Low Libido in Men:
Understanding What’s Really Going On
Why Has My Sex Drive Disappeared?
If you're reading this, you've probably typed "why has my sex drive disappeared" into a search engine at 2am, feeling alone with a problem you've not told anyone about. Perhaps you're just not interested in sex anymore. Maybe your partner's said something, or you've noticed you've lost your drive. You're wondering whether this is normal, if there's something medically wrong.
You're not alone. And there's usually a way forward
Loss of sexual desire is sometimes a testosterone problem — but often it isn’t. And it’s rarely “all in your head”. My approach brings together medical investigation, psychological understanding, and relationship dynamics to work out what’s really going on.
You’re Not Broken — Creating a Safe Space to Talk About Desire
The first thing I do is provide a really safe space for you to be heard, to share the problem, and reduce shame. Most people have been completely on their own with this. I'm non-judgemental. I've talked to thousands of people about their sexual lives -- there's pretty much nothing you can say which I've not heard before.
Many men tell me their previous experience of healthcare has been dismissive – your testosterone is normal – off you go – with barely even a chance to talk about the problem. That's not how this works.
At the other extreme, some men are now being steered toward testosterone treatment by online clinics before anyone has really explored what’s going on. I increasingly see men arriving with results from online clinics where they’ve been told their testosterone is “low” or “sub-optimal” — when in fact it’s completely normal and very unlikely to be the cause of their difficulties.
What Is a “Normal” Sex Drive for Men?
Here's the thing: there is no single "normal." Is low sex drive normal for men? It's a spectrum. Some people have no desire and it causes them no distress – this is termed asexuality. Others want sex every day or multiple times a day and that’s also normal.
The key is whether it's a change for you, whether it's causing you distress or difficulties in a relationship.
Is Low Sexual Desire Actually The Problem?
Before we jump to causes or treatment, the first question is a simple but important one: is desire actually the problem?
Or has your desire faded because sex has become stressful — because of erection difficulties, ejaculation problems, anxiety about performance, or disappointing sexual experiences? For many men, avoidance slowly replaces desire, not because desire is absent, but because sex no longer feels safe, relaxed, or enjoyable.
I often get asked does stress causes low libido? Or if anxiety and depression are the root cause of reduced sexual desire? And the answer is absolutely. Low libido and depression often go together. We can think of sexual desire and libido as life force energy, and when you’re depressed, your desire for connection, for excitement, for newness can be massively reduced. Antidepressants can also reduce desire. But sometimes the issue is not the medication, but under-treated depression. Working out which is driving the problem matters, because the treatment is very different.
I work closely with consultant psychiatrist Dr Jamie Arkell. For patients with overlapping mental health difficulties and sexual difficulties, Dr Arkell and I will can both review patients and see if we can make changes to medication to improve your sexual experience.
Low Libido vs Erectile Dysfunction: What’s the Difference?
Low libido means you’ve lost the desire for sex — you’re simply not interested. You don’t have sexual thoughts or don’t feel sexual. By contrast, erectile dysfunction means difficulties getting or maintaining an erection for sex, over a period of time.
They're different problems, though they can coexist. You can have perfectly functioning erections but no desire. Or strong desire but struggle with erections. Understanding which you're dealing with shapes the whole treatment approach.
When Should a Man See a Doctor About Low Libido?
All you need is curiosity about yourself. To be open to understanding what might be going on from a physical, hormonal, individual, psychological, and relational standpoint.
If it's just been a couple of weeks, it's probably worth waiting out. Things often fluctuate. But once you get to three to six months and it's persistent and not going away, that's usually the time. Equally, if it's been 10, 15, 20 years and you've not found anyone or had the opportunity to talk to about it -- it's never too late.
Is Low Libido Psychological, Physical — or Both?
Low libido is rarely caused by just one thing
It usually reflects a combination of biology, psychology, and what’s happening in your relationships. Our bodies, emotions, histories, relationships, and sexual experiences interact in complex ways — and understanding that interaction is often the key to making sense of what’s going on.
Sometimes there are things we can do which make a difference fairly rapidly, both when there’s a biological or psychological cause.
When Low Libido Is Medical: Testosterone, Health and Hormones
Sometimes there is something medically wrong. Particularly if you notice a gradual decrease in desire over time, often with fatigue and erection problems - that's where testosterone and cardiometabolic issues often come in.
It can become a self-reinforcing loop:
Weight gain leads to lower testosterone, worsens sleep apnoea and fatigue
→ which can lead to lower testosterone
→ and increases cardiovascular risk
→ which affects erection quality
→ which leads to poorer sexual experiences
→ which reduces desire.
Tests for Low Libido in Men
Can low testosterone cause low libido? Absolutely. But knowing if your testosterone is low requires proper comprehensive testing, not just a home finger prick blood test.
You need SHBG to calculate your free testosterone. You need to look at your pituitary hormones - LH and FSH - and your haematocrit and haemoglobin. You need blood tests taken over a period of time not just a one off. Together, these are part of a comprehensive male libido assessment.
The international guidance is clear: if you've got key symptoms (low desire, loss of morning erections, difficulties with erections) and your total testosterone level is less than 8 nmol/L, or 230 ng/dL, you're likely to benefit from treatment. Between 8 and 12 nmol/L (230 to 345 ng/dL) with symptoms, you may well benefit.
Free Testosterone, SHBG, and Why Numbers Alone Don’t Tell the Story
Free testosterone is the amount of testosterone which is free to enter cells, not bound by proteins such as SHBG. The evidence shows that free testosterone is more important than total testosterone in causing symptoms. Free testosterone less than 0.225 nmol/L with symptoms suggests deficiency.
Your androgen receptor genetics also matter. You can have a normal testosterone level but still have symptoms if your receptors aren't very responsive. This is a nuanced assessment, but sometimes I might recommend doing genetic testing of your androgen receptor.
Testosterone Treatment for Low Libido: When It Helps — and When It Doesn’t
If you’re overweight and have low testosterone, there’s currently some debate about which is the best treatment. Overall, you’re likely to benefit from weight loss, whether through lifestyle change or weight loss medications such as Mounjaro or Ozempic.
As you lose weight, your sleep improves, your testosterone can improve naturally, your overall health improves. It becomes part of a health kick: more physical activity, better sleep, better nutrition. Not just TRT.
However, for many men, losing weight without medication is incredibly difficult, particularly if you have low testosterone levels. Here weight loss medication or testosterone therapy can help bring back your energy and motivation to exercise. There is conflicting information about the impact of weight loss medications such as the GLP-1s and sexual desire. For some men, improved sleep and metabolic health increase desire; for others, the medication itself dampens it. This needs monitoring over time.
Does TRT help low libido in men? Yes, absolutely when testosterone deficiency has been diagnosed properly and when we have thought about other other factors too.
If you're wanting future fertility, we use HCG or clomiphene alongside testosterone. If not, it's more straightforward - injections, gels, or capsules.
If you're truly testosterone deficient and replacing to a normal level, there's no evidence of an increased risk of prostate cancer or cardiovascular disease. We have good evidence from the TRAVERSE study that gels are pretty safe. Injections have a bit more risk.
What If Your Testosterone Is Normal?
Often blood tests come back completely normal. Your sexual drive from testosterone plateaus in the normal range anyway. Between about 12 and 25 nanomoles per litre, it stays flat - the receptors are saturated.
If you're in that normal range but still have low desire, we need to think about your sexual experiences, your erotic world, your relationship dynamics.
We can also do the androgen receptor genetic testing, which in combination with other blood tests can give us more of a picture of whether your hormones might be the issue, even with a normal testosterone level.
Other Medical Causes of Low Libido in Men
Diabetes, cardiovascular disease, chronic illness, many medications (blood pressure drugs, some antidepressants, finasteride), sleep problems - all can reduce libido. If your sex drive disappeared since starting a new medication, that's worth investigating.
Sex, Desire, and Ageing
Sex does often decrease as you get older, and sexual difficulties increase because of blood flow, hormones, tissue changes. But often people become less distressed by it. But it doesn't mean sexual intimacy isn't important. Sometimes it's about expectation. People have low expectations about ageing. "I'm over 50, over 60, that's it."
But it's not at all. If you're not bothered, that's fine. But if you do want more sexual intimacy or want to explore it more, it's totally possible. Plenty of people in their 80s have good sexual lives.
I see people across the full spectrum – my oldest patient is 89.
I work with people who've been in long-term relationships where a partner died, and they had an asexual relationship for years. Then in their 70s or 80s they have a new burst of connection -- someone from when they were younger comes back, or they meet someone new they really like. Sometimes their desire is really stimulated by this new person, but there can be problems. It can be really frustrating if you've not been a sexual person for decades and then have this opportunity but feel you can't be.
I also work with people who've gone through bereavement after a really great loving relationship. With grief and death comes sex and eros. The three often go together. Making sense of the life they've lived, and what life is left, and what haven't they experienced -- particularly if they lived through the 80s and 90s as a gay man, or just a different period of sexual norms and freedom.
PSYCHOLOGICAL CAUSES OF LOW LIBIDO
When Desire Fades: Anxiety, Avoidance, and the Vicious Cycle
If you have really good sexual experiences, you get a positive loop of desire. Good sex makes you want more sex.
But the opposite is also true. If sex has become stressful or disappointing or anxiety-provoking, you go off sex.
Avoidance slowly replaces desire — not because desire is absent, but because sex no longer feels safe, relaxed, or enjoyable.”
For a lot of men, the loss of desire itself creates anxiety, which creates more avoidance, which reinforces the problem.
Equally if you’ve had traumatic experiences in your past, particularly traumatic sexual experiences, sex may no longer be associated with pleasure but fear and anxiety, which can have a big impact on your present sexual experience.
Spontaneous vs Responsive Desire: Two Normal Ways Desire Works
Some people have spontaneous desire - they just wake up feeling sexual. Others have responsive desire - they don't feel spontaneous arousal, but desire comes if they're exposed to something sexual or have a good sexual experience.
Both are normal. But the person with responsive desire can feel ‘pathologised’ because they don't wake up wanting sex. There's a social norm that all men should want sex several days a week. If you don't, you wonder what's wrong with you.
The answer might be: nothing. You might just have responsive desire, lower baseline desire, or you're in a mismatched desire situation, all of which can be worked through.
Understanding Your Sexual World
What was your first sexual experience? What are some of the best sexual experiences you've had? What's your current sexual life like? What makes a really good sexual experience for you? What are your sexual needs? What feels good physically? What turns you on? What's your erotic world? And how present -- how mindfully present -- are you when you have sex?
By unpicking some of that, we can understand what might be going on.
Can Relationship Dynamics Cause Low Libido?
A big part of assessing low libido is working out what's happening in a relationship. Often the person who comes to see me has had the problem placed squarely on their shoulders -- "go and sort yourself out." But it's often a relational difficulty.
Unresolved conflict kills desire. If you're angry at your partner, if there's unspoken resentment, if you feel criticised or controlled -- desire often evaporates.
Lack of novelty and erotic tension in long-term relationships is incredibly common. Desire thrives on a degree of mystery and difference. When you become too merged with your partner, when there's no erotic space between you, desire can fade.
There can be so many factors: having had children, gone through IVF, fertility struggles, pregnancy, childbirth. Worries about your erotic world. Feeling guilty about masturbating but not wanting sex with your partner.
Starting to talk about these experiences, how things have changed over time, and becoming curious about your own as well as your partner(s) sexual and erotic self can help bring back sexual energy to a relationship.
Mismatched Desire: When One Partner Wants Sex More Than the Other
Sometimes the person in my room isn't actually the person with the problem. It's the partner who's sent them to "go and get sorted." If they were alone, they wouldn't be bothered by it. It’s very common for one person to be labelled the high desire partner, and the other the low desire partner. We call this ‘mismatched desire’ and often exploring it as a couple can be very helpful.
Working With Couples: Moving Beyond Blame
If you're in a monogamous relationship and you're only having sex with one person, your issue is almost always in part, a couple issue, because it's part of a system.
Usually I'll try and encourage people to bring in their partner, at least for an assessment session. Often there's a dynamic which gets set up that's maintaining the difficulty.
I create a space which feels supportive and is not about blaming. I stop blame quite early on and am very interventionist. I get people to think about their own development -- what's their own part in problems and how can they both develop as individuals and as a couple.
If you get both people to think that way, and stop blame, and create really good supportive communication, you can travel a huge distance together. Learning to share your sexual selves with each other in a more relaxed and a fun way. Because it can get too fraught, people often feel very anxious communicating about sex, which kills desire and pleasure. We create room for safety and playfulness again.
Treatment which works: what’s the best way of improving low libido?
There are many different ways to treat low libido, and no single approach is right for everyone. The options below work in different ways, and the most effective treatment depends on a clear understanding of why the problem has developed.
What Is the Best Treatment for Low Libido in Men?
What is the best treatment for low libido in men? It depends entirely on what's causing it.
If it's primarily hormonal and you have genuinely low testosterone, hormone therapy might be part of the answer -- but rarely the whole answer.
If it's psychological, addressing the underlying mental health issues is crucial. Does sex therapy work for low libido in men? Yes, particularly when the issues are psychological, relational, or behavioural.
If it's relational, couple's therapy or sex therapy with your partner is often most effective.
Usually it's a combination. That's why low libido treatment for men needs to be comprehensive, addressing all the factors at play not just a one way ticket to testosterone replacement therapy.
How Long Does Treatment for Low Libido Take?
If it's medical - with a couple of blood tests four weeks apart, within a month or six weeks, you usually know what's going on medically.
If testosterone is helpful, within three to six months of treatment, you know whether it's going to help. And it's not the end of the world if it doesn't work and you need to come off again. If you've been on it for a short period, you can.
From an individual perspective, usually within six sessions, you have an idea of what's going on. Within six to twelve sessions of couples work, you're at a point where you've improved communication, increased understanding, and developed curiosity.
Sometimes you just decrease anxiety, increase communication, and learn to share your sexual selves with each other in a more relaxed way.
Can Low Libido in Men Be “Cured”?
Can low libido be cured? The word 'cured' suggests there's a disease. Low libido isn't always a disease - sometimes it's a natural response to difficult circumstances, relationship problems, exhaustion.
But can it improve? Absolutely. Can desire return? Yes. Is it permanent? Rarely, when we address the underlying causes.
Who Is the Right Doctor to See for Low Libido in Men?
If you're searching for a male libido specialist doctor, a sexologist for low libido in men, or a low libido doctor near me, you're looking for someone who understands the whole picture -- medical, psychological, relational, and hormonal.
Many men come to me after seeing their GP and being told everything’s normal, or after having a sales pitch from an online testosterone clinic. Or they've been told it's just stress, without any real exploration.
As a male libido specialist, I bring together medical expertise as a physician with training in sexual medicine, psychotherapy, and relationship therapy. That integration is what makes the difference.
I see people of all sexes, genders, and sexual orientations. I particularly specialise in men's difficulties, but work with men in same-sex, heterosexual, and bisexual relationships, and in monogamous, open, and polyamorous relationships.
Gay, bisexual, and queer men often find their way to me because they want someone who's comfortable talking about queer sexuality and desire. Someone who 'gets it', who doesn't need things explained, and who's non-judgemental and non-shaming. But that openness is often also very helpful for heterosexual people who come to see me.
If you're struggling with low libido and want someone who'll actually work out what's going on rather than just signing you up for a life long testosterone subscription, you're in the right place.
What to expect when you come to see me
Most people are anxious before their first appointment. Almost everyone finds it easier than they expected. Men usually find that having a chat about it feels fine, even though they were quite anxious beforehand.
In the first few minutes, there's a feeling of safety and compassion for the problem you’ve been facing. Having talked to thousands of people about their sexual lives means I'm just not uncomfortable -whereas often medical professionals want to get someone out of the room as quickly as possible.
There's then a very systematic medical review of your history, your family history, all the risk factors. We’ll go through an assessment that's medical, biological, psychological, relational, and cultural.
The big ones are usually: hormone problems (particularly testosterone, but also thyroid and prolactin), metabolic disease (diabetes, obesity, metabolic syndrome), cardiovascular disease, medication side effects and mental health conditions (depression and anxiety are massive factors).
Sometimes a physical examination is indicated, sometimes not. It's always optional.If you’ve had blood tests before, you can send them ahead of the appointment. If not, we’ll usually arrange blood tests, which need to be taken before 11am.
Everything is discussed with you, and nothing is compulsory. I never suggest anything I don’t believe is evidence-based or genuinely helpful, and nothing I wouldn’t recommend for my own family member.
What I Hope You Gain From Working With Me
By the end of a few consultations, my hope is that:
You’re enjoying sex again, with a positive and realistic vision for your sexual life. You feel confident and at ease in your sexual self, with a deeper understanding of your sexuality and a fuller experience of pleasure.
You have a clear understanding of your physical health, alongside a practical plan to improve it in both the short and long term — whether that means significantly reducing future cardiovascular risk or treating an underlying medical condition contributing to your erection difficulties.
You feel taken seriously, understood, and no longer alone in dealing with the difficulty.
How Long Does Treatment Take?
If the issue is primarily medical, improvement can sometimes be relatively quick. Particularly if you haven’t tried much before, addressing underlying medical factors and adjusting medications can lead to noticeable improvements once a clear plan is in place — sometimes within just two or three appointments.
If the difficulty is primarily psychological or relational, progress can also be made relatively quickly. Meaningful change often occurs within around six sessions. When an anxiety loop has developed, and you’re willing to engage with the process — whether within a relationship or through ongoing sexual experiences — change tends to follow when you’re able to reflect on what’s happening and try things differently.
If you’re in a relationship, I may recommend one or two sessions with your partner to explore things from a relationship therapy perspective.
Who Tends to Benefit Most From Seeing Me?
1. Men in midlife who haven’t engaged much with healthcare
If you're a man in your 50s or 60s who doesn't have a relationship with a good GP, doesn't particularly like going to the doctor, but you realise you need to take your health seriously and want to improve your health
2. Gay, bisexual and queer men
If you want to seek help but are worried about seeing someone heterosexual who's not comfortable talking about gay or queer sex. You can come to someone who ‘gets it’, who doesn't need things explained, and who's non-judgmental and non-shaming
3. Men who want a thoughtful, whole-person assessment
Perhaps you’ve tried quick fixes, or had a very medical or therapy based approach which hasn’t helped. I often see men for second opinions or after they’ve seen several other specialists.
That said, I see men across the spectrum – all ages – from men in their 20s to late 80s,all relationship statuses, all orientations. If you're struggling with erection problems and want someone who'll actually work out what's going on rather than just handing you a prescription, you're in the right place.
That said, I work with men across the spectrum — from their 20s to their late 80s, across all orientations and relationship statuses.
Why Sexual Desire Is So Often Missed in Medicine
I believe strongly in whole person medicine. Sex life is rarely talked about in medical consultations, but it's a crucial missing piece of our health. As well as being a sexologist and sex and relationship therapist, I'm also a general physician with a very broad medical training.
Sexual health gets left out of medicine because of shame and discomfort. And lack of knowledge -- a lot of doctors don't have the awareness of how to integrate the physical, the psychological, the relational, the sexual.
I moved into sexual medicine because I saw how poorly it was dealt with. Low libido was either dismissed as "just stress" or treated with testosterone without proper investigation. But sexual desire is complex. It requires all these different aspects brought together.
This work exemplifies truly holistic, whole person medicine. Sexual health and sexual pleasure get to the heart of needing all these different aspects brought together.
Taking this next step takes courage. If you’d like a thoughtful, unhurried assessment that looks at the whole picture — medical, psychological, and relational — you’re welcome to book below, or reach out via the contact form.