Exploring Key Factors That Lead to Low Sex Drive in Men

Low sex drive in men can be caused by low testosterone, stress, depression, poor sleep, medicines, or relationship issues. See a doctor if it persists.

Common causes

• Low testosterone.
• Stress and anxiety.
• Depression.
• Poor sleep.
• Medicines (SSRIs, blood pressure drugs).
• Relationship problems.
• Alcohol and drug use.
• Chronic illness, obesity and diabetes.
• Thyroid issues.

Facts

About 1 in 5 men report low desire at times.

What helps

Exercise, sleep and counseling.

See a doctor

For a testosterone test and review.

Medical and lifestyle causes

Low libido in men has many causes. Low testosterone (below about 300 ng/dL) affects an estimated 2 to 6 percent of men overall and more among older men. Other factors include depression, anxiety, stress, poor sleep, relationship problems, obesity, diabetes, thyroid disease, sleep apnea and medications such as SSRIs, opioids and finasteride.

• Alcohol and cannabis use can lower desire.
• Cardiovascular disease and erectile dysfunction may reduce desire.
• Heavy cycling or other long periods of intense endurance training can lower testosterone in some men.

What helps

Exercise, weight loss, better sleep, stress management and counseling help. A doctor can check morning testosterone twice, thyroid, prolactin, glucose and a medication review. Testosterone therapy is for men with confirmed deficiency and symptoms, and has risks including fertility reduction and polycythemia. The TRAVERSE trial (2023) found no increase in major cardiac events with testosterone therapy in men with hypogonadism at high cardiovascular risk over 22 months.

Medical and lifestyle causes

Low sex drive in men can be due to low testosterone, depression, stress, sleep problems, medications (SSRIs, blood pressure drugs), diabetes, thyroid disease, relationship issues and alcohol use. Testosterone declines about 1 percent per year after 30 to 40.

What helps

A doctor can check testosterone, thyroid and glucose. Exercise, sleep and counseling help. Do not self treat with unregulated supplements.

Hormonal and psychological factors

Testosterone levels fall about 1 percent a year after age 30 to 40, and low T in men is defined by the Endocrine Society as below 264 ng/dL on repeated morning tests, with symptoms. Depression, relationship problems, performance anxiety and sleep apnea are frequent causes. SSRIs reduce libido in 30 to 60 percent of users. Opioids lower testosterone.

Evaluation and approaches

Doctors review medicines, check testosterone, prolactin, thyroid and glucose. Treatment depends on cause: testosterone therapy for confirmed deficiency, switching medications, counseling, exercise and weight loss. Over the counter supplements are poorly regulated. Sudden loss with headaches or vision change needs evaluation for pituitary tumor. Talk openly with a partner.

Based on data from the Endocrine Society and the American Urological Association