Decreased Sex Drive: Causes and Treatment

What counts as low sex drive

There is no "normal" amount of sexual desire. It varies widely between people and across a lifetime. A decreased sex drive is a change from your own baseline. Doctors consider it a disorder (hypoactive sexual desire disorder) only when it lasts at least 6 months and causes personal distress, and is not fully explained by another condition, medicine or relationship problem.

Desire is shaped by hormones, brain chemistry, physical health, emotions and relationships. Problems in any of these can lower it, and often several overlap.

Common causes in men and women

Psychological and lifestyle factors

• Stress from work, money or caregiving
• Fatigue and poor sleep, including from shift work or a new baby
• Depression and anxiety, which lower desire directly
• Body image concerns and low self-esteem
• Past sexual trauma
• Alcohol and drugs: heavy drinking, cannabis and opioids reduce desire and performance

Relationship factors

Conflict, poor communication, lack of trust, boredom, and differences in desire between partners are among the most common reasons. Unresolved issues often lower desire more than anything physical. See relationship stress.

Medicines

Do not stop a prescribed medicine on your own. Your doctor can often change the dose, switch to a medicine with fewer sexual side effects (for example bupropion for depression), or add a treatment.

Chronic illness

Diabetes, heart disease, kidney failure, cancer and its treatment, chronic pain, hypothyroidism and obesity all reduce desire, through fatigue, hormone changes, pain or worry.

Causes specific to women

• Menopause and perimenopause: falling estrogen causes vaginal dryness and painful sex, which reduce desire. Testosterone also declines gradually with age.
• Pregnancy, childbirth and breastfeeding: hormone shifts, tiredness and body changes commonly reduce desire for months. Breastfeeding raises prolactin and lowers estrogen.
• Surgical removal of the ovaries causes a sudden drop in hormones.
• Pain during sex: from vaginal dryness, vulvodynia, endometriosis or pelvic floor problems. If sex hurts, desire understandably falls. See pain during intercourse.
• Hormonal contraception in some people.

Causes specific to men

• Low testosterone: the most important hormonal cause. Other signs include erectile problems, fewer morning erections, tiredness, low mood, reduced muscle and body hair. Testosterone falls slowly with age, and faster with obesity, diabetes, opioid use and some pituitary or testicular problems.
• Erectile dysfunction: worry about performance can reduce desire. See erectile dysfunction.
• High prolactin from a pituitary tumor or medicines.

How doctors assess low libido

A doctor will ask when the change started, whether it is constant or depends on the situation or partner, about mood, sleep, stress, relationships, medicines, alcohol and drug use, periods or erections, and pain during sex. A physical exam may include blood pressure, weight, and genital examination where relevant.

Blood tests depend on the history:

• Men: morning total testosterone, measured on at least two separate mornings, plus LH, prolactin, glucose and lipids.
• Women: thyroid tests and prolactin; sex hormone tests are useful only in specific situations.
• Both: thyroid function, blood count, glucose or HbA1c, liver and kidney function.

Treatment

Address the cause

• Treat depression, anxiety or sleep problems.
• Review medicines and alcohol use.
• Manage chronic illness and pain.
• Treat vaginal dryness with lubricants, long-acting vaginal moisturizers or low-dose vaginal estrogen.
• Treat erectile dysfunction.

Therapy

• Sex therapy with a certified sex therapist helps with differences in desire, performance anxiety and communication. It often uses structured exercises called sensate focus.
• Couples counseling for relationship conflict.
• Individual therapy such as cognitive behavioral therapy or mindfulness-based approaches, which have good evidence for low desire in women.

Hormone and medicine options

• Testosterone therapy for men with confirmed low testosterone and symptoms. It is not recommended for men with normal levels.
• Testosterone for women: some guidelines support a trial of carefully dosed testosterone for postmenopausal women with distressing low desire, under specialist supervision.
• Flibanserin and bremelanotide are FDA-approved for low desire in premenopausal women. Their benefits are modest and they have side effects and restrictions.

Self-help

• Prioritize sleep and reduce stress.
• Regular exercise improves energy, mood and body image, and raises testosterone in men.
• Limit alcohol.
• Schedule time for intimacy, and talk openly with your partner about needs and preferences.

Frequently asked questions

What causes a sudden loss of sex drive?

A sudden drop is often linked to a new stressor, a relationship problem, starting a medicine such as an antidepressant, depression, illness, or a hormonal event like childbirth or stopping the pill. If there is no clear reason, ask a doctor to check for hormonal or medical causes.

What causes low libido in women?

Common causes are stress, tiredness, relationship issues, depression, antidepressants, menopause, pregnancy and breastfeeding, and pain during sex from vaginal dryness or other conditions. Often several factors combine. Treatment targets each one.

Is low sex drive in men always low testosterone?

No. Stress, depression, relationship problems, alcohol, medicines and erectile difficulties are common causes. Low testosterone is one possibility, especially with tiredness, fewer morning erections and loss of muscle. Two morning blood tests can check it.

Can antidepressants lower sex drive?

Yes. SSRIs and SNRIs commonly reduce desire and delay orgasm. Talk to your doctor rather than stopping. Options include a lower dose, a different antidepressant such as bupropion, or adding a treatment for the sexual side effects.

Is it normal to have a low sex drive?

Desire varies widely and naturally rises and falls with age, stress, health and relationships. Low desire is only a problem if it bothers you or affects your relationship. If it does, help is available and most causes can be improved.