Low libido in men: causes, when to see a GP and what can help

Libido is the desire for sex. Everyone's level varies over time and between people, so there is no single normal. NHS inform describes the symptoms of low sex drive as little or no interest in sex and experiencing low sexual desire. It becomes a concern when the change is persistent, differs from your usual pattern and causes distress to you or your relationship.

Low libido is different from erectile dysfunction, although the two often occur together. Desire is about wanting sex, whereas erection is about the physical response. The NHS lists sexual problems such as erectile dysfunction among the causes of a low sex drive, so each may feed the other, and treating one can help the other.

The NHS lists some of the main causes of low sex drive as relationship problems, stress, anxiety or depression, sexual problems like erectile dysfunction, lower hormone levels as you get older, taking certain medicines, and drinking too much alcohol. NHS inform adds that low sex drive is often linked to stress either in personal life or at work, and that an unexpected loss of libido that lasts a long time or keeps returning can be linked to something else.

• Mental health and stress: anxiety, low mood and depression, work pressure and tiredness are among the commonest contributors.

• Relationship factors: communication problems, conflict, or changes after becoming a parent.

• Medicines: the NHS names medicines for high blood pressure and antidepressants. Patient.info also lists opiate painkillers and some hormones as medicines that can affect testosterone production.

• Alcohol: the NHS includes drinking too much alcohol among the causes.

• Long-term conditions: heart disease, diabetes, an underactive thyroid and cancer, according to the NHS.

• Low testosterone: caused by ageing or by conditions of the testicles or the pituitary gland.

• Overweight and obesity: Patient.info says being significantly overweight or obese at any age is linked to low testosterone.

Testosterone is the main male sex hormone and has effects on sexual function. Patient.info says that from the age of about 30 years, testosterone levels usually start to decrease, and that one large study in Europe found testosterone deficiency affected about 2 in 100 men aged 40 to 79 years and about 5 in 100 men aged 70 to 79. It adds that low testosterone is more common in men who are overweight and men with long-term health conditions.

Patient.info lists the signs of low testosterone in adult men as erectile dysfunction, infertility, a decrease in beard and body hair growth, a decrease in muscle mass, development of breast tissue and loss of bone density, and says that as levels decrease in older men some experience excessive tiredness, decreased sex drive, difficulty concentrating and hot flushes. These symptoms overlap with many other causes, which is why testing is advised rather than guessing.

Patient.info distinguishes primary causes, where the testicles fail to make enough testosterone (for example Klinefelter syndrome, undescended testicles, mumps orchitis, haemochromatosis, injury and cancer treatment), from secondary causes, where a problem in the hypothalamus or pituitary gland is responsible, such as a pituitary tumour called a prolactinoma, HIV or some medicines. Physical illness, surgery or emotional stress can also temporarily reduce testosterone, which returns to normal once the underlying problem has been treated.

The NHS says to see a GP if you are worried about your low sex drive, if you are taking a medicine and think it may be affecting your sex drive. NHS inform gives similar advice. There is no need to wait for it to become a crisis, and a GP can often identify a cause in one or two appointments.

A GP will normally ask about the pattern and timing of the change, mood, stress, sleep, alcohol, medicines, erections and relationship issues, and may examine you and check your blood pressure. Patient.info says testosterone deficiency can be identified by blood tests, which might be suggested when describing reduced libido or erectile dysfunction, and that men who do not respond to erectile dysfunction medicines should also have their testosterone level checked.

A blood test is the main investigation for suspected low testosterone. If a low level is confirmed, Patient.info says referral to a urologist or andrology specialist would usually be suggested, and they can offer further testing to determine whether a problem with the testicles or a pituitary abnormality is the cause. These further tests may include other hormone levels, semen analysis, pituitary CT or MRI scanning, genetic tests and, in some cases, testicular biopsy.

Other tests depend on the story. Because heart disease, diabetes and an underactive thyroid can affect sex drive according to the NHS, a GP may consider whether these need checking, and may review medicines that could be contributing.

The NHS says treatment for a low sex drive depends on what is causing it, and gives examples: relationship counselling for relationship problems, medicines to help get an erection for erectile dysfunction, antidepressants or cognitive behavioural therapy (CBT) for mental health problems, and changing to a different medicine or discussing treatment options if a medicine or health condition is responsible. NHS inform lists individual or relationship counselling, medicines to help you get an erection, antidepressants, CBT and changing contraception, and adds that testosterone replacement therapy may also be appropriate for some people.

For confirmed low testosterone, Patient.info says treatment is usually testosterone given as a gel, with long-acting injections or a patch as other options, and that treatment can improve tiredness, general wellbeing, erectile dysfunction and sex drive. It also lists side effects, including worsening sleep apnoea, acne, enlargement of the prostate, growth of prostate cancer in men who already have it, breast enlargement, shrinking of the testicles and reduced sperm count, and over-production of red blood cells which can raise the risk of blood clots. Testosterone replacement is therefore a specialist-guided treatment with monitoring, not something to start without a confirmed deficiency.

For men without another underlying cause, Patient.info notes that maintaining a healthy body weight is important. General measures such as sleep, activity, cutting down alcohol and addressing stress are sensible regardless of the cause.

Many men find this a difficult subject to raise, and Patient.info observes that tiredness, low sex drive and erectile dysfunction can be put down to ageing so that medical help is often not sought. Saying it plainly to a GP or practice nurse is usually enough, and it can help to say whether the change was sudden or gradual and what else has changed in your life.

If your partner is affected, involving them in the conversation, or attending relationship or sex therapy together, can help. The NHS lists relationship counselling as a treatment for relationship problems affecting sex drive.

On the NHS a GP can assess symptoms, check blood tests, treat contributing conditions and refer to urology, endocrinology or psychosexual services. Some men use private clinics for faster blood tests, hormone assessments or therapy. The same principles apply on either route: a diagnosis should be made from symptoms and blood tests, other causes should be considered, and treatment with testosterone needs follow-up checks. It is sensible to ask which tests were done and to keep your GP informed.