Low Libido In Men

  • Grace Olatunde  Student - Bachelor of Medicine, Bachelor of Surgery – MBChB (Medicine) degree, Aston Medical School

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Overview

Libido is the term used to refer to a person’s sex drive or their desire to have sex. A person’s libido can be said to be high or low, but this is subjective and variable, with each person having their own perception of their desired frequency of sex. What one person calls a low sex drive may be a high sex drive for another, so it is important to take an individualistic approach when discussing changes in libido.

When a man feels that his libido is low, he will lack an interest in sex or sexual thoughts, and there can be difficulty in engaging in sex or initiating sex. This may be due to one or multiple physical or psychological reasons, which will be covered in this article.

Low libido can have negative effects on relationships and men can feel burdened and alone because of this experience. This can be a source of embarrassment and shame, and men may not seek help because of this. It may be helpful for men struggling with low libido to know that this is a common experience — many men will experience ebbs and flows in their sex drive throughout their lifetimes.

If you’re experiencing a persistent, distressing decrease in your sex drive, it is important to speak to a healthcare professional. They can explore the potential causes or factors contributing to your lowered sex drive, as well as perform investigations if they suspect an underlying cause. Together, you can work towards forming a management plan that will help you tackle this issue and hopefully ease any negative impacts.

Causes of low libido in men

What is low libido?

Decreased or low libido can appear with other symptoms or occur in isolation. It is a form of male sexual dysfunction.

Male sexual dysfunction is an umbrella term that encompasses the issues men may have around the act of sex. This includes decreased libido, erectile dysfunction, premature ejaculation, and others.1 One way of classifying male sexual dysfunctions is by the area of sexual function that is affected (desire, arousal, or orgasm).2 Colloquially, desire and arousal can be used interchangeably, but in medical terms, desire is the mental aspect, which can be triggered by thoughts, sight, smell, and sound, whilst arousal describes the physical manifestations of this desire.

In men, the most noticeable physical sign of arousal is the development of an erection. It can be easy to mistake low libido for erectile dysfunction and vice versa as the two can be linked and occur alongside each other. Erectile dysfunction is a difficulty achieving or maintaining an erection, while low libido is a reduced or absent desire to have sex. Low libido is a disorder of the desire aspect since affected men experience less or no interest in sex or experience fewer sexual thoughts, while erectile dysfunction is a disorder of the arousal aspect. However, not every man struggling with low libido will experience erectile dysfunction.

What causes low libido?

Normal sexual function is multifactorial and has a biopsychosocial basis — that is, biological, psychological, and social factors that contribute to it. Therefore, any sexual dysfunction also has a biopsychological basis and often has many contributing factors. It is also essential to consider the interpersonal factors that could be contributing to low sex drive, although it is worth noting that low sex drive affects solo sex or masturbation, as well as sex with another person. Here are common causes of low libido.

Biological

  • Side effects of some drugs (antidepressants and antiepileptic drugs)4
  • Hormone imbalances (low testosterone)5 
  • Lifestyle factors
    • Poor diet
    • Poor sleep
    • Sedentary lifestyle
    • Smoking and alcohol
    • Recreational drug use
  • Medical conditions
    • Type 2 diabetes
    • Obesity
    • Cardiovascular conditions
  • Neurological conditions (epilepsy and multiple sclerosis)6

Psychological

  • PTSD and trauma
  • Stress, depression, and anxiety

Social

  • Cultural or religious views on sex

Interpersonal

  • Relationship difficulties

Signs and symptoms of low libido in men

Men struggling with low libido will notice a decreased desire to have sex. They may have fewer sexual thoughts.

Other symptoms include

  • Erectile dysfunction (difficulty producing or maintaining an erection)
  • Decreased desire to have sex in response to usual stimuli
  • Low mood
  • Feelings of anxiety surrounding the act of sex

Diagnosis

There is no defined threshold for a libido to be called low, as perceptions of adequate levels of sexual interaction are subjective and vary between individuals. However, there are questionnaires that can be used to quantify sexual desire and assist in diagnosis.

Doctors may perform blood tests, especially looking closely at the testosterone levels, as these can indicate a more organic cause for a low sex drive. However, not all doctors feel that testosterone levels are required unless a patient presents with other symptoms that may suggest hypogonadism, which presents with low testosterone due to a problem with the testes, hypothalamus, or pituitary gland.8

Other tests or scans may be undertaken to explore other organic causes for low libido, such as other hormone blood tests, or an MRI scan of the pituitary gland to rule out secondary causes.

If low libido occurs in isolation for more than six months and causes a man distress and difficulty in relationships, it can be acknowledged as a disorder, which is known as hypoactive sexual desire disorder (HSDD). HSDD affects men and women, but there is limited research on the disorder in men.9

Management and treatment for low libido in men

Management and treatment of low libido is heavily dependent on any identifiable causes. And of course, as the causes of low libido are multifactorial, so too is its management.

For example, men with low testosterone can be started on testosterone therapy, which involves using some form of testosterone supplementation. However, this is somewhat controversial management due to variable results, with the consensus being that testosterone should only be supplemented if a man is found to have low testosterone.10

Men presenting with low libido following a specific distressing situation or experiencing severe stress may benefit from counselling or a form of talking therapy.

Men experiencing relationship difficulties because of their low libido (or vice versa) may find some benefit in relationship therapy, in which both partners sit and discuss their relationship with a therapist to guide and facilitate what may be difficult conversations.

If low libido is linked to a specific medication or medical condition, further consultations can explore alternative medications and doses or altered management of the medical condition to reduce the impact on libido.

It is also important to maintain general health and address any unhealthy lifestyle factors such as a poor diet or a lack of exercise. Monitoring general stress levels and keeping them at a manageable level is also a key element of management.

FAQs

How common is low libido in men?

Up to 20% of men are affected within their lifetime.11 However, low libido is likely underreported.

Who is at risk of low libido in men?

 Men aged 50-59 are more than three times more likely than men aged 18-29 to report a decreased desire for sex.12

All men can experience low libido at some point in their life. However, some men are at a higher risk of developing persistent, distressing low libido (hypoactive sexual desire disorder), and this group includes men who:13

  • Have experienced childhood sexual trauma
  • Have difficulties with their sexual identity
  • Have been raised in a strictly conservative community

How can I prevent low libido in men?

Maintain a good diet and exercise regimen, as well as ensure that you get a good amount of sleep each night. Poor diet, poor sleep, and lack of exercise are all known to contribute to low libido.

When should I see a doctor?

If you are experiencing a persistent, distressing decrease in your libido, you should see a doctor at your earliest convenience. You do not have to suffer alone, and there are steps that can be taken to tackle the issue. While it can be embarrassing to discuss sex, it may be reassuring to know that healthcare professionals endeavour to assist you in all aspects of your health, and that includes your sexual health.

Summary

Decreased libido is very common, and most men will experience a period of low libido within their lifetime. Libido commonly decreases gradually with age or decreases suddenly during periods of elevated stress and anxiety.

Low libido is a form of male sexual dysfunction which can occur in isolation or with other dysfunctions, such as erectile dysfunction. However, when low libido occurs persistently for at least six months and causes a man significant distress, it can be classed as hypoactive sexual desire disorder.

Management of low libido is multifaceted and may span multiple domains, such as psychological or biological. Couples therapy may be included in a management plan if a relationship may be contributing to low libido, or if a relationship is impacted by a decreased sex drive.

It is important to remember that a healthcare professional can help you if you are suffering from a decreased sex drive, and that you do not have to keep it to yourself!

References

  1. Diaz VA, Close JD. Male sexual dysfunction. Primary Care: Clinics in Office Practice [Internet]. 2010 Sep [cited 2024 Mar 22];37(3):473–89. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0095454310000424
  2. Rösing D, Klebingat KJ, Berberich HJ, Bosinski HAG, Loewit K, Beier KM. Male sexual dysfunction. Deutsches Ärzteblatt international [Internet]. 2009 Dec 11 [cited 2024 Mar 22]; Available from: https://www.aerzteblatt.de/10.3238/arztebl.2009.0821
  3. Fertig RM, Gamret AC, Darwin E, Gaudi S. Sexual side effects of 5-α-reductase inhibitors finasteride and dutasteride: A comprehensive review. Dermatology Online Journal [Internet]. 2017 [cited 2023 Jul 21];23(11). Available from: https://escholarship.org/uc/item/24k8q743
  4. Herzog AG, Drislane FW, Schomer DL, Pennell PB, Bromfield EB, Kelly KM, et al. Differential effects of antiepileptic drugs on sexual function and reproductive hormones in men with epilepsy: interim analysis of a comparison between lamotrigine and enzyme-inducing antiepileptic drugs. Epilepsia [Internet]. 2004 Jul [cited 2023 Jul 21];45(7):764–8. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.0013-9580.2004.60703.x
  5. Travison TG, Morley JE, Araujo AB, O’Donnell AB, McKinlay JB. The relationship between libido and testosterone levels in aging men. The Journal of Clinical Endocrinology & Metabolism [Internet]. 2006 Jul 1 [cited 2024 Mar 22];91(7):2509–13. Available from: https://academic.oup.com/jcem/article/91/7/2509/2656285
  6. Petersen M, Kristensen E, Giraldi L, Giraldi A. Sexual dysfunction and mental health in patients with multiple sclerosis and epilepsy. BMC Neurol [Internet]. 2020 Jan 31 [cited 2023 Jul 21];20:41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995085/
  7. Henning OJ, Nakken KO, Træen B, Mowinckel P, Lossius M. Sexual problems in people with refractory epilepsy. Epilepsy & Behavior [Internet]. 2016 Aug [cited 2023 Jul 21];61:174–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1525505016301391
  8. Petering RC, Brooks NA. Testosterone therapy: review of clinical applications. afp [Internet]. 2017 Oct 1 [cited 2024 Mar 22];96(7):441–9. Available from: https://www.aafp.org/pubs/afp/issues/2017/1001/p441.html
  9. Clayton AH, Kingsberg SA, Goldstein I. Evaluation and management of hypoactive sexual desire disorder. Sex Med [Internet]. 2018 Mar 6 [cited 2023 Jul 21];6(2):59–74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960024/
  10. Corona G, Torres LO, Maggi M. Testosterone therapy: what we have learned from trials. The Journal of Sexual Medicine [Internet]. 2020 Mar 1 [cited 2024 Mar 22];17(3):447–60. Available from: https://academic.oup.com/jsm/article/17/3/447/6973598
  11. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the united statesprevalence and predictors. JAMA [Internet]. 1999 Feb 10 [cited 2023 Jul 21];281(6):537–44. Available from: https://doi.org/10.1001/jama.281.6.537
  12. Montgomery KA. Sexual desire disorders. Psychiatry (Edgmont) [Internet]. 2008 Jun [cited 2023 Jul 21];5(6):50–5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695750/

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Grace Olatunde

Student - Bachelor of Medicine, Bachelor of Surgery – MBChB (Medicine) degree, Aston Medical School

Grace is a medical student due to enter her final year of study. She has a passion for patient education and is especially interested in the field of Urology.

She has several years of clinical experience in both public and private sector practice.

She is currently undertaking a PGCert in Health Leadership which she is due to complete in Summer 2024.

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