Low Libido (Low Sex Drive)

What counts as low libido

There is no "normal" amount of sexual desire. It varies between people and changes with age, health, life stage and relationships. Doctors consider it a problem when it causes personal distress. When low desire persists for at least 6 months and causes distress, it may be diagnosed as hypoactive sexual desire disorder in men or female sexual interest/arousal disorder in women.

It helps to distinguish:

• Low desire: little interest in sex, few sexual thoughts.
• Arousal problems: interest is there but the body does not respond, such as erectile dysfunction or vaginal dryness.
• Pain: sex hurts, so desire fades as a protective response.

These often overlap and feed each other.

Common causes of low libido

Psychological and relationship factors

• stress at work or home, and anxiety
• depression, which reduces pleasure in most activities
• relationship conflict, poor communication, or loss of emotional closeness
• low self-esteem or body image concerns
• past sexual trauma
• boredom or routine in a long-term relationship

Medicines

• Antidepressants, especially SSRIs and SNRIs, are one of the most common causes
• hormonal contraceptives in some women
• antipsychotics, opioids and benzodiazepines
• some blood pressure medicines, including certain beta blockers and diuretics
• finasteride and dutasteride for prostate or hair loss
• anti-androgen and hormone therapies for prostate and breast cancer

Lifestyle

• tiredness and poor sleep, including sleep apnea
• heavy alcohol use and recreational drugs
• lack of exercise or excessive exercise
• smoking

Health conditions

• diabetes, heart disease and high blood pressure
• obesity
• chronic pain and arthritis
• kidney or liver disease
• cancer and its treatments
• underactive thyroid
• neurological conditions such as multiple sclerosis and Parkinson's disease

Low libido in women

• Menopause: falling estrogen causes vaginal dryness and thinning (vaginal atrophy), making sex uncomfortable. Hot flashes and poor sleep add to it. Surgical menopause from removal of both ovaries can lower desire more abruptly.
• Pregnancy, birth and breastfeeding: fatigue, physical recovery, and low estrogen during breastfeeding commonly reduce desire for months.
• Pain during sex: from vaginal dryness, endometriosis, vulvodynia or vaginismus.
• Hormonal contraception: may reduce desire in some women.
• Responsive desire: many women experience desire in response to intimacy rather than spontaneously. This is normal, not a disorder.

Low libido in men

• Low testosterone: reduced desire, fewer morning erections, fatigue, low mood, loss of muscle and body hair. Testosterone falls slowly with age and faster with obesity, diabetes, opioids and some pituitary conditions.
• Erectile dysfunction: worry about performance can lead to avoiding sex.
• High prolactin: from a pituitary tumor or certain medicines, causing low desire and erectile problems.
• Prostate problems and treatment.

How doctors find the cause

A doctor will ask when the change started, whether it is specific to a partner or situation, your mood, stress, sleep, relationship, medicines, alcohol and drug use, and any pain, dryness or erection problems. Many people find this hard to raise. Doctors are used to these conversations, and it is fine to start with "I've noticed a change in my sex drive."

Possible tests:

• Men: morning total testosterone, repeated if low, plus LH, prolactin and blood count
• Women: usually none, unless symptoms suggest thyroid or pituitary problems. Testosterone levels do not reliably predict desire in women
• Both: thyroid function, blood sugar and HbA1c, lipids, and liver and kidney function where relevant
• Depression and anxiety screening questionnaires

Treatment and ways to increase libido

Treat the cause

• switching or adjusting medicines, for example changing to bupropion or lowering an SSRI dose, with your prescriber's guidance
• treating depression, anxiety, sleep apnea or thyroid disease
• managing pain during sex with lubricants, vaginal moisturizers or vaginal estrogen

Talking therapies

• Sex therapy with a certified therapist addresses desire differences, anxiety and communication.
• Couples counseling for relationship problems.
• Cognitive behavioral therapy and mindfulness-based therapy have evidence for improving desire, particularly in women.

Hormone treatments

• Testosterone replacement for men with confirmed low testosterone and symptoms.
• Testosterone for postmenopausal women with hypoactive sexual desire disorder, used off-label in the US under specialist guidance.
• Menopausal hormone therapy and vaginal estrogen for menopause symptoms.
• Flibanserin and bremelanotide are FDA-approved for premenopausal women with acquired hypoactive sexual desire disorder. Benefits are modest and side effects such as dizziness and nausea are common.

Self-help

• prioritize sleep and reduce alcohol
• exercise regularly, which improves energy, mood and body image
• schedule time for intimacy without pressure for intercourse
• talk openly with your partner about what you want and what has changed

Frequently asked questions

What causes low libido?

Common causes include stress, tiredness, relationship difficulties, depression and anxiety, medicines such as antidepressants, hormonal changes like menopause or low testosterone, pain during sex, and long-term conditions such as diabetes, heart disease and thyroid problems. Often more than one factor is involved.

What causes low libido in women?

In women, low desire is often linked to stress, relationship issues, fatigue, depression, antidepressants, hormonal contraception, pregnancy and breastfeeding, menopause and pain during sex. Many women have responsive rather than spontaneous desire, which is a normal pattern rather than a disorder.

Is low libido in men always low testosterone?

No. Low testosterone is one cause, but stress, depression, relationship problems, medicines, alcohol, poor sleep, erectile dysfunction and chronic illness are more common. A morning blood test can check testosterone if symptoms suggest it.

How can I increase my libido naturally?

Improve sleep, reduce alcohol, exercise regularly, manage stress, and make time for intimacy without pressure. Talking openly with your partner helps. If low desire persists, see a doctor to check medicines, mood and hormones, since some causes need specific treatment.

Can antidepressants lower libido?

Yes. SSRIs and SNRIs commonly reduce desire and make orgasm harder. Do not stop them suddenly. Talk to your prescriber about options such as adjusting the dose, switching to a medicine with fewer sexual side effects like bupropion, or adding treatments.