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Have you noticed a decreased sex drive? Have you lost motivation or feel depressed or fatigued? If so, you may be a candidate for testosterone replacement therapy (TRT).
While fluctuations in your libido are expected, a near-complete loss of sexual interest becomes a problem if you once had a consistent sex life, feel distressed about this loss of interest, or it begins to impact your partner.
Sexual wellness and a satisfying sex life are essential to most people's overall quality of life. Every person has a sex drive that is normal to them. A chronically decreased sex drive can affect happiness for many people.
Low libido may be caused by one primary factor or by a combination of several factors–unexpected, persistent loss of sex drive can indicate underlying physical issues.
What is a decreased libido?
Libido is a term used to describe a person's sex drive or sexual desire. Low libido is a lowered interest in sexual activity of any kind. There is a lack of interest in sex, sexual images, or other items that would typically lead to arousal. In addition, the frequency of sex or masturbation decreases, and your partner may notice a change in sexual habits.
Duration of symptoms
Depending on the cause, decreased sex drive may last for varying amounts of time. A decrease in sex drive that lasts for a long time or keeps returning may indicate an underlying medical or lifestyle problem that can be distressing to both partners.
- Temporary: A decrease in sex drive is due to a time-limited condition, such as a stressful or life-altering event.
- Persistent: A decrease in sex drive due to an illness, ongoing stress, or a side-effect of medication often persists until the underlying cause is addressed.
What causes decreased libido?
Hormone-related causes
Hormone imbalances are among the most common causes of decreased libido and include:
- Low testosterone.
- Thyroid disorders.
- Chemotherapy.
Physical causes
- Medication side effects often interfere with sexual response.
- Obesity may interfere with average hormone balance.
- Obstructive sleep apnea.
- Diabetes.
Lifestyle causes
- Alcohol use.
- Illicit drug use.
- Smoking.
- Poor diet.
- Poor sleep habits.
- Too much or not enough exercise.
Emotional and psychological causes
- Difficulty with an ongoing relationship.
- Stress.
- Anxiety.
- Low self-esteem.
- History of unwanted sexual contact.
- Erectile dysfunction.
Mental causes
- Chronic depression.
- Genialized anxiety disorder.
- Trauma or post-traumatic stress disorder (PTSD).
Psychosomatic stress most commonly causes decreased libido in younger men.
How common is low libido?
- On average, low libido affects 20–25% of US men and increases in males over 55.
- Loss of libido is common, affecting 1 in 5 men (and even more women) at some point.
- About 40% of men over 45 and 50% in their 80s are hypogonadal (testosterone deficient). Testosterone levels decrease by 100 ng/dL every ten years or an average of 1-2% per year beyond age 30.
What are treatments for low libido?
Treatments for low libido include:
- Education and communication between sexual partners.
- Stress management.
- Medication change.
- Hormone therapy for low testosterone.
- Psychotherapy.
- Lifestyle improvement–diet, exercise, sleep habits, and socialization.
- Limited use of drugs and alcohol.
- Massage therapy.
- Experimentation with different sexual techniques, alone or with others.
When should you see a healthcare provider?
You should seek medical care for low libido when symptoms include:
- Difficulty achieving erections.
- Diminished testicle size.
- Loss of muscle mass.
- Increased body fat.
- Poor concentration.
- Interrupted sleep.
- Fatigue.
- Depression.
- Hot flashes or sweats.
- Declining sense of overall well-being.
Why is Testosterone Important?
Testosterone stimulates the development of male sexual characteristics and is essential for sperm production (spermatogenesis). In addition, testosterone plays a significant role in:
- Libido.
- Sexual function.
- Bone density.
- Maintaining lean muscle mass and decreased fat.
- Red blood cell production.
- Growth of facial and body hair.
- Mood.
What is the relationship between testosterone and low libido?
A low testosterone level is one of many possible reasons for low sex drive and erectile dysfunction; treating it can help raise libido. Libidos and testosterone levels vary widely. Thus, defining a "normal" sex drive is challenging. While some people maintain sexual desire at low testosterone levels, other people's libido may lag even with normal testosterone levels. If testosterone is lowered far enough, almost all men will experience a decline in sex drive.
How is testosterone deficiency diagnosed?
A healthcare provider will ask questions about your symptoms, medical history, medication history, sexual history, relationships, stress level, and thoughts about sex. If a physical condition is suspected as the cause of a lowered libido, the healthcare provider will order:
- Physical exam.
- Blood tests, such as hormone level tests.
According to the American Urology Association (AUA), less than 300 nanograms per deciliter (ng/dL) for adult men is considered low blood testosterone. Symptoms are the other primary consideration for providers when diagnosing testosterone deficiency.
Whom does low testosterone affect?
Male hypogonadism is a medical condition that can affect men at any age but is more likely to affect men who are:
- Older.
- Have poorly managed Type 2 diabetes.
- Have obesity.
- Have chronic medical conditions.
- Have HIV/AIDs.
- Have obstructive sleep apnea.
What are the symptoms of low testosterone?
In older men, symptoms of hypogonadism (low testosterone) include:
- Decreased spontaneous erections.
- Decreased nocturnal penile erections.
- Decreased Libido.
- Reduced testicular volume.
In younger men, hypogonadism may be related to:
- An underlying genetic condition.
- Problems with the hypothalamic-pituitary-gonadal axis.
- Environmental factors.
- Past infection or injury to the testis.
If your testosterone level is low, testosterone replacement therapy may be a solution that restores your sex drive–it could help manage depression and motivation and decrease body fat.
