Loss of Libido: Causes and Treatment

What counts as loss of libido?

Libido varies widely between people and changes across life. There is no "normal" amount of desire. Loss of libido matters when:

• it is a clear change from your usual level
• it lasts several months
• it causes you distress or strain in your relationship

When low desire is persistent and distressing, doctors may diagnose hypoactive sexual desire disorder. For a broader overview of low desire, see low libido.

Common causes of loss of libido

Psychological and lifestyle

• Stress and exhaustion: work, caregiving, money worries and lack of sleep are among the most common causes.
• Depression and anxiety: reduced pleasure and interest are core symptoms of depression.
• Relationship problems: conflict, poor communication, resentment, infidelity or loss of intimacy.
• Body image and self-esteem issues.
• Past sexual trauma.
• Alcohol and recreational drugs: heavy drinking, cannabis and opioids reduce desire over time.

Medicines

Do not stop a prescribed medicine on your own. Ask your doctor about alternatives, dose changes or adding a treatment.

Hormonal causes

• Menopause and perimenopause: falling estrogen and testosterone, plus vaginal dryness making sex uncomfortable.
• Pregnancy, after childbirth and breastfeeding: high prolactin and tiredness reduce desire for months.
• Low testosterone in men: low desire, fewer morning erections, fatigue, reduced muscle mass, low mood.
• High prolactin: from a pituitary tumor (prolactinoma) or medicines, sometimes with milky nipple discharge, irregular periods or erectile problems.
• Hypothyroidism: tiredness, weight gain, low mood and low libido.

Physical health conditions

• Diabetes, heart disease, kidney or liver disease
• Chronic pain and arthritis
• Cancer and its treatments
• Obesity and sleep apnea
• Painful sex from vaginal dryness, endometriosis, vaginismus or infections, which naturally reduces desire
• Erectile dysfunction, which can lead to avoiding sex and reduced desire

Loss of libido in women

Women's desire is often more responsive, arising during intimacy rather than spontaneously. Common contributors are tiredness, caregiving, relationship factors, pregnancy and breastfeeding, menopause, painful sex and antidepressants. Hormonal contraceptives affect libido in some women and not others.

Loss of libido in men

In men, loss of libido is more likely than erectile dysfunction alone to point to a hormonal problem such as low testosterone or high prolactin. Depression, stress, alcohol, opioids and medicines such as finasteride are other common causes. Testosterone naturally declines slowly with age, but a large drop is not a normal part of aging.

Sudden loss of libido

A sudden drop often follows a clear trigger: a new medicine (especially an antidepressant), a major stressor, a relationship crisis, childbirth, surgery or illness. Hormone causes usually develop gradually. If there is no obvious trigger, see your doctor.

How doctors find the cause

Your doctor will ask about your sexual history, relationships, mood, stress, alcohol and drug use, medicines, periods or menopause symptoms, and erections. They will examine you and may order blood tests:

• men: early-morning total testosterone, measured twice, with LH and FSH if low
• both: prolactin, thyroid function, blood sugar or HbA1c, blood count and sometimes kidney and liver tests
• women: hormone tests are less useful for diagnosis but may be checked for irregular periods or suspected early menopause

Treatment for loss of libido

Address the cause

• Medicine changes: switching antidepressants (for example to bupropion or mirtazapine) or adjusting doses can help.
• Treat depression, anxiety, thyroid disease or diabetes.
• Hormonal causes: testosterone therapy for confirmed testosterone deficiency in men; treatment of high prolactin with medicine.

Talk therapies

• Sex therapy and couples therapy are effective for many people, focusing on communication, reducing pressure and building intimacy.
• Cognitive behavioral therapy and mindfulness-based approaches help with desire problems in women.

For women around menopause

• Vaginal estrogen or moisturizers and lubricants ease dryness and pain during sex.
• Hormone therapy helps menopausal symptoms that affect desire.
• Testosterone may be offered by specialists to postmenopausal women with low desire after other causes are addressed. It is used off-label in some countries.
• Prescription medicines such as flibanserin and bremelanotide are approved in the US for low desire in premenopausal women, with modest effects and specific side effects.

Lifestyle

• Prioritize sleep and reduce stress.
• Exercise regularly, which improves energy, mood and body image.
• Cut down on alcohol and stop smoking.
• Make time for intimacy without pressure for intercourse.

Frequently asked questions

What causes a sudden loss of libido?

A sudden loss of libido usually follows a trigger such as starting an antidepressant or other medicine, a major stress, relationship difficulties, childbirth, illness or heavy alcohol use. Hormonal causes tend to develop more gradually. If there is no clear reason, ask your doctor for an assessment.

Can antidepressants cause loss of libido?

Yes. SSRIs and SNRIs commonly reduce desire, delay orgasm and cause erectile difficulties. Do not stop them suddenly. A doctor may adjust the dose, switch to an antidepressant with fewer sexual side effects such as bupropion, or add a treatment.

Is loss of libido a sign of low testosterone?

It can be, especially in men with fewer morning erections, fatigue, low mood and reduced muscle mass. A blood test taken in the early morning, repeated on a second day, confirms low testosterone. Many other causes, especially stress and depression, are more common.

How can I get my libido back?

Start by identifying the cause: review medicines, treat depression or anxiety, improve sleep, reduce alcohol, exercise and address relationship issues. Sex or couples therapy helps many people. If tests show a hormone problem, specific treatment can restore desire.

Is it normal for libido to drop with age?

Libido often changes with age, but a large drop is not inevitable. Menopause, falling testosterone, chronic illness, medicines and relationship changes all play a role, and many are treatable. Sexual desire can remain healthy well into later life.