Low Sexual Desire: What Are The Possible Causes?

Take-home points

• Low sexual desire can be a persistent and distressing issue that lowers your quality of life.
• Numerous factors contribute to the development of low sexual desire, and it is important to discuss your personal situation with a healthcare professional.
• There are many treatment options for low sexual desire - in men with hypogonadism, the most popular option is TRT.

Sexual desire

Sexual desire, or libido (or sometimes referred to as 'sex drive'), is a natural and healthy part of life. But for some people, low sexual desire is a persistent and distressing issue associated with lower quality of life, happiness, and relationship satisfaction.¹

The diagnosis of low sexual desire, known clinically as hypoactive sexual desire disorder (HSDD), is based on a lack of desire for sexual activity for at least 6 months, with marked personal distress that cannot be explained by health or psychiatric conditions. Healthcare professionals will consider other symptoms when diagnosing HSDD, including erectile dysfunction, delayed orgasms, the absence of sexual fantasies, and the loss of motivation for sexual activity even in response to erotic cues or stimulation.

How many men experience low sexual desire?

Millions of men experience low sexual desire (low sex drive). Population-based studies consistently estimate that 15%–20% of men report symptoms of low sexual desire (though not official HSDD diagnoses), about half that of women.^2,3

When studies separate men into different age categories, men in the oldest groups (50 years of age or older) are usually more likely to experience low sexual desire compared to men in the younger groups. These figures align with the fact that up to 25% of men seek treatment for sexual dysfunction, with a lack of sexual interest as one of the primary causes.⁴

What are the potential causes of low sexual desire?

There are many potential causes of low sexual desire, including psychological, physical, and environmental factors. Some common causes of low sexual desire in men include:

1. Psychological factors: Stress, anxiety, depression, and relationship problems can all contribute to low sexual desire. In younger men, the most common cause of decreased libido is psychosomatic stress.^5,6

2. Physical factors: Chronic illnesses such as diabetes, heart disease, and high blood pressure can affect sexual desire, as can hormonal imbalances and medications such as antidepressants.⁷

3. Lifestyle factors: Unhealthy lifestyle choices such as smoking, excessive alcohol consumption, and lack of exercise can all contribute to low sexual desire.⁸

4. Social and environmental factors: Environmental factors such as work stress and household or neighbourhood disorder increase the risk of low sexual desire.⁹ Also, if men do not find a long-term partner, the number of partners available to engage in sexual activity declines with age.¹⁰

What is the relationship between ED and low sexual desire?

Erectile dysfunction (ED) and low sexual desire are related and often occur together. The frustration and low self-esteem that can stem from ED might contribute to low sexual desire, and low sexual desire itself could make it challenging to maintain an erection for sexual intercourse.

Researchers have made it clear, however, that while HSDD and ED are associated with similar psychological and personal consequences, they affect different phases of the sexual response model (desire versus arousal) and often require different treatments.¹¹ It is possible to experience high sexual desire while having trouble maintaining an erection; equally, many people can maintain an erection with low sexual desire.

We recommend reading our Guide to Erectile Dysfunction for more detailed information.

What is the link between testosterone and low sexual desire?

Testosterone is the hormone responsible for regulating many aspects of male sexual function. One of these roles relates to sexual desire, as decreased libido is a well-known symptom of late-onset hypogonadism.¹²

Testosterone supplementation among hypogonadal men with low sexual desire is an effective treatment.¹³ In one study, healthy older men with symptoms of androgen deficiency and low-normal testosterone levels had improved sexual desire after receiving 12 months of transdermal testosterone therapy, despite no effect on other markers of sexual function.¹⁴ In the highest quality of clinical trials, testosterone gels have even shown a dose-dependent increase in sexual desire in men with associated signs and symptoms of hypogonadism.¹⁵

Importantly, research has not yet elucidated what level of testosterone increases the risk of low sexual desire. Low testosterone levels are not always the cause of low sexual desire, and TRT is unlikely to treat the condition if the cause does not relate to low testosterone levels.

We recommend reading our Guide to Low Testosterone for more detailed information.

What to do if you have low sexual desire?

If you are experiencing low sexual desire, the first step is to talk to a healthcare professional. Unfortunately, less than half of patients with sexual problems seek help from or initiate discussions with physicians, inhibited by the fear of embarrassment.¹ 

Healthcare professionals are the only reliable source of information to determine the underlying cause of your condition and recommend appropriate treatment options. Some common treatments for low sexual desire in men include:

1. Therapy: Some clinical trials in women suggest that psychotherapies can effectively address psychological factors contributing to low sexual desire, such as stress, anxiety, or relationship problems. The Journal of Sexual Medicine suggests that more evidence is needed, however, particularly in men.

2. Medication: 2 FDA-approved drugs are available for treating HSDD (flibanserin are bremelanotide) but are both specific to premenopausal women. In men with HSDD, a recent study found that Kisspeptin infusion increased sexual arousal in men compared to a placebo group (read more about this study here).¹⁶ Medication such as sildenafil or tadalafil can also effectively treat ED and possibly work to improve sexual desire indirectly. 

3. Lifestyle Changes: Evidence is scarce but it is plausible that making healthy lifestyle choices, such as quitting smoking, reducing alcohol consumption, and getting regular exercise, will contribute to greater sexual desire. It certainly will not be harmful.

4. Hormone Therapy: If testosterone levels are low, hormone therapy such as testosterone replacement therapy may be recommended to address low sexual desire and other related symptoms.

Join the conversation on the TRTed Community!  

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References

1. Parish SJ et al. Sex Med Rev. 2016; 4(2):103-120.

2. Rosen RC et al. Curr Psychiatry Rep. 2000;2(3):189-95.

3. Mercer CH et al. BMJ. 2003;327(7412):426-7.

4. Laumann EO et al. Int J Impot Res. 2009;21(3):171-8.

5. Nimbi FM et al. J Sex Med. 2018;15(2):230-244.

6. Lykins AD et al. J Sex Res. 2006;43(2):136-43.

7. Chen L et al. Biomed Pharmacother. 2019;112:108585.

8. Mollaioli D et al. Reprod Biol Endocronol. 2020;18:10.

9. Schafer MH et al. Gerontologist. 2018;58(1):181–190.

10. DeLamater J et al. J Sex Res. 2012;49(2-3):125-41.

11. Kinsberg SA et al. Curr Med Res Opin. 2020;36(6):1069-1080.

12. Hisasue S. Int J Urol. 2015;22(12):1084-95.

13. O’Carroll et al. Br J Psychiatry. 1984;145:146-51.

14. Allan CA et al. Int J impot Res. 2008;20(4):396-401.

15. McNicolas TA et al. BJU Int. 2003;91(1):69-74.

16. Mills EG, et al. JAMA. 2023;6(2):e2254313.