Loss of Sex Drive (Low Libido)

What counts as low sex drive

There is no "normal" amount of desire. It varies between people and changes over a lifetime with age, health, relationships and life events. Doctors focus on whether the change is new for you and whether it causes distress. When low desire lasts at least 6 months and is distressing, it may be diagnosed as hypoactive sexual desire disorder (in women, often called female sexual interest/arousal disorder) or male hypoactive sexual desire disorder.

Common causes in both men and women

Psychological and relationship factors

• Stress and fatigue: work, money worries, caring for young children or relatives.
• Depression and anxiety: loss of interest and pleasure is a core symptom of depression.
• Relationship problems: conflict, poor communication, lack of trust or emotional distance. See relationship stress.
• Body image and self-esteem issues.
• Past sexual trauma.

Medicines

• SSRIs and SNRIs (such as sertraline, fluoxetine, venlafaxine) are among the most common causes.
• Some blood pressure medicines (beta blockers, thiazide diuretics).
• Antipsychotics, which can raise prolactin.
• Opioids, which lower testosterone.
• Hormonal contraception in some women.
• Finasteride and anti-androgen treatments.
• Some anti-seizure medicines.

Lifestyle

• Heavy alcohol use, cannabis and other drugs
• Poor sleep and sleep apnea
• Lack of exercise and obesity

Medical conditions

• Hypothyroidism
• Diabetes
• Heart disease, kidney or liver disease
• Chronic pain and fatigue conditions
• Cancer and its treatment
• Hyperprolactinemia: high prolactin, often from a small pituitary tumor or medicines

Low sex drive in men

• Low testosterone (hypogonadism): low libido, fewer spontaneous erections, tiredness, low mood, loss of muscle and body hair. Levels fall gradually with age, and obesity, diabetes and opioids lower them further.
• Erectile dysfunction: anxiety about performance can reduce desire. Treating ED often restores interest.
• Prostate cancer treatments that block testosterone.

Low sex drive in women

• Menopause and perimenopause: falling estrogen causes vaginal dryness and pain during sex, which can reduce desire. Hot flashes and poor sleep add to it.
• Pregnancy, the postpartum period and breastfeeding: tiredness, hormone changes, physical recovery and adjustment to a new baby. Low desire is very common for months after birth.
• Pain during sex: from dryness, vaginismus, endometriosis or infections.
• Removal of the ovaries, which causes an abrupt drop in hormones.
• Hormonal contraception in some women.

How a doctor assesses loss of sex drive

Your doctor will ask how long it has been, whether it is with all partners or situations, about mood, stress, sleep, relationships, medicines, alcohol and other symptoms. For women they ask about periods, pain and menopause symptoms; for men, erections and testosterone-related symptoms.

Tests depend on the history and may include:

• Morning testosterone, measured on two separate days, for men with symptoms
• Prolactin
• Thyroid function
• Blood sugar (HbA1c) and cholesterol
• Blood count, liver and kidney function

Treatment

Address the cause

• Treat depression, but discuss medicine side effects. Switching to an antidepressant with fewer sexual effects (such as bupropion or mirtazapine) or adjusting the dose may help. Do not stop antidepressants abruptly.
• Review blood pressure and other medicines with your doctor.
• Treat thyroid disease, high prolactin, sleep apnea and diabetes.

Therapy

• Sex therapy and couples counseling address communication, expectations, anxiety and relationship issues. They are effective for many couples.
• Cognitive behavioral therapy and mindfulness-based approaches help with stress, body image and focusing on sensation.

Hormone treatment

• Men: testosterone therapy is recommended only for men with confirmed low levels and symptoms. It is not advised for those planning to have children, because it suppresses sperm production.
• Women: vaginal estrogen or moisturizers treat dryness and pain. For postmenopausal women with HSDD, specialists sometimes prescribe low-dose testosterone, though no testosterone product is FDA-approved for women. Flibanserin and bremelanotide are FDA-approved for premenopausal women with HSDD, with modest benefits.

Lifestyle steps

• Prioritize sleep and reduce stress.
• Exercise regularly, which improves mood, energy and body image.
• Limit alcohol and stop smoking.
• Set aside time for intimacy without pressure for sex, and talk openly with your partner about what you each need.
• Use a lubricant if dryness is an issue.

Frequently asked questions

What causes sudden loss of libido?

Sudden loss of libido is often due to a new medicine (especially antidepressants), a stressful event, relationship conflict, depression, illness, childbirth, or heavy alcohol use. Hormonal causes usually develop more gradually. If it persists for more than a few weeks, talk to your doctor.

What is the most common cause of low sex drive in women?

There is rarely a single cause. Stress, tiredness, relationship factors, depression, antidepressants, hormonal changes around childbirth and menopause, and pain during sex are among the most common. A doctor or sex therapist can help identify which factors apply.

Can low testosterone cause loss of sex drive?

Yes. Low testosterone is a recognized cause of reduced libido in men, along with fewer morning erections, tiredness and loss of muscle. Diagnosis requires symptoms plus low morning testosterone on two blood tests. Treatment can improve desire in men with confirmed deficiency.

Do antidepressants lower sex drive?

Many do. SSRIs and SNRIs commonly reduce desire, delay orgasm or cause erectile problems. Options include adjusting the dose, switching to bupropion or mirtazapine, or adding treatments. Do not stop your medicine suddenly; discuss changes with your prescriber.

How can I increase my libido naturally?

Improving sleep, exercising regularly, limiting alcohol, managing stress and spending relaxed, pressure-free time with your partner all help. Supplements marketed for libido have little reliable evidence and can interact with medicines. If low desire persists, see a doctor to look for treatable causes.