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This new sexual health trend has your patients seeking unverified health benefits

MDlinx Mar 23, 2024

There is a trend among men to refrain from masturbation for a variety of reasons—the “NoFap” movement, as it is known by some, became popular on Reddit and is now a dot-com organization calling itself a “comprehensive community-based porn recovery site.”

About us. NoFap. 2023.


With more than 738,000 Reddit followers, this community has convinced many that refraining from masturbation for weeks to months at a time has a significant, positive impact on one’s physical and mental health.

Mascherek A, Reidick MC, Gallinat J, et al. Is ejaculation frequency in men related to general and mental health? Looking back and looking forward. Front Psychol. 2021;12:693121.




What does the research say?


This movement has become highly controversial, as members of the NoFap community have proposed many unproven benefits associated with what they refer to as “semen retention,” or abstaining from masturbation. These purported benefits include increased testosterone levels and improved sperm quality, along with alleged mental health benefits such as improving self-confidence, social/romantic interactions, and energy levels.  


While hypersexuality and pornography addictions may be examples of problematic behavior, there is no scientific evidence supporting physical or mental health effects related to masturbation/ejaculation habits.

Advocates of the NoFap movement often cite studies in an effort to back up their claims. However, these studies have limitations that weaken their support. 

For example, an older study from China found that men who refrained from masturbation for a week had a 45% boost in testosterone on day 7.

Jiang M. Periodic changes in serum testosterone levels after ejaculation in men. Sheng Li Xue Bao. 2002;54(6):535–538.[Chinese]

This study was very small, with only 28 male participants, and on the day following the testosterone spikes, levels returned to normal. 


A larger study, among both men and women in the US, showed that the “men's findings indicated their [testosterone] might be elevated by their sexual (masturbatory) activity but not vice versa,” meaning that masturbation is what boosts testosterone.

Das A, Sawin N. Social modulation or hormonal causation? Linkages of testosterone with sexual activity and relationship quality in a nationally representative longitudinal sample of older adults. Arch Sex Behav. 2016;45(8):2101–2115.

In terms of improved sperm quality from abstention, a study from Israel showed that abstaining from masturbation for one day improved sperm quality, and produced a peak in sperm motility. However, After a longer interval (11 to 14 days), the sperm motility declined.

Levitas E, Lunenfeld E, Weiss N, et al. Relationship between the duration of sexual abstinence and semen quality: analysis of 9,489 semen samples. Fertil Steril. 2005;83(6):1680–1686.




Clinical implications


A 2022 study by a group of urologists who reviewed the quantity and accuracy of content related to men’s health on TikTok and Instagram found "semen retention" and its related hashtags to be the most popular topics. Unlike every other men's health topic they studied, none of the semen retention posts were coming from trained physicians.

Dubin JM, Aguiar JA, Lin JS, et al. The broad reach and inaccuracy of men’s health information on social media: analysis of TikTok and Instagram. Int J Impot Res. 2022.


Sexual health is an essential conversation in the doctor’s office, and masturbation is a component of sexual health that often goes untouched. Sexual health is not only something that can be meaningful from a disease standpoint, but it is also something that should be discussed as a wellness topic. 

Wellness encompasses many different aspects of a patient’s life, including their mental health, overall sexual satisfaction, and healthy relationships.

Talking about masturbation from a physician's perspective can help uncover any signs of mental health distress, an unhealthy or abusive relationship, and pornography addiction. At the same time, it can strengthen the physician-patient relationship.


Porn addiction and dopamine cycles


The American Psychiatric Association (APA) does not identify porn addiction as a mental health addiction. However, “gambling disorder” and “gaming disorder” were not recognized as mental health disorders, either, until 2013 and 2019, respectively. Presumably, as the scientific community continues to learn more about “obscure” or “taboo” addictions, the APA and DSM-5 will adjust their guides accordingly. 

Pornography, like drugs, food, and other addictive substances, tends to hijack the brain’s reward system by increasing the dopamine output. When an individual continues to engage in pornography, the dopamine setpoint changes and, as a result, the individual needs more pornography consumption to feel the same desired effects. 

Behavioral addictions, such as an addiction to pornography, have been shown to have similar effects on the addiction circuit in the brain as hard drugs.

“Researchers have found functional magnetic resonance imaging (fMRI) evidence of activation of the same circuitry in cocaine users when they were shown drug-related visual images and subsequently erotic images.”

Horn L, Mansfield AS, Szczesna A, et al. First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer. N Engl J Med. 2018;379(23):2220-2229.



Porn addictions also have negative impacts to an individual’s mental health as well as their intimate relationships. In a blog post for FHEHealth, Sachi Ananda, PhD, LMHC, MCAP, a mental health and addiction professional, wrote that the most common mental health issues linked with porn addiction are substance abuse, depression, anxiety, and post-traumatic stress disorders. 

She elucidated these connections: “Some people with depression will use porn for a spike in dopamine. Highly anxious people may use porn as a self-soothing coping skill. Victims of sexual trauma may inadvertently re-traumatize themselves by watching porn. Substance abuse may result from porn addiction, where one feels shame for engaging in it and numbs these emotions through substances."

An individual may prefer to watch or view pornography rather than be in an intimate relationship with another person that involves emotional, physical, and sexual intimacy.

Given these interrelationships, it would appear that the NoFap movement would have the potential to be beneficial to individuals struggling with an addiction to pornography, although there is no research suggesting that refraining from masturbation is proven to be an effective treatment against addictive behaviors around pornographic material. Like other addictions, concerns about pornography addiction is best addressed by a licensed mental health professional. 


What this means for you

The NoFap movement is a growing trend online that encourages men to refrain from masturbating to increase their testosterone levels, sperm motility, and other physical and mental health benefits. However, there is not enough research to support these claims. When talking to your patients, it is important to discuss sexual health concerns, including those related to masturbation.


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