What is Low Libido (low sex drive)?

Low sex drive, known as low libido, constitutes a facet of male sexual dysfunction, encompassing conditions such as erectile dysfunction (ED), ejaculation disorders, and delayed or inhibited orgasm. In its common meaning, low libido or low sex drive refers to a lack of interest in sex and sexual desire. Although these alterations are common, they can be troubling. Men who engage in high levels of sexual activity might find changes in their libido especially distressing. At times, low libido can indicate potentially serious underlying medical conditions.

How Common is Low Libido?

Loss of libido in men is commonly observed throughout their lifespan. The occurrence of low libido in men worldwide shows significant variation influenced by factors like age, health status, and lifestyle choices. The number of men experiencing low libido can be anywhere from 5% to more than 17%. Additionally, reduced sexual desire is frequently reported among gay men, with prevalence rates ranging from 19% to 57%. Yet, establishing an exact prevalence proves challenging owing to variations in definitions and methodologies and the inherently subjective nature of libido.

What are the Symptoms of Low Libido in Males?

Symptoms of low libido in males could include:

• Lack of interest in any form of sexual activity, including masturbation.
• Rarely or never experiencing sexual fantasies or thoughts.
• Feeling dissatisfied with a diminished desire for sexual activities or thoughts.
• Tension or conflict within the relationship due to a lack of fulfillment among partners.

Assessment by a medical professional becomes necessary for a man experiencing consistent or recurring disinterest in sex, causing concern for himself and/or his partner(s).

What Causes Low Libido?

Our desire for sex is regulated by parts of the brain that either boost or limit this desire. When someone experiences low libido, it could be due to less active excitatory parts, overly active inhibitory parts, or a combination of both. Specifically, certain pathways in the brain related to dopamine play a role in making us sexually excited, while other pathways linked to opioids, endocannabinoids, and serotonin regulate how much control we have over those feelings. It is suggested that dopamine, working via the mesolimbic dopaminergic reward pathway, potentially boosts desire, while prolactin is believed to lower libido, although the precise mechanisms remain unclear. Additionally, dopamine has a direct role in restraining prolactin release from the pituitary gland. The challenge with decreased sexual desire in men is that it often does not arise from a single cause. Instead, it arises from a complex array of underlying issues.

Table 1: Factors Contributing to Low Sex Drive

Common Causes of Low Libido in Men

A decrease of libido can be a symptom of both psychological and physical factors, affecting one’s interest in sexual activities and intimacy. Understanding the root cause is crucial to addressing the causes of low libido in men and seeking appropriate guidance for resolution.

Low testosterone: one of the most common symptoms of low testosterone in males is low sex drive. A number of studies have supported the association between testosterone and low sex drive. An epidemiological study evaluated the connection between 1632 men’s serum testosterone levels and their self-reported low sex desire. According to the study, low testosterone levels were predicted by a low libido score. Similarly, a cross-sectional study that used questionnaires to poll a representative sample of men showed that there was an inverse correlation between rising sexual symptoms of low sex desire and falling testosterone levels.

Medications: There are a number of medications that have the side effect of drug-induced sexual dysfunction. Table 1 above reports the classes and drugs that have been proven to cause low sex desire as a side effect. When prescribing a medication that has been linked to sexual side effects, doctors should let their patients know that these effects are likely and advise them to be aware of the symptoms. Since these patients don’t typically provide this information on their own, they ought to inquire. Doctors can switch to a different medication or lower the dosage if sexual dysfunction occurs.

Depression: Patients with depression are disproportionately affected by low sex desire. Also, depression medications (like amitriptyline, fluoxetine, imipramine, etc.) have been shown to impair sexual function and libido.

Chronic illness: A chronic illness can deeply impact satisfaction levels in relationships and sexual experiences for both individuals managing the illness and their partners. Conditions like diabetes, cardiovascular issues, cancer, and chronic respiratory diseases can lower sex drive.

Sleep problems: Several studies suggest that inadequate sleep, interruptions in sleep patterns, and sleep-related disorders have an impact on various aspects of human health, including sexual function. Obstructive Sleep Apnea (OSA) involves recurring instances of partial or complete blockage in the upper airways during sleep, prompting affected individuals to wake up frequently. Frequently, individuals with OSA have been noted to have a decrease in libido.

Aging: As men age, it's common to observe a gradual decline in their sexual drive. The extent of this decrease can differ, yet many men retain at least some level of sexual interest well into their 60s and 70s. Studies have shown that sexual activity, in general, exhibits a decreasing trend as age increases. With aging, various factors like hormonal shifts, such as reduced testosterone in men, physical alterations like heightened fatigue, chronic health issues, medications, and shifts in body image can impact one’s libido.

Stress: Psychological stressors disrupt sexual function through both psychological and physiological pathways. Prolonged or chronic stress notably impairs sexual functioning in both men and women. Stress can lead to hormonal imbalance, cause fatigue, and also impact relationships.

How is Low Libido Diagnosed?

If a man keeps feeling uninterested in sex and it’s bothering him or his partner(s), it's a good idea for him to see a doctor who knows more about these things.

The initial and most crucial steps in examining issues with sexual desire in men involve gathering a comprehensive history. It is vital to check if there are other sexual problems happening because sometimes low desire could be connected to issues like trouble getting or keeping erections or having little control over when ejaculation happens. Understanding a man’s relationship with his partner is essential too. Even men without partners might experience a drop in libido, which can have both positive and negative aspects. It is especially important to ask about any medications taken because many drugs can affect libido negatively. Also, it is necessary to know about any psychological or neurological diseases or past trauma. Basic tests, like measuring testosterone levels in the blood, are often helpful in this evaluation. If they find out that the testosterone levels are low, they do more tests to figure out if the problem is in the testicles, the brain’s hypothalamus, or the pituitary gland.

How is Low Libido Treated?

The approach to addressing low libido in men relies on identifying its cause. Consulting a general practitioner can provide insights into treatment for low libido in males. Here are some approaches commonly used treatment for low libido in males:

• Testosterone Replacement Therapy: Research indicates a direct correlation between the level of testosterone and libido in men. Treatment involving testosterone therapy (testosterone replacement therapy [TRT]) consistently demonstrates a positive effect on boosting libido among men with initially low testosterone levels. The Testosterone Trials, which examined sexual desire, are a coordinated set of seven trials. This trial demonstrated that libido improved proportionately with an increase in testosterone levels. A finding of a meta-analysis involving 2298 participants showed improved libido in hypogonadal men.

Caution: The long-term effects of TRT (testosterone replacement therapy) can include potential risks such as increased red blood cell production and a potential impact on cardiovascular health. Monitoring by a healthcare professional is essential to assess and manage any potential long term effects of TRT.

• Psychotherapy, counseling, and sex therapy: Psychosocial elements such as stress, anxiety, depression, or relational challenges causes of low libido in males. Therapeutic interventions like psychotherapy, counseling, or specialized sex therapy are instrumental in mitigating these factors, consequently ameliorating decreased libido in men. Research has demonstrated the effectiveness of cognitive-behavioral therapy in effectively treating anxiety, depression, and various other psychiatric conditions.
• Treatment of low libido in men secondary to the use of medicine causing low libido: the first stage of effective management is a thorough assessment to ensure that the reported sexual dysfunction is indeed a consequence of concomitant treatment. Treatment may involve a reduction of concomitant drug dosage, switching to medicine with less or no side effect of sexual dysfunction, introducing adjunct treatment to counter the side effect, and providing cognitive behavior therapy.
• Managing a positive lifestyle: This approach involves increasing physical activity, medically managing excessive weight (without excessive measures), and eliminating any remaining habits of excessive alcohol, nicotine, or drug use. These steps offer significant health benefits that extend beyond improvements in sexual health.

Physical and Emotional Side Effects of Low Libido

Low libido is an important issue impacting the quality of life for couples. A persistently low libido can create stress, lower self-esteem, and contribute to marital troubles. Owing to societal stigmas rooted in strict gender expectations and harmful ideals of masculinity, men often suppress their emotions and conceal stressful experiences of low sex desire. Consequently, this stress can build up and develop into chronic stress. Prolonged stress is significantly linked to the onset of erectile dysfunction (ED). Decrease of libido is often associated with depression and anxiety. Studies have shown that low sex drive increases with the increasing severity of psychologic illness.

Conclusion

Discussing your sex life with a medical professional might seem awkward or uncomfortable but recognizing that sexuality is a natural and significant aspect of your well-being is crucial. If you are worried about your sex drive, do not hesitate to reach out to Science & Humans — we are here to offer support and guidance.