Many men experience changes in their sexual drive (also known as libido) over the course of their lives. It is normal for sexual interest to wax and wane intermittently. Temporary decreases in libido can be due to changes in relationships, work or family obligations, or other life changes. Sexual interest also tends to decline with advancing age and/or in in long-term committed relationships. While these changes are typical, they can be bothersome; some men who are highly sexually active may experience particular distress from changes in their sexual interest.
In many cases, low sex desire gets better over time and/or with resolution of stressors. However, in some men the changes in libido may be persistent. Sex drive is not essential to life; however, sexual wellness and a satisfying sexual life is an important component of overall quality of life for most people. The absence of sexual interest can lead to personal distress and may put some strain on intimate relationships. In some cases, low libido may also be a sign of underlying medical conditions that may be serious.
Evaluation by a physician may be indicated in the man who has a persistent or recurrent lack of interest in sex that is troubling him and/or his partner(s). Many physicians do not have expertise in addressing issues of sexuality, let alone issues of sexual desire, so consultation with a specialist is oftentimes recommended.
The first and most important steps in evaluating sexual desire issues in men is getting a good history. Date of onset, severity, situational and/or medical factors around that time, and treatments previously taken are key elements of this history. It is important to determine if other sexual problems are present; in some cases low desire may be the result of another sexual problem such as erectile dysfunction (trouble getting or keeping erections) or premature ejaculation (lack of control over when ejaculation happens). In these men, a decline in sexual desire may be an attempt to adapt by avoiding sexual situations in which the man feels that he might “fail”.
It is essential to evaluate the man’s relationship with his partner(s); key considerations are the length of relationship and any relationships stressors or prior sexuality issues. If the man has more than one partner details on situational or partner-specific factors may be important. Many men are hesitant to communicate with their partners about sex and sexual desires; indeed, some cases of low desire may stem from failure to discuss and agree on what sort of sexual activities are desired. Men without a partner may also experience a decline in in libido; this may be in some ways adaptive but may also lead to men not seeking out new and potentially positive relationships.
In addition to detailed evaluation of the sexuality concern and the man’s relationship, a general medical history and physical examination should be performed. It is particular important to inquire about medication use as many drugs, particularly anti-depressants, blood pressure medications, and recreational drugs can have negative effects on libido. History of psychological or neurological diseases or trauma should be determined as these may have strong influences on sexual interest. Men with systemic or metabolic diseases (e.g. diabetes, HIV, cancer) oftentimes have low libido which may relate to a number of causes. Basic laboratory tests, including measurement of serum testosterone, are often useful. Additional testing may be appropriate in some cases but is typically not necessary.
There is no FDA approved “libido pill” for men although there is a medical option for women with low sexual desire. If the man has another sexual problem that led to changes in libido, treatment of that condition may lead to a secondary improvement in sexual desire. If the changes in libido are associated with a specific medication, it may be worth stopping or changing the medication to an alternative agent. General health conditions that may predispose to changes in libido should be managed as appropriate; for instance, men with obesity and or poorly controlled diabetes should work towards losing weight and getting better control of their blood sugars. In some cases this may lead to improvements in libido.
As low blood levels of testosterone are associated with low libido, supplementation may be appropriate in some cases. Testosterone supplementation is somewhat controversial so it should only be considered after careful consultation with a health care provider who is knowledgeable about this topic. Testosterone is helpful in many, but not all, cases of low libido.
Fostering open and honest communication between the man with low libido and his partner is essential. Being open and explicit about sexual desires and wants is essential to healthy relationships. In some cases a man may be interested in sexual activities that are not appealing to his partner, and vice versa. Working out a compromise that leaves all parties feeling sexually fulfilled may resolve some issues of low sex desire and interpersonal conflict.