Low sex drive: causes, red flags and when to get it checked

Desire arises from a mix of hormones, brain chemistry, physical wellbeing, mood and the quality of a relationship. A change in any of these can dim it. Because the causes are often combined, a broad review of health, medicines and life circumstances is more useful than focusing on a single factor.

• Stress, fatigue, poor sleep and busy life stage, including new parenthood.

• Depression and anxiety, which commonly reduce desire.

• Relationship difficulties, lack of intimacy or communication, and past trauma.

• Medicines: SSRIs and other antidepressants, hormonal contraception, antihypertensives, antipsychotics and opioids.

• Menopause: lower oestrogen and testosterone, vaginal dryness and painful sex.

• Low testosterone in men, obesity, diabetes, alcohol excess and sleep apnoea.

• Thyroid disease, high prolactin, anaemia, chronic illness and pain.

• Erectile dysfunction, pain during sex and other sexual difficulties that lead to avoidance.

Sudden loss of desire with headaches, vision changes or breast discharge (high prolactin), unexplained weight change, fatigue, loss of body hair or erections, symptoms of depression including hopelessness, and symptoms linked to starting a new medicine warrant assessment.

• Same-day help (999 or crisis line): thoughts of harming yourself or feeling hopeless.

• GP within weeks: low desire with other symptoms such as erectile problems, severe tiredness, headaches or breast changes.

• GP: loss of desire starting after a new medicine.

• Routine: persistent, distressing change in desire lasting several months.

The doctor asks about how long, whether desire is lost entirely or only with a partner, relationship, mood, stress, sleep, alcohol, drugs, medicines, periods and menopause, erections, pain with sex and general health. They check weight, blood pressure and, if appropriate, examine genitals and look for signs of hormonal disease.

• Blood tests: thyroid function, glucose or HbA1c, full blood count, ferritin and prolactin.

• Morning total testosterone in men with symptoms and sometimes SHBG, with repeat if low.

• Menopause assessment is mainly clinical; hormone tests are not needed in most women over 45.

• Depression and anxiety screening questionnaires.

• Sleep study if sleep apnoea is suspected.

Prioritise sleep, exercise, and a balanced diet; reduce alcohol; and make time for intimacy without pressure. Talk openly with your partner. Psychosexual therapy and couples therapy can be very effective. Do not stop prescribed medicines; ask about alternatives. Vaginal oestrogen helps menopausal dryness, and testosterone treatment is only considered after proper testing and by specialists.

The NHS route is a GP, with sexual health or psychosexual services. Private sexual medicine and psychosexual therapists are available directly.