What low libido feels like
Low libido means a drop in sexual desire that feels different from your normal. You may think about sex less often, feel less responsive to a partner or notice that desire no longer returns the way it used to. For some people it comes with physical changes, such as erectile difficulties or vaginal dryness and discomfort.
A lower sex drive is common and nothing to be embarrassed about. It matters when it bothers you or affects your relationship, and it often travels with fatigue, poor sleep or mood changes.
Common low libido causes
Desire depends on hormones, health and circumstances, so causes often overlap.
In women
- Perimenopause and menopause, including falling estrogen and testosterone
- Vaginal dryness or pain with sex
- Hormonal birth control
- Pregnancy, the postpartum period and breastfeeding
- Thyroid dysfunction or PCOS
In men
- Low testosterone, confirmed by repeat early-morning blood tests
- Excess abdominal fat and insulin resistance
- Poor sleep and sleep apnea
- Erectile difficulties, which can dampen desire
- Thyroid dysfunction or high prolactin
In both
- Chronic stress, fatigue and burnout
- Depression and anxiety
- Medications such as some antidepressants and blood pressure medicines
- Alcohol and recreational drug use
- Relationship strain and body image concerns
Medications that can lower libido
Some of the most common culprits are antidepressants, especially SSRIs and SNRIs, hormonal birth control, some blood pressure medicines, medicines that lower testosterone or block its effects, opioid pain medicines and some seizure medicines. If a medicine may be involved, do not stop it on your own; the prescribing doctor can often adjust the dose or suggest an alternative.
When low libido is hormonal: perimenopause and low testosterone
Low libido in perimenopause and menopause
Falling estrogen can cause vaginal dryness and pain with sex, which understandably dampen desire. Night sweats and broken sleep sap energy, and mood changes, anxiety and body changes can affect how you feel about intimacy. Testosterone also declines gradually with age. Treating the physical symptoms, such as dryness, often helps desire return, and the options are part of menopause care.
Low libido in men: when testosterone is checked
Reduced sexual desire is one of the recognized signs of low testosterone, along with fewer spontaneous erections, fatigue and low mood. Testosterone is checked with early-morning blood tests, and low testosterone is confirmed only with consistent symptoms and low levels on at least two separate mornings. When levels are normal, we look for other causes. Our page on low testosterone explains the process.
What we evaluate
Your evaluation covers your sexual and relationship history, cycle or menopause history, sleep, stress, mood, medications and general health. Depending on your concerns, testing may include:
- Estrogen, progesterone and testosterone
- In men, free and available testosterone and hormone-binding proteins
- Estrogen balance in men
- A complete thyroid panel
- Cortisol and stress response
- Blood sugar control, lipids and inflammation markers
How low libido is treated
Treatment depends on what is driving the change. Improving sleep, lowering stress, addressing insulin resistance and adjusting nutrition can help on their own. When labs and symptoms together show a hormonal cause, hormone therapy may be considered when clinically appropriate and with ongoing monitoring, including bioidentical hormone therapy for women and, only when low testosterone is confirmed, testosterone therapy for men.
Testosterone is a Schedule III controlled substance, prescribed only after an in-person evaluation when benefits outweigh risks, and never for age-related decline alone, athletic performance or bodybuilding. It requires ongoing monitoring of testosterone levels, red blood cell count and PSA when appropriate, and it can reduce sperm production and fertility.
The four-month Hormonal Wellness program, offered in men’s and women’s versions, is designed for concerns such as low libido, fatigue, sleep changes and mood. Compare the tiers on our wellness programs page.
When to see a doctor urgently
Call 911 for chest pain, pressure or shortness of breath, including during sexual activity. Erectile difficulties can be an early sign of heart disease, so new problems are worth raising with your primary care doctor, especially if you also have high blood pressure, diabetes or high cholesterol.
Go to an emergency room for an erection lasting more than four hours. See your doctor promptly for new pelvic pain or bleeding after sex. If low desire comes with persistent hopelessness or thoughts of suicide, call or text 988.
Getting evaluated in Little Rock, Searcy or Miami
Low libido is evaluated privately and in person at our offices in Little Rock, Searcy and Miami, by appointment. Request a free 15-minute discovery call to talk about your concerns and how an evaluation works. You can also explore our full symptom guide.
Questions
Common questions about low libido
Why have I lost interest in sex?
A drop in desire usually has more than one cause. Hormonal shifts such as perimenopause or low testosterone are common, but stress, fatigue, poor sleep, depression, anxiety, relationship strain, medications and health conditions such as diabetes can all reduce interest, and several often act together. That is why we look at the whole picture before deciding whether hormone treatment makes sense.
What causes low libido in women?
In women, common causes include the hormonal shifts of perimenopause and menopause, vaginal dryness or pain during sex, hormonal birth control, pregnancy and breastfeeding, thyroid problems, chronic stress, fatigue, depression and certain medications such as some antidepressants. Relationship factors matter too. Because several causes often overlap, an evaluation looks at hormones, health history and daily life together.
What causes low libido in men?
In men, low testosterone is a common hormonal cause, but not the only one. Poor sleep, sleep apnea, excess abdominal fat, insulin resistance, chronic stress, depression, alcohol and medications such as some antidepressants and blood pressure drugs can also lower desire. Erectile difficulties can affect libido as well and may signal underlying cardiovascular or metabolic problems.
Does testosterone affect libido in women?
Testosterone plays a role in sexual desire for women as well as men, and levels decline gradually with age. For some postmenopausal women with low desire that causes distress, testosterone therapy may be considered after other causes have been evaluated. No testosterone product is FDA-approved for women in the US, so any use is off-label, at low doses, only when clinically appropriate and with careful monitoring; the evidence is more limited than for estrogen.
Does menopause lower sex drive?
It often does, though not for everyone. Falling estrogen can cause vaginal dryness and pain with sex, and night sweats, poor sleep and mood changes can lower desire further. Testosterone, which also plays a role in women’s desire, declines gradually with age. Treating dryness and discomfort, improving sleep and addressing mood often help, and options are chosen after an individual evaluation.
What is the difference between low libido and erectile dysfunction?
Low libido is reduced interest in sex. Erectile dysfunction is difficulty getting or keeping an erection firm enough for sex, even when desire is present. The two can overlap, since repeated erectile difficulties can dampen desire. Erectile dysfunction is often linked to blood flow and can be an early sign of heart disease or diabetes, so new problems deserve a medical evaluation.