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, perhaps late at night, feeling alone with a problem you haven't told anyone about. Maybe you're just not interested in sex anymore. Maybe your partner has said something, or you've noticed your drive has quietly faded. You're wondering whether this is normal — whether there's something medically wrong.
You're not alone. Low sexual desire affects around 15% of men at any given time, and the real figure is likely higher, given how rarely men disclose it. And there is, in almost every case, a way forward.
As a London GP and clinical sexologist with a PhD in men's sexual health, I see men every week who've been struggling with this in silence — often after dismissive encounters elsewhere. 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 — A Safe Space to Talk About Desire
The first thing I do is provide a genuinely safe space for you to be heard, to share what's been going on, and to feel less alone with it. Most men have been completely on their own with this. I'm non-judgemental. Having talked to thousands of men about their sexual lives, there's very little I haven't heard before.
Many men tell me their previous experience of healthcare has been dismissive — 'your testosterone is normal, off you go' — with barely a chance to articulate the problem. That's not how this works.
At the other extreme, some men are now being steered towards 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 too is normal.
The key questions are: is this a change for you? Is it causing distress, or creating difficulties in a relationship? If so, it's worth exploring. If not, it may not be a problem at all.
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, performance anxiety, or a run of 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.
Does stress cause low libido? Absolutely. Can anxiety and depression reduce sexual desire? Yes — significantly. Low libido and depression often go together. Sexual desire functions like a life-force energy: when you're depressed, your appetite for connection, excitement, and novelty can diminish across the board. Antidepressants can also reduce desire — though sometimes the issue is under-treated depression rather than the medication itself. 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 and sexual difficulties, we can both review your situation and explore whether changes to medication might 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. Erectile dysfunction, by contrast, 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 entire treatment approach.
When Should a Man See a Doctor About Low Libido?
If low libido has persisted for three to six months and is causing you distress or relationship difficulties, it's worth a professional assessment.
If it's been a couple of weeks, it may be worth waiting — things often fluctuate. But if it's been three to six months and isn't resolving, that's usually the time to seek help. And if it's been 10, 15, or 20 years and you've never had the opportunity to properly explore it, it's never too late. My oldest patient is 89.
All you really need to bring is curiosity — a willingness to understand what might be going on from a physical, hormonal, psychological, and relational standpoint.
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, 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 relatively quickly, whether the underlying cause is biological or psychological.
When Low Libido Is Medical: Testosterone, Hormones, and Health
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. Sexual drive from testosterone plateaus once levels are within the normal range — roughly between 12 and 25 nmol/L, the receptors are saturated and more testosterone doesn't increase desire.
If you're in that normal range but still have low desire, we need to think about your sexual history, your erotic world, your relationship dynamics, and what's happened over time. Androgen receptor genetic testing, used alongside other markers, can sometimes provide additional insight.
Other Medical Causes of Low Libido in Men
Diabetes, cardiovascular disease, chronic illness, and many medications — including blood pressure drugs, certain antidepressants, and finasteride — can all reduce libido. If your sex drive disappeared after starting a new medication, that connection is worth investigating.
Sex, Desire, and Ageing
Sexual difficulties do become more common with age, due to changes in blood flow, hormones, and tissue. But it doesn't follow that sexual intimacy stops being important, or that nothing can be done. I see men across the full age range — from their 20s to their 80s — and plenty of people in their 70s and 80s have active, satisfying sexual lives. If you want that, it's absolutely possible.
I also work with men who've gone through bereavement after long relationships, men who've had periods of asexuality and then find themselves wanting connection again, and men navigating the complex interplay of grief, desire, and identity — particularly those who lived through the 80s and 90s as gay men, or during very different periods of sexual freedom.
PSYCHOLOGICAL CAUSES OF LOW LIBIDO
When Desire Fades: Anxiety, Avoidance, and the Vicious Cycle
Good sexual experiences create a positive feedback loop — good sex makes you want more sex. But the opposite is equally true. If sex has become stressful, disappointing, or anxiety-provoking, desire tends to retreat.
Avoidance slowly replaces desire — not because desire is absent, but because sex no longer feels safe, relaxed, or enjoyable. For many men, the loss of desire itself creates anxiety, which creates more avoidance, which reinforces the problem.
Traumatic past experiences — especially traumatic sexual experiences — can also mean that sex becomes associated with fear or anxiety rather than pleasure, with a lasting impact on present-day desire.
Spontaneous vs Responsive Desire: Two Normal Ways Desire Works
Some people have spontaneous desire — they simply wake up feeling sexual. Others have responsive desire — desire doesn't arise spontaneously, but emerges in response to something sexual or an enjoyable sexual experience.
Both are completely normal. But the person with responsive desire can feel as though something is wrong, because the cultural expectation is that all men should want sex regularly and spontaneously. The answer, often, is that nothing is wrong — you may simply have a lower baseline desire, or responsive rather than spontaneous arousal. These are workable.
Understanding Your Sexual World
A significant part of my assessment involves exploring your erotic history: what were your early sexual experiences? What makes a good sexual experience for you? What are your sexual needs, your fantasies, your erotic world? How present — how mindfully present — are you during sex?
Unpacking these questions is often where real understanding begins.
Can Relationship Dynamics Cause Low Libido?
A big part of assessing low libido is understanding what's happening in a relationship. Often the man who comes to see me has had the problem placed entirely on his shoulders — 'go and sort yourself out.' But it's frequently a relational difficulty, not an individual one.
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 also incredibly common. Desire thrives on a degree of mystery and difference. When partners become too merged, when there's no erotic space between them, desire can fade.
Other factors — IVF, fertility struggles, pregnancy, childbirth, changes in body image, guilt about masturbation — can all quietly erode sexual connection. Starting to talk about how things have changed over time, and developing curiosity about both partners' sexual and erotic selves, can help bring sexual energy back into a relationship.
Mismatched Desire: When One Partner Wants Sex More Than the Other
Sometimes the person in my consulting room isn't actually the person with the problem — it's the partner who's sent them to 'get sorted'. If they were single, they wouldn't be distressed by their level of desire at all. This is called mismatched desire, and it's very common. Exploring it as a couple is often more effective than treating one partner in isolation.
Working With Couples: Moving Beyond Blame
If you're in a monogamous relationship, your sexual difficulty is almost always, in part, a couple difficulty — because it exists within a system. I usually encourage people to bring their partner to at least one session.
I create a space that is supportive and explicitly not about blame. I'm interventionist in stopping blame cycles early, and I guide both people to think about their own part in what's developed, and how they might each grow — both as individuals and as a couple. Learning to share your sexual selves in a more relaxed, even playful way can travel a remarkable distance. Because anxiety about communicating about sex kills both desire and pleasure, and creating safety again is often where the change begins.
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 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 the issue is primarily medical, a clear picture usually emerges within a month to six weeks — two blood tests taken four weeks apart is the standard. If testosterone therapy is indicated, you usually know within three to six months whether it's making a meaningful difference.
From an individual psychological perspective, within six sessions you typically have a clear understanding of what's driving the problem. Within six to twelve sessions of couples work, communication has usually improved significantly and a different kind of sexual relationship has become possible.
Can Low Libido in Men Be “Cured”?
The word 'cured' implies there's a disease. Low libido isn't always a disease — sometimes it's a natural response to difficult circumstances, relationship problems, or exhaustion. But can it improve? Absolutely. Can desire return? Yes. Is low libido permanent? Rarely, when the underlying causes are properly addressed.
Who Is the Right Doctor to See for Low Libido in Men?
If you're searching for a male libido specialist, a sexologist for low libido in men, or a low libido doctor in London, 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 a sales pitch from an online testosterone clinic. Or they've been told it's 'just stress', without any real exploration.
As a London-based GP with dual training in sexual medicine (FECSM) and psychosexual therapy (COSRT registered), and a PhD focused on men's sexual health, I bring together the clinical and psychological expertise that this problem genuinely requires — in one consultation, in central London.
I see people of all sexes, genders, and sexual orientations, and I specialise in men's difficulties across all relationship structures — monogamous, open, and polyamorous. 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 is non-judgemental and non-shaming.
If you're struggling with low libido and want someone who'll actually work out what's going on, rather than signing you up for a lifelong 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 talking about this feels fine — even a relief — despite the anxiety beforehand.
In the first few minutes, I aim to create a sense of safety and compassion for the problem you've been facing. Having spoken with thousands of men about their sexual lives, I'm genuinely comfortable with whatever you bring.
What follows is a systematic review: medical history, family history, risk factors, and a full assessment that covers the biological, psychological, relational, and cultural dimensions. The big drivers are usually hormonal problems (particularly testosterone, thyroid, and prolactin), metabolic conditions (diabetes, obesity, metabolic syndrome), cardiovascular disease, medication side effects, and mental health conditions — especially depression and anxiety.
Physical examination is sometimes indicated and always optional. If you've had blood tests already, send them ahead of your appointment. If not, we'll arrange them — they need to be taken before 11am.
Everything is discussed with you. Nothing is compulsory. I never suggest anything I don't genuinely believe is evidence-based and helpful — nothing I wouldn't recommend to my own family.
What I Hope You Gain
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.
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
Men who've tried quick fixes, or had a purely medical or purely therapy-based approach that hasn't helped — I often see men for second opinions or after seeing several other specialists. And men at any age, in any relationship structure, who want to understand what's going on rather than just being handed a prescription.
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.
Dr Ben Davis is a London GP, men’s health physician, and clinical sexologist specialising in men's sexual health, testosterone therapy, and psychosexual therapy.
He holds an MA from Cambridge, MBBS from UCL, and a PhD focused on men's emotional and sexual health from UCL & LSHTM.
He is a Fellow of the European Committee of Sexual Medicine (FECSM) and a COSRT (College of Sexual and Relationship Therapists) registered therapist.
He practises at Central Health London, 23 Devonshire Place, London W1G 6JB, and works in the NHS as a GP in East London
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.