann, which Mayo lists among herbs that can affect blood pressure. If you want to show your doctor exactly what a product contains, bring the full label; for Ultra Bann, the complete ingredient list with amounts is published. For a broader look at which products can push readings up, see our guide to supplements that raise blood pressure.

Frequently Asked Questions

What are the most common side effects of hydrochlorothiazide?

Frequent urination, headache, diarrhea, loss of appetite and hair loss are the common side effects listed by MedlinePlus. Dizziness when standing up is also possible. Report any that are severe or do not go away.^[1]

Can hydrochlorothiazide cause erectile dysfunction?

It can. MedlinePlus lists hydrochlorothiazide among drugs that may cause erection problems and says thiazides are the most common cause among blood pressure medicines.^[3] High blood pressure itself and other health factors can also cause it, so talk to your doctor rather than stopping the medicine.

Does hydrochlorothiazide increase skin cancer risk?

The label says HCTZ is associated with a small increased risk of non-melanoma skin cancer, mainly squamous cell carcinoma, with the extra risk concentrated in white patients taking large cumulative doses. Protect your skin from the sun and get regular skin checks.^[2]

Can hydrochlorothiazide cause gout?

Thiazides can raise uric acid, and the label notes that gout may be triggered in some patients. Tell your doctor if you have had gout before.^[2]

Can I stop taking hydrochlorothiazide if I have side effects?

Not on your own. HCTZ controls blood pressure but does not cure it, and stopping can let your pressure rise. Call your doctor, who can adjust the dose or switch you to another medicine safely.^[1][3]

References

1. Hydrochlorothiazide. MedlinePlus Drug Information, U.S. National Library of Medicine. medlineplus.gov
2. Lisinopril and hydrochlorothiazide tablets, prescribing information (Cipla USA, revised 10/2021). DailyMed, U.S. National Library of Medicine. dailymed.nlm.nih.gov
3. Drugs that may cause erection problems. MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. medlineplus.gov
4. Symptoms and causes of erectile dysfunction. National Institute of Diabetes and Digestive and Kidney Diseases. niddk.nih.gov
5. Medications and supplements that can raise your blood pressure. Mayo Clinic. mayoclinic.org
6. Hypertension (high blood pressure). National Center for Complementary and Integrative Health. nccih.nih.gov

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. This article is for information only and is not medical advice.