Low Male Sex Drive: 5 Main Reasons and What to Do Next
Low libido (reduced sexual desire) is a common and often treatable problem for men. In most cases, low sex drive is more complex as we can think: psychological, relational, and lifestyle factors interact. This article, written from a clinical perspective, summarizes the five most common causes of decreased male libido and outlines practical, evidence-based next steps you can take or discuss with your healthcare provider.
Important: This information is educational and does not replace personalised medical advice. If you experience a sudden or severe change in sexual function, breast enlargement, nipple discharge, severe headaches, or vision changes, contact a clinician promptly.
Key takeaways
- Low male libido is usually multifactorial — biological, psychological, interpersonal, and lifestyle drivers often coexist.
- The five most common contributors are: hormonal issues, medical/vascular disease, psychological health, relationship factors, and medications/substances & lifestyle.
- A structured clinical evaluation (history, focused exam, morning labs) helps identify treatable causes.
- Many cases improve with targeted lifestyle changes, medical optimization, and behavioural or relationship therapies.
1) Hormonal causes — especially low testosterone and related endocrine problems
Hormones strongly influence sexual desire. Testosterone is a principal driver of male libido; levels that are below the expected range for age can substantially reduce interest in sex. Other endocrine disorders — for example, thyroid dysfunction (hypothyroidism or hyperthyroidism), hyperprolactinemia, or pituitary disease — may also reduce libido.
Clinical clues that suggest a hormonal cause
- Persistent fatigue or low energy
- Loss of spontaneous (morning) erections
- Reduced muscle mass or unexplained weight changes
- Decreased body/facial hair, changes in libido or mood
Typical clinical approach
- Measure morning (AM) total testosterone (usually between 7–10 AM). If low, repeat the test and consider free testosterone, SHBG, LH/FSH to distinguish primary vs secondary hypogonadism.
- Check TSH (thyroid function) and prolactin when clinically indicated.
- Refer to endocrinology/urology if results are abnormal or if pituitary disease is suspected.
2) Medical and vascular conditions
Chronic illnesses commonly reduce sexual desire by decreasing overall energy, impairing vascular function, or altering hormonal balance.
Common contributors:
- Cardiovascular disease — atherosclerosis and reduced cardiac reserve can limit sexual activity and reduce libido.
- Type 2 diabetes mellitus — vascular and neuropathic complications frequently impair erectile function and may lower sexual confidence and interest.
- Obesity & metabolic syndrome — associated with lower testosterone and systemic inflammation.
- Chronic pain and inflammatory disorders — persistent pain often reduces interest and opportunity for sexual activity.
Clinical note: New or worsening erectile problems alongside declining libido require prompt medical evaluation because they can signal cardiovascular risk.
3) Psychological health — stress, anxiety, depression, and trauma
Mental health is a major determinant of sexual desire. Chronic stress and anxiety can lead to sustained elevations in cortisol and impair sexual interest. Major depressive disorder commonly presents with marked reductions in libido. A history of sexual trauma or performance-related anxiety can also cause persistent avoidance and low desire.
Management strategies
- Screen for depression and anxiety; consider referral to a mental health specialist.
- Evidence-based treatments such as cognitive behavioural therapy (CBT) or trauma-focused therapies are effective for many men.
- Sex therapy can help with performance anxiety, mismatched desire, and intimacy issues.
4) Relationship and interpersonal factors
Sexual desire is often relational. Conflicts, unresolved resentment, poor communication, or reduced emotional intimacy can erode sexual interest over time.
Signs that relationship factors may be important
- Frequent arguments about sex or avoidance of intimacy
- Emotional distance, decreased nonsexual affection
- Significant life stressors (financial, parenting, caregiving) that reduce relational bandwidth
Practical interventions
- Start with open, nonjudgmental communication about needs and expectations.
- Couples therapy or structured sex therapy can help rebuild trust and desire.
- Scheduling intimate time and reducing external stressors often improves outcomes.
5) Medications, substances, sleep and lifestyle factors
A wide range of commonly used medications and lifestyle choices can reduce libido:
Medications associated with lower libido
- Several antidepressants (notably SSRIs and SNRIs)
- Certain antihypertensives and antiandrogens
- Chronic opioid therapy and some antipsychotics
Substances and behaviours
- Excessive alcohol use and recreational drugs — both can blunt sexual desire and performance.
- Tobacco — impairs vascular health.
- Sedentary behaviour and poor diet — contribute to obesity and low energy.
Sleep
- Chronic sleep loss and untreated sleep apnea reduce testosterone and daytime desire. Screening and treatment of sleep disorders can be an important, reversible cause.
What to do
- Review medications with the prescribing clinician — alternatives, dose adjustments, or adding treatments to address side effects may be possible.
- Aim for smoking cessation, moderate alcohol intake, regular physical activity, and improved sleep hygiene.
How clinicians evaluate low libido (brief practical overview)
An efficient, targeted evaluation typically includes:
- Comprehensive history — onset, duration, symptom pattern (libido vs erectile function), relationship context, mental health, substance use, and a medication review.
- Focused physical exam — general exam with attention to signs of hypogonadism (reduced body hair, testicular size, muscle bulk).
- Laboratory testing (morning samples preferred):
- Total testosterone (AM) — repeat if low on initial test.
- If indicated: free testosterone, SHBG, LH/FSH, TSH, prolactin, fasting glucose or HbA1c, lipids.
- Psychosocial assessment — screen for depression, anxiety, and relationship distress.
- Specialist referral — urology, endocrinology, sleep medicine, or mental health as appropriate.
Practical, evidence-based steps to try now
These are safe, high-value actions that often improve libido:
Lifestyle & general health
- Sleep: target consistent 7–9 hours nightly; evaluate for sleep apnea if symptoms (snoring, daytime sleepiness) are present.
- Exercise: combine regular aerobic activity with resistance training; even modest weight loss (5–10%) often improves hormones and libido.
- Nutrition: follow a whole-food pattern with adequate protein, healthy fats (including omega-3 sources), and micronutrients (check vitamin D, zinc, magnesium if suspected deficiency).
- Limit alcohol, stop smoking, and treat chronic medical conditions (diabetes, hypertension, pain).
Medication & medical interventions
- If labs confirm clinically low testosterone and symptoms are significant, discuss risks and benefits of testosterone replacement therapy (TRT) with a specialist — this requires careful baseline testing and monitoring.
- Review and adjust medications that may reduce libido in consultation with the prescriber.
Psychological & relational care
- Treat mood disorders or anxiety with therapy and, when appropriate, medication under psychiatric guidance.
- Couples therapy or sex therapy can resolve communication and intimacy barriers.
When to seek urgent medical care
Seek prompt evaluation if you experience:
- Sudden, marked loss of libido or erectile function.
- Breast enlargement (gynecomastia), nipple discharge, severe headaches, or vision changes — these can indicate pituitary pathology.
- Suspected medication overdose or new systemic symptoms.
Bottom line
Low male sex drive is common and frequently reversible or improvable. A stepwise approach — identify and treat medical causes, review medications, address mental health and relationship factors, and optimise lifestyle — often restores desire and function. If symptoms persist despite these measures, seek evaluation from a primary care clinician, urologist, or endocrinologist for targeted testing and management.
Practical next step for your appointment
Track the following for 2–4 weeks before your visit:
- Sleep hours and quality
- Frequency of spontaneous erections and sexual thoughts
- Current medications and supplements
- Mood and stress level
- Any relevant symptoms (weight change, hot flashes, breast changes)
Bringing this information to your clinician will help speed diagnosis and guide appropriate treatment.