Low Libido
Also known as: Hypoactive Sexual Desire Disorder (HSDD)
Low libido — clinically termed hypoactive sexual desire disorder (HSDD) — is a persistent reduction in sexual desire that causes personal distress. It affects an estimated 15% of men and 40% of women at some point. While often attributed to psychological factors, the underlying cause is frequently hormonal — particularly declining testosterone, which is the primary driver of sexual desire in both sexes.
In this article
Causes
Hormonal Causes
- Low testosterone (men and women): The primary hormone driving sexual desire. Declines with age in both sexes. By age 40, most women have half the testosterone they had at 20.
- Estrogen decline (women): Causes vaginal dryness and reduced blood flow to genital tissue, making arousal difficult and intercourse uncomfortable.
- Low progesterone (women): Contributes to anxiety and poor sleep, which suppress sexual interest.
- Elevated prolactin: Directly suppresses libido. Can be caused by medications or pituitary conditions.
- Thyroid dysfunction: Both hypo- and hyperthyroidism affect sexual desire.
Medication-Related
- SSRIs and SNRIs (antidepressants) — the most common medication cause
- Oral contraceptives (increase SHBG, reducing free testosterone)
- Beta-blockers and some blood pressure medications
- Opioid pain medications
- Finasteride (5-alpha reductase inhibitors)
Lifestyle Factors
- Chronic stress and cortisol elevation
- Poor sleep quality
- Excessive alcohol consumption
- Sedentary lifestyle
- Relationship and communication factors
Treatment Options
For Men
- Testosterone replacement therapy: Directly addresses the most common cause of male libido decline
- PDE5 inhibitors (tadalafil, sildenafil): Address erectile function, which often restores confidence and desire
- PT-141 (bremelanotide): Acts on brain melanocortin receptors to increase desire
For Women
- Low-dose testosterone: The most effective treatment for female HSDD
- Estrogen therapy: Addresses vaginal dryness and physical discomfort
- Progesterone: Improves sleep and reduces anxiety, supporting desire
- Comprehensive HRT: Addresses the full hormonal picture
Lifestyle
- Stress reduction (cortisol directly suppresses sexual desire)
- Exercise (improves blood flow, body image, hormonal balance)
- Sleep optimization (testosterone production requires quality sleep)
- Medication review (discuss alternatives to libido-suppressing medications)
When to Seek Care
Consider evaluation if:
- Your sexual desire has noticeably declined from your personal baseline
- The change is causing distress in your life or relationship
- You are experiencing other symptoms that suggest hormonal imbalance (fatigue, weight gain, mood changes)
- You started a new medication that may be contributing
Low libido is not “just part of getting older.” It is a symptom with identifiable causes and effective treatments.
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Medical disclaimer: This article is for informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website.
Medically reviewed. Last updated: March 2026.