Libido Loss: When Men Don’t Want Sex
The desire for sex – your libido – tends to lessen with age in men. A 2019 study of more than 12,000 45-year-old men found that about 1 in 20 reported low sexual desire, or low libido.
But sex drive varies between men, so how low is too low?
“There’s not any kind of universally agreed upon definition of low libido, but the key is that it is bothersome,” says urologist Petar Bajic, MD, a specialist in men’s sexual health at Cleveland Clinic.
So what exactly counts as bothersome? If your sex drive has dropped but it’s not a sign of serious health issues and it doesn’t “bother” you, it might be fine to ignore it. But if low libido causes personal anxiety, depression, or relationship stress, it might be time to seek some help.
Partly this is a function of how long it lasts. It’s normal to lose interest in sex occasionally, says Bajic. For example, if you didn’t sleep well the night before or if you’re recovering from an injury, your libido might drop.
“If you broke your leg, sex might not be at the top of your priority list,” says Bajic.
But if your loss of interest in sex lasts long enough to become bothersome, it’s time to see your doctor. It can be important both for your physical and mental health and also for the health of your intimate relationships.
“If you’re in a couple, it affects both of you,” says Bajic.
What Is Low Libido?
Before discussing causes, let’s talk first about what low libido is and isn’t. Men often confuse low libido with erectile dysfunction, or ED.
ED is the inability to get or keep an erection, says urologist Rajiv Jayadevan, MD, of UCLA Health. Libido is simply your desire for sex. While ED and low libido may occur at the same time and are often closely linked, they’re quite different problems, Jayadevan says.
Your libido is powered in part by your overall physical health, including your genes and hormones such as testosterone. But it’s not all biological. Psychological factors like stress and anxiety also influence your interest in sex, as do physical factors such as chronic disease.
The desire for sex does drop naturally to some extent as we age, says Jayadevan, but there’s no reason it should necessarily go away completely, even in your 60s, 70s, and beyond.
Is Low Testosterone the Culprit?
Testosterone is the main sex hormone for males. Low testosterone levels can reduce libido in some men. But not every man will lose sex drive with this drop. Also, some older men may not be bothered by the decline in sex drive.
If low libido is a problem, your doctor may start by testing your testosterone level. And if it’s low, there’s a clear fix. “If it is testosterone that’s the issue, we can give them the testosterone that their body’s not producing,” says Bajic.
Most men will see their sex drive start to rev up within a few weeks of starting this replacement therapy.
Testosterone levels go down in men as they age. And it also drops in men with type 2 diabetes and those who are obese. In fact, as many as 35% of men over 45 have low testosterone, or hypogonadism.
Normally, a man’s testosterone measures between 300 and 1,000 nanograms per deciliter on a blood test. Your doctor may consider levels below 300 low, especially with symptoms of hypogonadism, which can include low libido.
How Do Chronic Disease and Smoking Affect Libido?
Once men hit their 60s, they tend to have more chronic health conditions, such as diabetes and heart disease. These can affect sex drive as well.
How? Both diabetes and heart disease can lower testosterone levels in some men. These diseases can also lead to ED because they change the blood vessels in your penis, limiting your ability to achieve or maintain an erection.
Smoking appears to have a similar effect, though scientists are still trying to work out why. Male smokers aged 40 to 70 are nearly twice as likely to develop ED.
And though ED and libido are different things, they are often closely related because men with ED often lose interest in sex.
“If a man tries and fails several times, that may decrease his desire for even attempting sex,” says Bajic.
Treating the ED and its causes often can revive libido. “A healthy body will lead to a healthy sex life,” says Bajic.
The Psychology of Libido: Is It All in My Head?
Mental health issues also play a part in loss of libido in men. This is especially the case in younger men, for whom low testosterone levels are less likely.
The problem could be personal – such as depression, anxiety, or substance abuse issues – or it could be a problem that develops between you and your partner.
“We often involve a sex therapist – especially with younger men – to tease apart how mental health and individual experiences can contribute to low libido,” says Bajic.
“I cannot emphasize enough how important that is.”
Sometimes, the issue is simply too much psychological stress. That stress can have many causes, such as significant changes at work or school, or family issues.
There are a number of psychological approaches that address both personal mental health issues and relationship dynamics. For example, conflict in an intimate relationship can compromise sexual desire. In that case, Bajic likes to involve both people in therapy.
“It can be very revealing to have both partners there for the conversation,” he says. “It’s really appropriate in this situation to involve a couples therapist.”
Talk to your doctor about a good starting point for you or possibly for you and your partner.
How Do Medications Affect Libido?
Your doctor may be able to treat some mental health issues with medication. Unfortunately, those medications frequently contribute to low libido as well.
For example, SSRIs, a common class of drug prescribed for both anxiety and depression, are notorious for sexual side effects, including loss of libido.
“I’ve had patients on SSRIs describe a numbness toward sexual activity, where they just feel no pleasure from it,” says Jayadevan.
And it’s not just SSRIs. Most antidepressants, antipsychotics, and psychiatric medications broadly can have a negative impact on libido.
What can you do? Talk to the doctor who’s treating you. There may be alternate medications with less side effects. The antidepressant bupropion (Wellbutrin) seems to improve libido in some men compared to SSRIs.
Another medication that can stall your sex drive is finasteride (Propecia, Proscar, Entadfi). It is commonly prescribed to treat male pattern baldness or noncancerous prostate growth (doctors call this benign prostatic hyperplasia, or BPH).
“I see a lot of men who experience low libido and erectile dysfunction due to this commonly prescribed medication,” says Bajic.
“Talk to your doctor. There are a number of alternative options.”
How Does Sleep Affect Your Sex Drive?
Sleep loss is another common libido killer. And it’s not just in older men. Jayadevan says he often sees young men at the start of their careers whose lost libido he traces to the long hours they put into their jobs.
“I see a lot of men who say they’re so tired they’re just not interested in sex anymore,” he says.
Another problem could be obstructive sleep apnea. This chronic condition interrupts your breathing throughout the night, making it difficult to settle into a deep, restful sleep.
The result is daytime fatigue that can dampen your sex drive. Sleep apnea also is tied to lower levels of testosterone, another possible reason the disorder can affect your sex drive. Talk to your doctor about it if:
- You’re having trouble sleeping.
- You’re always tired during the day.
- Your partner says that you snore loudly or stop breathing for short periods throughout the night.
Your doctor may recommend an overnight sleep study. It measures your brain activity, oxygen level, heart rate, and more as you sleep. If your doctor diagnoses sleep apnea, treatment may help restore your sex drive. Jayadevan points to a patient of his who was in his mid-50s who was treated for sleep apnea.
“A month later, he says his libido was back to where it was when he was in his mid-20s.”
What Can You Do?
The most important thing you can do at first is to recognize the problem and bring it up with your doctor. For some men, that can be difficult.
“Don’t be ashamed to bring these things up,” says Bajic. “They are very common, and there are very effective solutions.”
A medical checkup is a good place to start. Talk to your doctor about a full assessment of your health, including hormone levels and mental health, says Bajic. Tell them about any medications that you take and any side effects that you have noticed.
Follow your doctor’s prescription for medication or therapy, and keep them posted on side effects. If you smoke, consider quitting. Smoking is a cause of ED as well as of conditions that lead to ED, which can lessen libido. Your doctor can help you find a quitting plan that works for you.
Finally, says Bajic, don’t forget the importance of a healthy diet and regular exercise, which can help improve both physical and mental health and lead to a better sex life.