Low libido in men – causes and research

Content author: physician. Arthur Abbazov, urologist, andrologist · Editorial work: Editorial team of Wyspa Medycyny Przyjaznej · Medical review: lek. Arthur Abbazov · Creation date: 07/08/2026 · Review date: 07/08/2026 · Update: 07/08/2026

The article is educational in nature and does not replace a medical consultation or be used to start hormonal treatment on your own. A sudden loss of libido with headaches and visual disturbances, breast enlargement, loss of body hair, shrinking of the testicles, as well as persistent low mood or thoughts of taking one's own life require urgent medical evaluation.

The most important information at a glance

• Libido is sexual drive, i.e. the desire for sex. It is not the same as an erection or fertility.
• There is no single "correct" frequency of intercourse. The problem is a change from one's norm that persists and interferes with the patient or relationship.
• The most common causes are chronic stress, lack of sleep, depression and anxiety disorders, chronic diseases, obesity, alcohol abuse, side effects of medications and testosterone deficiency.
• Testosterone deficiency is a real, but not the most common cause. It is diagnosed based on symptoms and repeated blood tests, not on how you feel.
• Total testosterone is measured in the morning because its concentration changes throughout the day. A single abnormal result requires confirmation.
• Many commonly used medications can reduce libido, including some antidepressants, some high blood pressure medications, opioids and medications used to treat prostate disease.
• Reduced libido may be the first symptom of depression, sleep apnea, diabetes, hypothyroidism or increased prolactin.
• Treatment begins with determining the cause. Testosterone therapy alone is not the answer to every decrease in libido.
• Testosterone therapy has specific indications and contraindications, affects fertility and requires constant medical supervision.
• "libido supplements" and "testosterone boosters" do not replace diagnostics and may delay the diagnosis of the real cause.

Find out more about the specialist

Doctor. Arthur Abbazov is a urologist and andrologist at Wyspa Medycyny Przyjaznej in Gdańsk. He deals with the diagnosis and treatment of diseases of the urogenital system and andrology, including men's sexual health problems, hormonal assessment and qualification for further diagnosis or treatment. He also conducts consultations in Russian.

Meet the doctor. Arthur Abbazova

Libido, erection, potency - these are not synonyms

Distinguishing between these concepts is the first step to proper diagnosis, because it determines which direction the examination will go. Patients often say "I have a problem with potency", and when asked more carefully, it turns out that erections are normal, but the desire has disappeared.

These areas may occur together or separately. A man with low testosterone may have a lower libido and worse erections at the same time. A man with a fear of failure may have a strong sexual drive and weak erections. That's why the doctor asks in detail, instead of immediately ordering one test.

When is poor libido a medical problem?

There is no number below which drive is "too low." People are different and sexual needs change throughout life. Not every loss of interest in sex is a disease and not everyone requires treatment.

We usually talk about a problem when three conditions are met:

• occurred Change compared to what it was like before for this particular person,
• it persists longer time, usually counted in months, not in worse weeks,
• disturbing patient, reduces the quality of life or burdens the relationship.

It is especially worth examining the situation when the decline in libido appeared suddenly, when it is accompanied by other symptoms, or when it occurred in a young man without any identifiable cause. A sudden change is more likely to have a medical cause than a gradual decline in sexual drive with age.

The most common causes of reduced libido

There are usually several causes at once and they drive each other. A sleep-deprived, stressed, overweight man with high blood pressure usually has more than one reason for his decreased libido.

The last row of the table is very helpful in practice. If the drive has disappeared completely, even outside the relationship, it more often indicates a biological cause. If it only involves one situation or one person, psychological and relational factors are more likely to come into play. This distinction does not replace diagnosis, but it guides the conversation.

Drugs that may lower sexual drive

This is one of the most often overlooked causes. The patient looks for the reason in the hormones, and the answer may be in a daily pill. Libido may be influenced by, among others:

• some antidepressants, especially from the SSRI group,
• some antipsychotic drugs, especially those that increase prolactin,
• selected drugs for hypertension, including some beta-blockers and diuretics,
• opioid analgesics, especially when used chronically,
• 5-alpha-reductase inhibitors used in benign prostatic hyperplasia and alopecia,
• drugs used in the treatment of prostate cancer that intentionally lower testosterone levels,
• glucocorticosteroids taken chronically,
• anabolic steroids and "cycles" used in the gym that inhibit own production of testosterone,
• alcohol and psychoactive substances.

Very important: you should not stop taking any of these medications on your own. Discontinuing antidepressant or cardiac treatment may be more dangerous than the symptom it was supposed to eliminate. The solution is to talk to your doctor about a possible replacement of the preparation, dose modification or other action.

Testosterone - what is worth knowing before the test

Testosterone deficiency, i.e. hypogonadism, is a real cause of reduced libido, but not the most common one. Overinterpreting a single result leads to two errors: giving hormones to people who don't need them, and missing depression, sleep apnea or diabetes.

A few rules that really affect the reliability of the result:

• It's time for the test. Testosterone concentration changes throughout the day and is highest in the morning, which is why blood is collected in the morning.
• Replay. A single reduced result is not sufficient for diagnosis. Requires confirmation in the next marking.
• Health status on the day of the examination. Acute illness, infection, exhaustion and extreme exertion may temporarily lower your score.
• Symptoms matter. Diagnosis is based on symptoms and result combined, not on the laboratory count alone.
• Not only testosterone. Depending on the picture, your doctor may order LH, FSH, prolactin, TSH, SHBG and other tests to determine where the problem is.

It is also worth knowing that results "on the border of normal" are common and do not mean anything in themselves. Interpretation requires comparison with age, body weight, comorbidities and medications taken.

How is low libido diagnosed?

Diagnostics begins with a conversation, which for many patients is the most difficult part of the visit. The doctor asks how long the problem has been going on, whether it appeared suddenly or gradually, whether it applies to all situations, what morning erections look like, how sleep is, what medications the patient takes, how much alcohol he drinks, what work and relationships are like, and whether there are other symptoms.

Depending on the situation, the doctor may propose:

• physical examination, including the assessment of the testicles, penis and male characteristics,
• total testosterone measurement in the morning, with repeating the result,
• measurement of LH, FSH, prolactin, SHBG or TSH, if the image indicates it,
• metabolic tests: glucose or HbA1c, lipid profile,
• blood count and tests assessing kidney and liver function,
• assessment for depression and anxiety disorders,
• assessment for sleep apnea, if snoring and daytime sleepiness occur,
• semen test in case of parental plans,
• imaging diagnostics of the pituitary gland, if hormonal results indicate it,
• endocrinological, psychiatric or sexological consultation.

Not every patient needs all of these tests. The point of diagnostics is to match them to the clinical picture, not to perform the maximum package.

When to report sooner?

Decreased libido itself is rarely an emergency, but some accompanying symptoms require quicker evaluation:

• sudden loss of libido with headaches or visual disturbances,
• milk discharge from the nipples,
• enlargement of male breasts,
• shrinkage of the testicles, their hardening or palpability lump,
• loss of body hair and hot flashes,
• severe weakness, weight loss without cause, low-grade fever,
• urination disorders, hematuria or blood in semen,
• persistent low mood, sense of hopelessness, lack of meaning, and especially thoughts about taking one's own life.

The last point is the most important. If a decrease in libido is accompanied by a permanently low mood, you should not wait or hope that it will "go away" after your vacation. It is worth talking to your family doctor, psychiatrist or psychologist. In the event of a sudden mental crisis, help is available 24 hours a day, also by phone.

Treatment – ​​where does it start?

Treatment depends on the cause, not the symptom itself. Therefore, the first step is diagnosis, not a prescription. In practice, treatment most often includes several elements at once.

• Treat the cause. Controlling diabetes, treating hypothyroidism, treating sleep apnea, treating depression, lowering prolactin - in many cases, the drive returns as the general condition improves.
• Drug review. Together with your doctor, you may consider replacing the preparation suspected of affecting libido. Never alone.
• Sen. Chronic lack of sleep actually reduces libido. This is one of the most underestimated factors.
• Physical activity and body weight. Regular exercise and reducing excess body weight improve your metabolic profile and well-being.
• Alcohol and substances. Limiting alcohol can be one of the most effective changes, although it is rarely the one the patient wants to hear.
• Psychological or sexological support. Useful for fear of failure, conflict in a relationship, burnout and situational problems.
• Hormone treatment. Considered only in cases of confirmed testosterone deficiency with symptoms, after assessing indications and contraindications.

It is worth taking a realistic time perspective in advance. If the cause is lack of sleep, stress and metabolic disease that have accumulated over the years, improvement will not occur in a week.

Testosterone therapy - when yes and when not

Testosterone treatment can help men with diagnosed hypogonadism, i.e. with symptoms of deficiency confirmed by tests. However, it is not a method of improving the well-being of men with normal hormone levels or a way to relieve fatigue of other causes.

Before such treatment is considered, the doctor assesses, among other things:

• whether the deficiency has been confirmed by a repeated morning test,
• whether the symptoms correspond to the diagnosis,
• whether the patient is planning to have children - testosterone therapy inhibits sperm production and may impair fertility,
• whether there is any active prostate or breast cancer,
• what is the condition of the prostate and the initial PSA result,
• whether there is any hyperemia, severe heart failure or untreated sleep apnea.

Therapy requires regular check-ups: assessment of symptoms, blood count, PSA and hormone levels. This is treatment provided by a doctor, not a treatment ordered online. Testosterone preparations purchased outside the system, without diagnosis and without control, carry the risk of complications and may permanently disrupt the body's own production of the hormone.

Supplements and "testosterone boosters"

The market of supplements promising the return of energy and drive is huge, and the advertising message is simple and tempting. The problem is three things.

First, a supplement is not a drug and is not subject to the same requirements for effectiveness. Secondly, taking the preparation without diagnosis does not remove the cause, and sometimes delays the diagnosis of depression, diabetes or sleep apnea for many months. Thirdly, some preparations sold online contain undeclared substances, including hormones and potency drugs, which can be really dangerous in the case of heart diseases and some medications.

If there is a deficiency of vitamin D, iron or other nutrients, it is supplemented according to the results. This is completely different than taking a herbal mixture "for testosterone" without any diagnostics.

What about women's libido?

Low libido is not just a male problem. In women, it can also be a symptom of diseases, drug effects, hormonal disorders, chronic fatigue, depression, pain during intercourse and changes during perimenopause and after childbirth.

However, diagnosis and treatment are different and are usually carried out by a gynecologist, endocrinologist or sexologist. This article describes an andrological perspective on men and its diagnostic recommendations should not be applied to women.

The most common myths about low libido

• "Lack of desire always means low testosterone." No. Stress, depression, lack of sleep, medications and metabolic diseases are more often responsible for this.
• "It's just age." Drive changes with age, but a clear and sudden decline deserves checking, regardless of the number of years.
• "If I have an erection, my hormones are fine." Not always. A preserved erection does not exclude hormonal disorders or other diseases.
• "All you need is a supplement from the pharmacy." No. The supplement does not replace diagnosis and does not remove the cause.
• "Testosterone is for every man over 40." No. This is a treatment with specific indications and contraindications, requiring monitoring.
• "Testosterone improves fertility." Vice versa. Testosterone therapy inhibits sperm production and may impair fertility.
• "It's a shame and not a topic for a visit to a urologist." No. This is a common reason for andrology consultation and a standard element of the interview.
• "If I don't feel like it, it means I don't love my partner." No. Libido depends on health, sleep, hormones and stress, not just feelings.

The drive has significantly decreased and has been going on for months?

Instead of looking for a preparation on your own, it is worth determining the cause. A urological and andrological consultation allows you to select tests and plan further treatment.

Andrological consultation at the Island of Friendly Medicine in Gdańsk

In the Island of Friendly Medicine, Dr. Arthur Abbazov consults men with andrological problems, including low libido, erectile dysfunction, abnormal hormonal test results and questions about fertility. The purpose of the visit is to determine what is actually behind the symptom, and not just to prescribe the preparation.

During the consultation, the doctor collects an interview, assesses the medications taken and comorbidities, orders hormonal and metabolic tests, if necessary, and then discusses the results and further steps. Some patients require cooperation with an endocrinologist, psychiatrist or sexologist, and then it is worth planning it from the beginning. The current scope of tests, doctor availability and prices must be confirmed during registration.

Find out more about the medicine. Arthur Abbazov Urology consultation Urology

What to ask a doctor if you have low libido?

• Could my decreased libido be due to the medications I take?
• What hormonal tests are justified in my case?
• What time should I test my testosterone and do I have to fast?
• Does the result need to be repeated?
• Should I get my prolactin and thyroid checked?
• Could my symptoms indicate depression or sleep apnea?
• Do I need a metabolic assessment, for example glucose and lipid profile?
• Does planning a baby change the way you act?
• When is testosterone treatment justified and when not?
• What are the contraindications and what is the control like during this treatment?
• Is it worth seeking a sexological or psychological consultation?
• How long does it take to assess the effect of the changes introduced?

FAQ - Poor libido in men

What is libido?

Libido is sexual drive, i.e. the desire and interest in sex. It is not the same as the ability to have an erection or fertility. These areas can be affected independently of each other.

What level of libido is normal?

There is no single norm or recommended frequency of intercourse. What matters is the change in relation to one's own norm, its duration and whether it disturbs the patient or burdens the relationship.

Does low libido always mean low testosterone?

No. Testosterone deficiency is one possible cause, but not the most common. Stress, depression, lack of sleep, metabolic diseases, alcohol and side effects of medications are more often responsible for this.

When to measure testosterone?

Blood is collected in the morning because testosterone levels change throughout the day. A single abnormal result requires confirmation in a subsequent test, and interpretation always takes into account symptoms.

Can medications lower libido?

Yes. Some antidepressants, some antihypertensive drugs, opioids, 5-alpha-reductase inhibitors and glucocorticosteroids may have an impact, among others. Medications should not be stopped on your own - possible replacement should be discussed with your doctor.

Do stress and lack of sleep really affect libido?

Yes, and this is one of the most underestimated factors. Chronic lack of sleep, shift work and untreated sleep apnea reduce libido and worsen overall functioning.

Can decreased libido be a symptom of depression?

Yes. Loss of interest in sex can be one of the first symptoms of depression, especially when it is accompanied by low mood, lack of pleasure in other activities and sleep disturbances. In such a situation, it is worth talking to your doctor.

Does testosterone therapy affect fertility?

Yes. External administration of testosterone inhibits sperm production and may impair fertility. Therefore, in men planning a child, the treatment is chosen differently and it requires discussion before starting treatment.

Do libido supplements work?

The supplement does not replace diagnosis and does not remove the cause of the symptom. Preparations purchased outside the system may also contain undeclared substances. Nutrient deficiencies are supplemented based on test results, not preventively.

Which doctor should I see?

A good starting point is a urologist or andrologist who will assess symptoms, medications and comorbidities and order appropriate tests. Depending on the result, cooperation with an endocrinologist, psychiatrist or sexologist may be necessary.

Is it appropriate to talk about this problem during the visit?

Yes. This is a common reason for andrology consultation and a standard element of a medical interview. The more detailed the description of the symptoms, the more accurate the diagnosis.

Who consults andrological problems at WMP?

On the WMP website, MD. Arthur Abbazov is described as a urologist and andrologist dealing with the diagnosis and treatment of diseases of the urogenital system and andrology.

Sources

• Island of Friendly Medicine, MD. Arthur Abbazov: https://www.wyspamedycynyPrzyjaznej.pl/pl/artur-abazzov
• Wyspa Medycyny Przyjaznej, urology consultation: https://www.wyspamedycynyPrzyjaznej.pl/pl/konsultacja-urologiczna
• Island of Friendly Medicine, urology: https://www.wyspamedycynyPrzyjaznej.pl/pl/urologia
• European Association of Urology, Sexual and Reproductive Health Guidelines: https://uroweb.org/guidelines/sexual-and-reproductive-health
• European Academy of Andrology, guidelines and publications: https://www.andrologyacademy.net/guidelines
• NHS, Loss of libido: https://www.nhs.uk/conditions/loss-of-libido/
• NHS, Erectile dysfunction: https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
• NHS, Male hypogonadism: https://www.nhs.uk/conditions/male-hypogonadism/
• NHS, Obstructive sleep apnoea: https://www.nhs.uk/conditions/obstructive-sleep-apnoea/
• NICE Clinical Knowledge Summaries, Erectile dysfunction: https://cks.nice.org.uk/topics/erectile-dysfunction/
• British Association of Urological Surgeons, information for patients: https://www.baus.org.uk/patients
• Patient.gov.pl, depression: https://pacjent.gov.pl/jakleczyc/depresja