Posted On: September 24, 2026
Most patients do not bring up low libido as the reason for their visit. By the time someone mentions low libido to me, they have usually been wondering about it for months — whether it is normal or if it is even worth bringing up. Most never mention it at all. They tell me they feel tired, off, or simply different from how they used to feel.
Low libido is a common concern in both women and men. In a large population study, roughly 1 in 3 sexually active women and 1 in 6 sexually active men reported lacking interest in sex for at least three months during the previous year.1 It is still easy to leave it out of a medical visit because it feels more personal than talking about blood pressure, cholesterol, or sleep. Sexual health is part of overall health, and changes in desire can tell us something important about what is happening physically, hormonally, emotionally, or medically.
Desire depends on more than hormone levels, and that is where most evaluations stop. Energy, sleep, mood, physical comfort, medication effects, chronic illness, and a relationship itself all matter, and usually more than one of them is involved.
Sleep and stress are common examples. A stretch of poor sleep can leave very little energy for desire, while ongoing stress can make it harder to shift out of a constant problem-solving state. Depression and anxiety can lower sexual interest as well.
Medications are one of the most common causes of low desire, and the connection is easy to miss when the prescription started months or years ago. SSRIs and SNRIs, commonly used for depression and anxiety, can cause lower desire, delayed orgasm, or difficulty becoming aroused.2 Some blood pressure medications, opioids, and hormonal contraceptives can also affect sexual function.
Other medical conditions can contribute as well. Diabetes can affect the nerves and blood vessels involved in sexual response. Thyroid disorders can affect energy, mood, and sexual function. Chronic pain may make sex uncomfortable or leave someone too depleted to be interested in it.
This is why a thorough evaluation looks at the broader health picture before assuming low libido is solely a hormone problem.
For women, context matters. The timing of the change, reproductive stage, menstrual changes, pregnancy or breastfeeding, physical comfort during sex, medications, and major life changes can all affect desire.
During perimenopause and menopause, estrogen and testosterone both fluctuate, but they play different roles in sexual health. Estrogen helps support vaginal tissue, lubrication, sensitivity, and comfort.
As estrogen declines, vaginal dryness, irritation, reduced lubrication, and pain during sex can develop as part of genitourinary syndrome of menopause, or GSM. When sex becomes uncomfortable, desire may fall as well. Depending on the patient and their medical history, lubricants, vaginal moisturizers, low-dose local vaginal estrogen, or other therapies may improve comfort.
Testosterone has a more direct role in sexual desire. Women produce testosterone throughout adult life, and levels generally decline with age. The change can be more abrupt after surgical removal of the ovaries.
There is no single blood testosterone level that diagnoses hypoactive sexual desire disorder, or HSDD. For appropriately evaluated postmenopausal women with persistent, distressing low desire, low-dose transdermal testosterone may be considered. In the United States, this use is off-label, so the discussion should include potential benefits, side effects, dosing, monitoring, and the limits of long-term safety data.3
Pregnancy and the postpartum period bring a different set of changes. Hormones shift quickly, sleep is often fragmented, the body is recovering from pregnancy and delivery, and breastfeeding can lower estrogen. Add the physical and emotional demands of caring for a newborn, and a temporary drop in desire is common. For many women, it improves with time. If it does not, or if low desire comes with pain, significant mood changes, or other symptoms, that is worth bringing up at your next visit.
In men, the most common hormonal driver of low libido is age-related testosterone decline. Testosterone falls at roughly 1 to 2% per year from the mid-thirties onward. But symptomatic low testosterone is not an inevitable part of aging. Obesity, diabetes, sleep problems, chronic illness, medications, and overall health can all affect testosterone or cause similar symptoms. Current guidance recommends diagnosing hypogonadism — a condition where the testes do not produce enough testosterone, sperm, or both — only when symptoms fit and morning testosterone is consistently low on repeat testing.4
Erectile dysfunction and low libido are often discussed as separate problems, but they are frequently connected. ED can develop because of low desire, and low desire can arise in response to repeated difficulty with erections. The anticipatory anxiety that ED creates can suppress desire even when testosterone levels are normal.
What often surprises men is that erectile dysfunction can be an early signal of cardiovascular risk. A study of nearly 3.5 million U.S. men found that ED was associated with a higher risk of cardiovascular disease across age groups, while low testosterone was associated with several metabolic risks.5 That does not mean ED proves someone has heart disease. It does mean new or persistent ED is a reason to look at the full picture, including blood pressure, cholesterol, blood sugar, weight, smoking, exercise, and other risk factors rather than treating it only as a bedroom problem.
Prostate-related treatment can affect sexual function as well. Some treatments for benign prostatic hyperplasia can affect erections or ejaculation. Androgen deprivation therapy for prostate cancer works by intentionally lowering testosterone, so a drop in libido is an expected effect of treatment. Those changes still deserve discussion and management as part of ongoing care.
There is no correct amount of sexual desire. Libido varies from person to person and can change over the course of life. Clinically, what matters is whether the change is persistent, unusual for you, or causing distress.
HSDD is one term clinicians use for persistent low desire that causes significant distress. Population studies estimate distressing low desire in roughly 10% of women and around 8% of men, although exact prevalence varies by population and diagnostic criteria.6,7
Low libido can also affect relationships. Over time, a mismatch in desire may lead to frustration, avoidance, or a loss of closeness between partners. For the person experiencing it, the change can affect confidence and quality of life. If it bothers you, that’s reason enough to ask for help — no formal diagnosis is required.
Sexual health is also connected to broader well-being. Observational research has found an association between more frequent sexual activity and lower all-cause mortality, although this type of study cannot establish cause and effect.8 More importantly, in day-to-day practice, sexual symptoms can provide clues about hormone changes, medication effects, metabolic health, cardiovascular risk, pain, or pelvic floor problems.
Most people who notice a change in desire are never asked about it. In a fifteen-minute visit, low libido is what comes up on the way out the door, if it comes up at all. Our annual exams run 60 to 90 minutes, so we have the time to discuss what really matters.
Most of what explains a change in desire comes out in a conversation — often in what was happening in your life the year it began.
When labs are appropriate, they may include hormone and thyroid testing. In women, DHEA-S, an androgen produced mainly by the adrenal glands, can sometimes add context to the hormone picture. In men, LH and FSH, pituitary hormones that help regulate testosterone production, can help clarify why testosterone is low.
What comes next depends on what we find, and in my experience, it is often more straightforward than people expect. Figuring out the root cause and treating the pain during sex can bring desire back on its own, and a medication may need revisiting if we’re noticing side effects. When the timing points to menopause, hormone replacement therapy (HRT) belongs in the conversation, and what we know about it has changed more than most people realize. Pelvic floor physical therapy is one of the most underused tools in women’s health, and sex therapy addresses what hormones cannot.
Some shifts are expected as hormones change and life circumstances evolve. The distinction that matters clinically is whether the change bothers you. If your libido has dropped and you are distressed by it, that is enough reason to bring it up. You do not need to meet a formal clinical threshold to deserve an evaluation.
Yes, and it is more common than most patients realize. SSRIs and SNRIs used for depression and anxiety are among the most frequent contributors. Certain blood pressure medications, particularly beta-blockers, can blunt desire and response. Opioids and some hormonal contraceptives can also play a role. A medication review is usually one of the first steps when this concern comes up, since it’s often the most actionable place to start.
Rarely is it that simple. Hormones are worth checking, and a panel is usually appropriate. But sleep deprivation, depression, anxiety, relationship stress, and uncontrolled chronic conditions all reduce desire independently of hormone levels. A useful evaluation looks at the full picture, not just a single lab value.
It can. Low desire may be related to testosterone deficiency, medications, depression, sleep problems, or other health conditions. When erectile dysfunction is also present, cardiovascular and metabolic risk factors may deserve closer attention.
These connections do not mean something serious is definitely happening, but they are reasons to investigate.
Protecting sleep is the most helpful thing that someone can do. Moving your body regularly, reducing chronic stress, and limiting alcohol all have documented effects on hormone levels and desire. If a medication feels like it might be contributing, talk to your prescribing provider before making any changes. And if the drop in desire has lasted more than a few months and is bothering you, the most useful thing you can do is bring it up at your next visit.
Low libido is common, and there is rarely one simple cause. When something medical, hormonal, or medication-related is contributing, there are usually ways to address it. The evaluation is often straightforward, the options are real, and I consistently see the difference proper treatment can make in my practice.
Sexual health is part of overall health. It affects how you feel, how you relate to the people you care about, and how you move through your daily life. If any of what I have described here resonates with where you are right now, bring it to your next visit. A practice, with the time and commitment to take it seriously, is exactly the right place to start. Real help is available, and there is reason to be hopeful.
Leading the way in women's healthcare is renowned board-certified internal medicine doctor Dr. Eileen West. She has over 20 years of experience and is recognized for her expertise in menopause, osteoporosis, and cardiovascular disease prevention. Her excellence-driven compassionate approach, which is associated with the American College of Physicians, improves the lives of her patients by putting a strong emphasis on their overall well-being.
Location: Fairfax, Virginia
Areas of Expertise: Women's Health, Menopause Management, Cardiovascular Disease Prevention, Osteoporosis Diagnosis and Treatment.
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