Causes and Treatment of Low Libido in Men

The 6 Most Common Causes of Reduced Sex Drive

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Low libido is a term used to describe a decrease in sex drive that can interfere with sexual activity. While low libido can cause tension in a relationship, fostering doubt and guilt in both partners, It can often be treated if the underlying cause is identified. 

Low libido should not be confused with erectile dysfunction (ED), although the two conditions can co-exist. Communication and honesty are needed for a couple to cope while identifying the possible causes. Treatment can vary and may involve psychotherapy, hormone replacement, lifestyle changes, or the adjustment of drug therapies.

Low libido can sometimes be caused by a single factor but is more often related to multiple factors that each contribute in their own way. Among some of the more common causes are low testosterone, medications, depression, chronic illness, and stress.

Low Testosterone

Low testosterone (hypogonadism) commonly develops as a man ages but can also affect younger men for any number of reasons. Testosterone is the male hormone essential to development, strength, and sex drive. If the total testosterone drops below 300 to 350 nanogram per deciliter (ng/dL), the male libido can plummet, sometimes dramatically.

While testosterone replacement therapy may be useful in restoring the male sexual drive, it may increase the risk of blood clots and strokes in men with an underlying cardiovascular disorder. Sleep apnea, acne, and breast enlargement (gynecomastia) are other common side effects.

Medications

Medication side effects are common causes of low libido in men. These may include entire classes of drugs that can affect a man's sex drive to varying degrees. Common culprits include statins, beta-blockers, antidepressants, antipsychotics, benzodiazepines, and anticonvulsants.

Even over-the-counter drugs like Tagamet (cimetidine) can cause problems if taken for long periods of time. Stopping or changing the suspected drug may reverse the condition, although this is not always possible with certain chronic medications. A dose adjustment may also help.

Depression

Depression and low libido go hand-in-hand. Depression is often the cause of a reduced sex drive but may also be the consequence, making a tough situation worse. While psychotherapy may be effective in treating the depression, antidepressant medications can often exacerbate rather than improve the loss of libido. Switching drugs or reducing the dosage can sometimes help. Some couples will also dose after sex to minimize the potential effects.

Chronic Illness

Chronic illness can take a toll on your sex drive both physically and emotionally. This is especially true with conditions for which there is chronic pain or fatigue, including rheumatoid arthritis, fibromyalgia, cancer, and chronic fatigue syndrome.

When it comes to chronic illness and the loss of sexual function, there is rarely a straight line between cause and treatment. On the one hand, chronic illness is associated with an increased risk of depression, while, on the other, it can directly interfere with hormonal, neurological, or vascular functions central to the male sex drive.

Moreover, the medications used to treat the chronic condition (such as chemotherapy or cardiovascular drugs) may directly impair the male libido. As such, your doctor may need to explore the cause both from the perspective of the chronic illness and irrespective of the chronic illness. In some cases, multiple doctors may be needed.

Stress and Sleep Disorders

While stress can impair sexual interest by literally driving you to distraction, its effect on the sex drive is more insidious. Stress triggers the production of cortisol, a hormone that functions rather like a body's built-in alarm system. Cortisol not only causes the constriction of blood vessels, contributing to ED, it can cause a precipitous drop in testosterone.

Stress is also linked to insomnia and other sleep abnormalities, which can increase the risk of fatigue and leave you less interested in sex. There is even some evidence that elevated cortisol level may increase the risk of obstructive sleep apnea (OSA), a condition associated with the reduction of daytime testosterone by anywhere from 10 to 15 percent.

Treatment may involve stress management techniques and the use of positive airway pressure and improved sleep hygiene to treat conditions like OSA and insomnia. If the stress is associated with an anxiety disorder, medications may be needed, some of which (like benzodiazepines) may enhance rather than alleviate low libido.

Lifestyle

There are lifestyle factors that may contribute significantly to low libido in men. These tend to more readily remedied by simply changing or stopping the behavior. Among them:

  • Smoking not only directly increases the risk of ED but indirectly impairs sexual arousal, according to a 2012 study from the University of Texas Austin.
  • Alcohol, when used in excess or over the course of years, redirects enzymes needed to synthesize testosterone from the testes to the liver, resulting in reduced testosterone levels.
  • Obesity directly impairs metabolism and hormone function, resulting in significantly reduced total and free testosterone. By contrast, exercise and weight loss not only enhances mood and energy levels, it improves sexual function and self-image.

While the detrimental effects these behaviors are clear, it is never wise to "pin" low libido on single lifestyle factor without first conferring with a doctor to explore all other possible causes.

A Word From Verywell

If the loss of libido is affecting your relationship, you need to take extra care to avoid directing blame at yourself or your partner. Instead, you would be well served to approach solutions as a couple, neither assigning it as "his" issue or "my" issue but rather one to which you both actively participate.

This requires an open and honest communication about not only the physical symptoms of low libido but the emotional ones. Doing so allows you to identify which doctor or doctors are needed to diagnose and hopefully treat the condition.

This may include an endocrinologist, urologist, chronic disease specialist, psychiatrist, sex therapist, or other health professional. There may not be a quick fix, but, with time and patience, a solution may be found. 

In the meantime, try to remind yourself that the loss of sexual desire is not the same thing as the loss of a desire for intimacy. Even when struggling with sexual dysfunction, make every effort to connect emotionally and physically. By doing so, you can forge a closer bond and may even end up strengthening your relationship.

Sources:

Crawford-Anchour, C. Stress hormones in obstructive sleep apnea complications: the role of cortisol. Sleep Med. 2014:15:3-4. DOI: 0.1016/j.sleep.2013.10.004.

Harte, C. and Meston, C. Association between smoking cessation and sexual health in men. BJU Int. 2012;109(6):888-96. DOI: 10.1111/j.1464-410X.2011.10503.x.

Singh, P. Andropause: Current Concepts. Ind J Endocrinol Metab. 2013;17(Suppl 3): S621-S629. DOI: 10.4103/2230-8210.123552.

Nimbi, F.; Tripodi, F.; Rossi, R. et al. Expanding the Analysis of Psychosocial Factors of Sexual Desire in Men. J Sexual Med. 2018;15(2):230-44. DOI: 10.1016/j.jsxm.2017.11.227.