Decreased libido in women and men: why sexual desire disappears and what to do about it

Decreased libido is a decrease in sexual desire, interest in sexual activity, sexual thoughts and fantasies, or a weakened motivation for intimacy. It is not always a disease in itself: sexual desire varies greatly from person to person and can change significantly over the course of a person's life, due to fatigue, stress, pregnancy, menopause, relationship conflicts, illness, and medications. A problem becomes clinically significant when it persists, causes significant personal distress, or impairs relationships. [1]

In modern sexual medicine, it is important to distinguish between the common term "decreased libido" and the diagnostic term "hypoactive sexual desire disorder." The 2024 International Consultation on Sexual Medicine emphasizes that this refers to a persistent, widespread decrease in desire associated with clinically significant distress and not better explained by a mental disorder, relationship problems, medication, or other modifiable cause. [2]

Women and men experience the problem through both common and distinct mechanisms. In women, multifactorial biopsychosocial influences are more often involved, including relationships, pain during sex, menopausal changes, stress, depression, and medication effects. In men, the same psychological and relational factors play a significant role, but androgen deficiency, hyperprolactinemia, thyroid disease, and vascular and metabolic disorders also play a greater role. [3]

The main practical error is reducing everything to "hormones" or, conversely, to "psychology." Current recommendations view decreased libido as a symptom with multiple possible causes. Therefore, successful treatment begins not with a universal desire stimulant, but with an accurate assessment of the context: is there distress, how generalized is the problem, is there pain, depression, medication influences, testosterone deficiency, hyperprolactinemia, menopausal genitourinary syndrome, or couple conflict? [4]

What is important to understand right away	Practical meaning
Decreased libido is a symptom, not always a separate disease.	We need to find the cause, not a formulaic treatment.
Low desire without suffering is not always considered a disorder	Distress becomes the key criterion
The mechanisms are partially different in women and men	Examination and treatment may not be the same for everyone.
Hormones are important, but they don't explain everything	Psychological, relational and medicinal factors must be taken into account
There are temporary and permanent forms.	The tactics of observation and therapy depend on this.

The table summarizes current approaches to the definition and clinical interpretation of decreased libido. [5]

Code according to ICD-10 and ICD-11

There's an important caveat when coding decreased libido. The World Health Organization's International Classification of Diseases, 10th revision, uses code F52.0—absence or loss of sexual desire—but it specifically refers to sexual dysfunction not caused by an organic disorder or disease. Therefore, this code is appropriate not for any temporary decrease in interest in sex, but for clinically significant disorder of sexual desire. [6]

The International Classification of Diseases, 11th revision, uses the code HA00—hypoactive sexual desire disorder. This category is already divided into subtypes: lifelong generalized, lifelong situational, acquired generalized, acquired situational, and unspecified. This structure better reflects actual clinical practice because it allows for distinctions between congenital and acquired, generalized and contextual forms of decreased desire. [7]

Classification	Code	Comment
International Classification of Diseases, 10th revision	F52.0	Lack or loss of sexual desire
International Classification of Diseases, 11th revision	HA00	Hypoactive sexual desire disorder
International Classification of Diseases, 11th revision	HA00.0	Lifelong generalized
International Classification of Diseases, 11th revision	HA00.1	Lifelong situational
International Classification of Diseases, 11th revision	HA00.2	Acquired generalized
International Classification of Diseases, 11th revision	HA00.3	Acquired situational
International Classification of Diseases, 11th revision	HA00.Z	Unspecified

The table reflects the current structure of the International Classification of Diseases, 10th and 11th revisions for disorders of sexual desire. [8]

Epidemiology

Decreased libido is a common complaint, but the exact figures vary greatly depending on what is considered a case. If any decrease in interest in sex is included, the prevalence will be much higher than if only a persistent condition with significant personal distress is considered. This is why modern articles and guidelines consistently distinguish between "low desire" and "hypoactive sexual desire disorder." [9]

The problem is particularly prevalent among women. In an international study, which is the basis for the guidelines of the International Society for the Study of Women's Sexual Health, decreased interest in sex itself occurred in approximately 27% of women aged 40-80, while in a European sample, the incidence of low desire increased from 11% in those aged 20-29 to 53% in those aged 60-70. Meanwhile, the proportion of distressing sexual desire disorder remained relatively stable at approximately 6%-13%. [10]

In men, the prevalence is lower, but still clinically significant. The European Association of Urology cites data from a population survey, where the incidence of low sexual desire in middle-aged men was 4.7%. At the same time, more general clinical sources emphasize that up to 1 in 5 men experience a temporary decrease in libido at various stages of life, and such episodes are even more common in women. [11]

Modern systematic reviews show that rates vary widely across countries and age groups. In a 2025 review of women of reproductive age, the prevalence of sexual desire disorders ranged from 8% to 91%, reflecting not so much "chaos in biology" as differences in questionnaires, cultural context, sample structure, and distress criteria. In practice, this means that physicians are more concerned with the combination of complaints, suffering, and causes in a specific individual than with abstract population figures. [12]

Epidemiological landmark	Current data
A decrease in interest in sex in women aged 40-80 years	About 27%
Low desire in women aged 20-29	About 11%
Low desire in women aged 60-70 years	About 53%
Distressing hypoactive sexual desire disorder in women	Approximately 6%-13%
Low sexual desire in middle-aged men in one large survey	About 4.7%
Temporary decrease in libido in the population	Very common, especially among women

The table shows why, when assessing prevalence, it is always necessary to clarify whether we are talking about any decrease in desire or about a disorder with distress. [13]

Reasons

The causes of decreased libido are conveniently divided into biological, psychological, relational, and medicinal. The 2024 International Consultation on Sexual Medicine explicitly recommends the biopsychosocial model, and the European Association of Urology specifically emphasizes that in men, sexual desire is formed at the intersection of biological drive, psychological motivation, and broader cultural and personal influences. [14]

Biological causes include androgen deficiency in men, hyperprolactinemia, thyroid disease, diabetes, obesity, chronic kidney disease, neurological diseases, chronic pain, cancer and its treatment consequences. In women, the menopausal transition, genitourinary syndrome of menopause, vaginal dryness, dyspareunia, the postpartum period, surgical menopause, and a number of gynecological conditions play a special role.[15]

Psychological causes include depression, anxiety, post-traumatic stress disorder, chronic stress, exhaustion, negative sexual experiences, shame, and persistent anxious expectations related to sexual life. Guidelines for both men and women agree that depression and anxiety are among the most common non-medical causes of low desire, and in some people, they coexist with biological disorders and amplify their impact. [16]

Relational causes are no less important. Conflict within the couple, emotional distance, misaligned sexual expectations, sexual pain in one partner, lack of trust, chronic fatigue from childcare, and the phenomenon of divergent sexual desire between partners often play a central role in the problem. Modern recommendations for men and women emphasize that decreased libido is often not a "failure of one person," but a manifestation of relationship dynamics. [17]

A separate, major category is medication-related causes. The International Consultation on Sexual Medicine and clinical reviews identify antidepressants, especially selective serotonin reuptake inhibitors, some hormonal medications, anticholinergics, antiandrogen therapy, opioids, and some medications for chronic diseases, as common culprits. In this situation, decreased libido does not always resolve on its own and requires a review of the treatment plan with a specialist. [18]

Group of reasons	Typical examples
Endocrine	Testosterone deficiency, hyperprolactinemia, thyroid disease
Gynecological and menopausal	Menopause, surgical menopause, dryness, pain, genitourinary syndrome of menopause
Mental	Depression, anxiety, post-traumatic stress disorder, chronic stress
Relational	Conflict in a couple, divergence of desires, dissatisfaction with the relationship
Medicinal	Antidepressants, antiandrogens, opioids, and some hormonal agents
Somatic	Diabetes, obesity, chronic kidney disease, neurological and oncological diseases

The table reflects the main causal blocks that are constantly repeated in current recommendations on sexual medicine. [19]

Risk factors

Risk factors don't always equal direct cause, but they do increase the likelihood of long-term decreased sexual desire. In men, important factors include age, obesity, diabetes, depression, anxiety, antidepressant use, hyperprolactinemia, and testosterone deficiency. The European Association of Urology also emphasizes the link between low desire and sexual dissatisfaction and relationship strain. [20]

In women, risk factors are particularly often associated with the menopausal transition, surgical removal of the ovaries, genitourinary syndrome of menopause, pain during intercourse, depression, chronic stress, anxiety, medication load, and sleep disorders. The International Consultation on Sexual Medicine specifically recommends asking about recent childbirth, menopausal symptoms, dryness, urogenital infections, fatigue, and stress, as these conditions often underlie the complaint. [21]

For both sexes, a significant risk factor is a discrepancy in expectations within the couple and sexual pain. If sex is associated with discomfort, fear of conflict, a sense of obligation, or predictable disappointment, desire naturally declines. In this sense, decreased libido is often not a primary disorder, but an adaptive response to an unfavorable sexual experience. [22]

Risk factor	For whom is it especially significant?
Age and the menopausal transition	More common in women
Obesity and diabetes	In both sexes
Depression and anxiety	In both sexes
Drug load	In both sexes
Testosterone deficiency	Especially in men
Pain during sex	First of all, in women, but not only
Conflict and divergence of desires in a couple	In both sexes

The table summarizes the risk factors that most often require targeted questioning during an appointment. [23]

Pathogenesis

The modern understanding of the pathogenesis of decreased libido is based on the biopsychosocial model. This means that sexual desire cannot be explained by a single hormone or a single brain region. It is formed as a result of the interaction of hormonal signals, reward and inhibition neurotransmitter systems, past sexual experience, relationships, bodily sensations, pain, context, and stress level. [24]

In men, testosterone does play an important role, but even the European Association of Urology emphasizes that testosterone levels do not always directly reflect the severity of sexual desire, especially in older age. This explains why not every man with moderately low testosterone complains of libido problems and why not every man with low libido has androgen deficiency. [25]

In women, the hormonal picture is even more complex. The International Society for the Study of Women's Sexual Health guidelines indicate that there is no absolute androgen level that, by itself, diagnoses hypoactive sexual desire disorder. Circulating testosterone does not always reflect tissue and central effects, and therefore low libido may be present with "normal" test results and absent with decreased hormonal levels. [26]

Inhibitory mechanisms play a major role. Chronic stress, anxious thoughts, depression, pain, fear of failure, conflict with a partner, and negative expectations shift attention from erotic stimuli to threat, control, and self-observation. As a result, spontaneous desire decreases, the response to sexual stimuli weakens, and interest fades more quickly even after sexual activity has begun. [27]

Pathogenetic link	How it reduces libido
Hormonal deficiency	Reduces biological drive and sexual thoughts
Hyperprolactinemia	Suppresses sexual desire and may indicate pituitary pathology
Estrogen deficiency and genitourinary syndrome of menopause	Dryness and pain reduce motivation for sex.
Anxiety and depression	Increase inhibition and decrease erotic involvement
Conflict and low relationship satisfaction	Reduces desire in a partnership context
Medicinal influence	Changes neurotransmitter and hormonal regulation

The table reflects the key pathogenetic pathways that are the focus of modern diagnostics and therapy. [28]

Symptoms

The primary symptom is a decrease or disappearance of sexual interest. This may manifest as infrequent or absent sexual thoughts and fantasies, decreased spontaneous desire, a weak response to erotic stimuli, and difficulty maintaining interest even after sexual activity has begun. This set of features is the definition of hypoactive sexual desire disorder in the International Classification of Diseases, 11th revision. [29]

But in real life, the complaint often sounds different. People say things like "I don't feel like having sex," "I've lost my desire," "intimacy has become indifferent," "everything is done with effort," "I used to have interest, but now I almost don't." Importantly, low sexual frequency alone isn't enough for a diagnosis: for some people, infrequent sexual activity isn't accompanied by distress and isn't perceived as a problem. [30]

Decreased libido is often associated with other sexual complaints. In women, these include dryness, pain, difficulty achieving arousal, or orgasm. In men, these include erectile dysfunction, decreased morning erections, decreased sexual thoughts, and avoidance of sexual intimacy. These combinations are important because sometimes "loss of desire" is actually secondary to pain or fear of failure. [31]

If the problem becomes clinically significant, secondary consequences also appear: irritability, guilt, shame, decreased self-esteem, relationship tension, avoidance of discussing intimate matters, and distancing from the partner. Current guidelines consider personal distress and interpersonal difficulties to be the key marker of the transition from normal to disordered behavior. [32]

Symptom	What does it look like in practice?
Little or no sexual thoughts	The person hardly thinks about sex and does not fantasize
There is no spontaneous desire	Initiative is practically disappearing.
Poor response to stimuli	Touch, visual and emotional stimuli generate little interest
The desire quickly fades away	Interest is not maintained even after intimacy begins
Distress	The condition worries the person himself
Interpersonal difficulties	Conflicts, distance, or feelings of guilt arise in the couple

The table reflects the symptoms that are most significant in the clinical interview. [33]

Classification, forms and stages

The modern classification is built around several axes. The first axis is lifelong and acquired. Lifelong means that expressed sexual desire has never been a stable part of a person's life. Acquired means that sexual interest was previously satisfactory but then significantly declined. [34]

The second axis is the generalized and situational form. Generalized means that the problem manifests itself in almost all contexts, with any partner, and during any type of sexual activity. Situational form occurs only in a specific setting, with a specific partner, or only in a coupled, but not solitary, context. This is how the subtyping is constructed in the International Classification of Diseases, 11th revision. [35]

The third clinically useful axis is distress and non-distress. This is crucial because low desire without personal suffering is not always considered a disorder. Furthermore, men's guidelines recommend distinguishing between dyadic desire, that is, the desire for sexual activity with a partner, and solitary desire, that is, an interest in sexual activity alone. This distinction helps us understand where the underlying problem lies—biologically, within the couple, or within context. [36]

There is no single official "stage" for decreased libido. In practice, it is more convenient to speak of mild, moderate, and severe degrees based on the intensity of complaints, duration, generalization, and impact on quality of life. This approach is more useful for treatment than attempting to artificially divide the condition into strict stages. [37]

Classification axis	Options
By start time	Lifetime, acquired
By context	Generalized, situational
By degree of suffering	Without clinically significant distress, with clinically significant distress
In relational context	Dyadic, solitary
By severity	Mild, moderate, severe

The table reflects the modern clinical classification that is most useful for choosing tactics. [38]

Complications and consequences

Decreased libido itself does not lead to dangerous organ complications such as heart attack or stroke. However, its impact on quality of life can be very significant. In both women and men, this condition is associated with a decline in emotional well-being, sexual satisfaction, self-esteem, and relationships. The International Consultation on Sexual Medicine emphasizes that treatment should focus not only on the frequency of sex but also on reducing distress. [39]

The second consequence is chronic avoidance of intimacy. When sexual intimacy begins to be associated with pain, tension, guilt, anticipated conflict, or failure, a person may increasingly avoid not only sex but romantic physical intimacy in general. This gradually disrupts communication and increases feelings of alienation in the relationship. [40]

A third major problem is missing an underlying medical condition. Low libido can be an early manifestation of androgen deficiency, hyperprolactinemia, hypo- or hyperthyroidism, depression, drug toxicity, diabetes, and menopausal genitourinary syndrome. Ignoring the complaint or treating it solely with "stimulants" can lead to missing an endocrine, mental, or somatic disorder requiring separate treatment. [41]

Consequence	Why is this important?
Distress and decreased quality of life	The complaint becomes clinically significant
Conflicts and distance in a couple	They reinforce and support the problem
Avoiding intimacy	It worsens the emotional connection
Missing an endocrine or mental illness	May delay proper treatment
Reinforcing anxiety and uncertainty	Makes the condition more stable

The table shows that decreased libido is not a “minor complaint” if it is persistent and disrupts a person’s life. [42]

When to see a doctor

A doctor should be consulted when a decrease in libido persists, bothers the person, or begins to impair relationships. An important guide is not the absolute frequency of sexual activity, but rather the feeling that desire has become significantly lower than usual and is causing distress. [43]

It is especially advisable to seek help if, along with decreased libido, there is dryness and pain during sex, erectile dysfunction, loss of morning erections, irregular periods, hot flashes, milk secretion from the mammary glands, severe depression, severe fatigue, weight gain, muscle loss, or other signs of endocrine dysfunction. In such cases, the symptom may be part of a broader medical problem. [44]

A separate reason is the initiation or change of medication therapy. If a decrease in libido occurs after the prescription of an antidepressant, antiandrogen therapy, opioids, or other medications, do not stop treatment on your own, but discuss the issue with your doctor. Drug-induced sexual dysfunction is a common and clinically significant scenario. [45]

Situation	Should I contact?
The decrease in desire continues and bothers me	Yes
There is pain, dryness or erectile dysfunction	Yes
Signs of hormonal imbalances have appeared	Yes
The problem started after a new medication	Yes
The desire is low, but this does not bother the person.	Treatment is not always necessary, but discussion is possible.

The table helps to distinguish between a normal variant and a situation where a medical assessment is really needed. [46]

Diagnostics

Diagnosis begins with a detailed conversation, not just hormone testing. The International Consultation on Sexual Medicine explicitly states that the assessment should include a medical, surgical, drug, sexual, and relationship history, as well as a discussion of stress, fatigue, pregnancy, recent childbirth, menopausal symptoms, pain, dryness, partner concerns, and treatment expectations. [47]

The next step is to determine whether there is distress and how generalized the problem is. Duration, onset, severity, context, the presence or absence of desire in different situations, as well as the distinction between desire for partnered activity and solitary sexual motivation are important. Screening questionnaires, including the Decreased Sexual Desire Screener and the Brief Profile of Female Sexual Function, can be helpful, but diagnosis remains clinical and is not made by a single questionnaire. [48]

A physical examination isn't always necessary, but it's based on indications. For women, the International Consultation on Sexual Medicine recommends an examination only if there are physical complaints, particularly pain, dryness, signs of genitourinary syndrome of menopause, anatomical changes, or suspected consequences of violence. For men, the European Association of Urology considers an initial examination useful for detecting anatomical abnormalities and associated erectile dysfunction. [49]

Laboratory tests are selected based on the clinical situation. In men with suspected androgen deficiency, the European Association of Urology recommends repeating total testosterone levels on at least two separate morning measurements, using a threshold of approximately 12 nanomoles per liter, assessing sex hormone-binding globulin, luteinizing hormone, and follicle-stimulating hormone if necessary, and, in cases of low libido and secondary hypogonadism, determining prolactin and, if indicated, performing magnetic resonance imaging of the pituitary gland. [50]

For women, the hormonal approach is different. The International Society for the Study of Women's Sexual Health emphasizes that total testosterone should not be used to diagnose hypoactive sexual desire disorder. If testosterone therapy is considered, it is measured as a baseline for safety and subsequent monitoring, not as a diagnostic "libido marker." In women with menopausal complaints, signs of vaginal atrophy, pain, and the context of menopause are additionally assessed. [51]

Diagnostic stage	What is being assessed?
1	History of complaints, duration, onset, distress
2	Psychological and relational context
3	Medicines, alcohol, psychoactive substances
4	Pain, dryness, erection, arousal, orgasm
5	Physical examination as indicated
6	Laboratory tests if endocrine causes are suspected
7	If necessary, magnetic resonance imaging of the pituitary gland if there is secondary hypogonadism and hyperprolactinemia

The table reflects the step-by-step logic of the examination, and not a universal set of tests for everyone. [52]

Differential diagnosis

First and foremost, decreased libido must be distinguished from normal individual or age-related variability in sexual desire. Not every person with infrequent sexual activity is ill, and not every discrepancy in desire in a couple indicates a disorder. The key question is whether there is persistence, generalization, and clinically significant distress. [53]

The second important group is other sexual disorders. In women, these primarily include pain during intercourse, dryness, and impaired arousal and orgasm. In men, this includes erectile dysfunction, which may mistakenly describe the problem as "loss of desire," although the central mechanism remains fear of failure or the inability to maintain an erection. Statistical and clinical reviews emphasize that these conditions often overlap and require separate diagnosis when questioning. [54]

The third group includes mental and endocrine disorders. Depression, anxiety, androgen deficiency, hyperprolactinemia, thyroid disease, diabetes, and menopausal genitourinary syndrome may underlie the complaint and require primary treatment as the underlying condition. Men's guidelines specifically emphasize the need for laboratory testing to rule out endocrine causes, while women's guidelines emphasize the need to rule out modifiable medical and relational factors before making a diagnosis of hypoactive sexual desire disorder. [55]

The fourth group is drug-induced sexual dysfunction. If decreased desire began after taking an antidepressant or other medication, this is often a distinct clinical scenario, rather than a "spontaneous" libido disorder. In such a situation, a more accurate description would be drug-related sexual dysfunction, even if the patient describes it specifically as a loss of sexual interest. [56]

What should you distinguish from	Tip for the Clinician
Individual norm without distress	There is no suffering and no request for treatment
Pain and dryness	Desire is often secondarily reduced due to discomfort
Erectile dysfunction	The main complaint may be disguised as “I don’t want to”
Depression and anxiety	Sexual symptoms are part of a general syndrome.
Hypogonadism and hyperprolactinemia	Lab tests are needed
Drug-induced dysfunction	Timing of initiation of therapy is important.

The table emphasizes that a correct diagnosis is based on the exclusion of more specific and correctable causes. [57]

Treatment

Treatment for decreased libido is almost never one-dimensional. The 2024 International Consultation on Sexual Medicine explicitly states that effective care must utilize a biopsychosocial approach. This means that the physician does not limit themselves to psychotherapy, hormones, or "desire-boosting" medications, but rather consistently seeks out and addresses the underlying causes of each factor. [58]

The first therapeutic step is correcting reversible causes. This may involve reviewing medications, treating depression and anxiety, normalizing sleep, reducing chronic stress, correcting testosterone deficiency in men, treating hyperprolactinemia, thyroid disease, diabetes, chronic pain, and menopausal genitourinary syndrome. Men's guidelines specifically recommend modifying chronic therapy that negatively impacts sexual desire. [59]

When relationships, stress, sexual anxiety, or ingrained negative patterns play a central role, psychosexual therapy is highly valuable. The International Consultation on Sexual Medicine notes compelling evidence in favor of sex therapy, cognitive behavioral therapy, and mindfulness-based therapy. In women, these approaches have been shown not only to increase sexual desire but also to reduce sexual distress, with effects lasting for months. [60]

Couples often benefit from addressing discrepancies in sexual desire rather than looking for someone to blame. The European Association of Urology emphasizes that modern approaches increasingly view the problem as a dyadic one, rather than as a defect in one partner. In some cases, improved communication, recalibrating expectations, and addressing shame and fear of rejection are more effective than hormonal interventions. [61]

In menopausal women, the treatment of dryness, burning, pain, and dyspareunia becomes a separate issue. The 2025 European Endocrinology Guidelines indicate that systemic menopausal hormone therapy or topical vaginal estrogens may improve sexual symptoms if they are associated with the genitourinary syndrome of menopause. However, if the issue is specifically a decrease in interest, rather than pain and dryness, systemic estrogens alone usually do not have a convincing effect on desire. When choosing systemic estrogens for sexual complaints, the transdermal route is preferable to the oral route, as it has a lesser effect on the increase in sex hormone-binding globulin. [62]

In men with confirmed androgen deficiency, testosterone treatment has a proven role. The European Association of Urology recommends testosterone therapy in the presence of symptoms and recurrent low total testosterone levels, and meta-analyses cited in the guidelines show improvement in sexual desire in hypogonadal men. However, therapy should not be prescribed "just in case" for libido dissatisfaction alone without documented hormonal deficiency. [63]

In postmenopausal women with hypoactive sexual desire disorder, transdermal testosterone remains the most proven hormonal option. The International Society for the Study of Women's Sexual Health emphasizes that this is the only indication for testosterone in women with a real evidence base. However, total testosterone is not used for diagnosis, but only as a baseline for monitoring. The goal of therapy is not to achieve some "magic" number, but to maintain levels within the physiological premenopausal range. Compounded forms, injections, pellets, and oral testosterone are not recommended due to safety and dosing concerns. [64]

When transdermal testosterone is used in women, the effect is typically assessed after 6-8 weeks. Peak benefit is expected around week 12. If there is no improvement after 6 months, treatment is recommended to be discontinued. After initiating therapy, total testosterone levels are monitored after 3-6 weeks, then after dose adjustments, and then every 4-6 months. Acne, increased hair growth, alopecia, deepening of the voice, and other signs of androgen excess are monitored. [65]

Among non-hormonal prescription medications, flibanserin and bremelanotide are the most well-known. According to the current US 2025 labeling, flibanserin is indicated for women under 65 years of age with acquired generalized hypoactive sexual desire disorder, unless the problem is explained by a psychiatric or physical illness, relationship, or medication. The most common adverse reactions include dizziness, drowsiness, nausea, fatigue, and insomnia. The International Consultation on Sexual Medicine rates the evidence for flibanserin as strong for premenopausal women and moderate for postmenopausal women, although regulatory status varies by country. [66]

Bremelanotide remains another approved option, but only for premenopausal women with acquired generalized hypoactive sexual desire disorder. It is administered subcutaneously at 1.75 milligrams into the abdomen or thigh at least 45 minutes before anticipated sexual activity, no more than once every 24 hours, and no more than eight doses per month. It is contraindicated in patients with uncontrolled hypertension and known cardiovascular disease because it may temporarily increase blood pressure and slow the heart rate.[67]

Other options may be discussed for specific scenarios, but the evidence base is weaker. The International Consultation on Sexual Medicine notes moderate data for bupropion and buspirone, particularly in some women with low desire or antidepressant-associated sexual dysfunction. For sildenafil and trazodone, the data are less definitive and focus on specific subgroups rather than universal treatments for decreased libido. Therefore, such prescriptions are generally considered individualized rather than standardized. [68]

It's also important to be honest about what isn't yet considered a standard. There's no reliable evidence that any "aphrodisiacs," internet supplements, uncertified hormonal mixtures, testosterone implants, self-prescribed dehydroepiandrosterone, or "rejuvenation" procedures are safe and proven treatments for low libido. Current guidelines, on the contrary, warn against unproven and poorly standardized regimens, especially when they mask an underlying endocrine, psychological, or relational issue. [69]

Approach	When it is appropriate
Correction of the cause	Almost always the first step
Sex therapy, cognitive behavioral therapy, mindfulness-based therapy	With psychological and relational contribution
Treatment of pain and genitourinary syndrome of menopause	For dryness, dyspareunia and menopausal symptoms
Testosterone in men	If symptoms occur and deficiency is confirmed
Transdermal testosterone in women	In some postmenopausal women with hypoactive sexual desire disorder
Flibanserin	In a proportion of women under 65 years of age with acquired generalized hypoactive sexual desire disorder
Bremelanotide	In premenopausal women with acquired generalized hypoactive sexual desire disorder
Bupropion, buspirone and other selective options	In certain cases, not as a universal standard

The table does not reflect a “ranking of the best remedies,” but a modern step-by-step treatment logic. [70]

Prevention

Preventing decreased libido isn't limited to a single supplement or hormone. The most realistic preventative approach is to maintain sleep, reduce chronic stress, treat depression and anxiety, address pain during sex, promptly address menopausal genitourinary syndrome, and regularly review medication regimens if they impair sexual function. [71]

For men, prevention includes monitoring body weight, diabetes, vascular and endocrine disorders, and, if symptoms are present, timely assessment of testosterone, prolactin, and thyroid function. For women, early treatment of vaginal dryness, pain, and menopausal symptoms is especially important, as is open discussion of sexual well-being during a consultation rather than after years of cumulative distress. [72]

Prevention can also be achieved by normalizing conversations about sexual health within couples and during doctor visits. The International Consultation on Sexual Medicine recommends creating a safe, non-judgmental environment in which people can discuss sexual complaints as freely as they would about sleep, pain, or mood. The sooner the problem is identified, the higher the chance of resolving it without it becoming chronic. [73]

Preventive measure	Why is it needed?
Normalizing sleep and reducing stress	Reduces psychological inhibition of desire
Chronic disease management	Reduces biological contribution
Revision of medications	Helps avoid drug-induced dysfunction
Treatment of pain and dryness	Prevents secondary decrease in desire
Open discussion of sexual health	Allows you to avoid missing the early stages of a problem

The table reflects real preventative measures, not commercial promises to “increase libido.” [74]

Forecast

The prognosis depends primarily on the underlying cause. If decreased libido is due to medication, severe stress, depression, postpartum exhaustion, pain during sex, or menopausal genitourinary syndrome, the condition often improves after correcting the underlying factor. In such cases, it is not a lifelong disorder, but a potentially reversible sexual dysfunction. [75]

In men with confirmed androgen deficiency, testosterone treatment can improve sexual desire, although the effect depends on the severity of the deficiency and associated metabolic and psychological problems. European guidelines indicate that improvement is more pronounced in men with more severe hypogonadism, while concomitant diabetes and obesity may reduce the response. [76]

Women with hypoactive sexual desire disorder have the best prognosis with a combined approach: addressing distress, relationships, pain, and menopausal symptoms simultaneously, and, when indicated, using targeted pharmacotherapy or transdermal testosterone. The International Consultation on Sexual Medicine specifically emphasizes the durability of cognitive behavioral therapy and mindfulness-based therapy, as well as the proven benefits of some pharmacological interventions. [77]

The prognosis is worse when decreased desire goes unaddressed for years, is accompanied by chronic pain, severe depression, significant marital conflict, or is treated solely with "stimulants" without seeking the underlying cause. But even in such cases, modern sexual medicine views low libido as a treatable condition, not an inevitable loss of sexuality. [78]

Situation variant	Expected forecast
There is a clear reversible cause	Often favorable
The problem is multifactorial, but the person receives comprehensive treatment	Significant clinical progress is usually possible.
There is severe depression, pain, conflict and lack of treatment	The prognosis is worse
Only unproven stimulants are used without diagnostics	There is a high risk of chronic progression

The table shows that the prognosis is determined not only by the diagnosis, but also by the quality of the care route. [79]

FAQ

Is decreased libido always a disease?
No. Sometimes it's a temporary response to fatigue, stress, the postpartum period, conflict, or a change in life context. A disorder is usually considered when the problem is persistent and causes significant distress. [80]

Can a testosterone test alone determine the cause?
No. In men, testosterone is important, but a diagnosis of androgen deficiency requires both symptoms and repeated confirmation of low levels. In women, testosterone is not used at all to diagnose hypoactive sexual desire disorder, but only as a baseline for monitoring therapy. [81]

Is it true that low libido in women is almost always mental?
No. Modern recommendations emphasize the multifactorial nature of the problem. Menopause, dryness, pain, medications, stress, depression, relationships, and neuroendocrine mechanisms can all contribute. [82]

Can an antidepressant reduce cravings?
Yes. This is especially common with selective serotonin reuptake inhibitors and some other psychotropic medications. You shouldn't stop treatment on your own, but you should discuss the issue with your doctor. [83]

Will hormone replacement therapy during menopause help restore desire?
Not always. It's helpful if sexual problems are associated with dryness, burning, pain, and genitourinary syndrome of menopause. However, systemic estrogens alone usually don't have a significant effect on sexual interest. [84]

Are there proven medications specifically for women's desire?
Yes, but they are not suitable for everyone. Flibanserin and bremelanotide have regulatory indications for certain groups of women with acquired generalized hypoactive sexual desire disorder, and transdermal testosterone for postmenopausal women with this disorder has evidence support, although it remains unregistered for women in most countries. [85]

Is it possible to manage without medication?
In many cases, yes. If stress, relationships, sexual anxiety, pain, fatigue, or negative scenarios play a leading role, psychosexual therapy and correction of the underlying cause may be more helpful than medication. [86]

When is it especially important to seek immediate medical attention?
When decreased libido is accompanied by galactorrhea, a sharp decline in erectile function, amenorrhea, severe depression, severe fatigue, neurological symptoms, painful sex, or a sudden onset after taking a new medication. This may indicate an endocrine, neurological, or drug-related cause. [87]

Key points from experts

Tami Serin Rowan, MD, MS, associate professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, is the lead author of the 2024 International Consultation on Sexual Medicine guidelines. Her work emphasizes that hypoactive sexual desire disorder should be considered as a distinct clinical condition, and that diagnosis remains clinical and cannot be made solely by a questionnaire. The practical implication of her recommendations is to assess distress, context, pain, relationships, and mental state as carefully as hormones. [88]

Sharon J. Parish, MD, professor of clinical medicine and professor of medicine in clinical psychiatry at Weill Cornell Medicine, is a co-author of the International Society for the Study of Women's Sexual Health guideline on testosterone in women. Her clinical position is particularly important for menopausal women: testosterone should not be used as a diagnostic test for low libido, but in some postmenopausal women with hypoactive sexual desire disorder, transdermal therapy has evidence support with proper monitoring. [89]

John P. Mulhall, MD, a urologist and microsurgeon specializing in sexual and reproductive medicine at Memorial Sloan Kettering Cancer Center, is one of the foremost experts in male sexual medicine. The modern male approach, as reflected in European guidelines, boils down to a simple but important idea: testosterone is not beneficial for every man with a desire problem, but only for those with symptoms and a confirmed deficiency. However, with hyperprolactinemia, thyroid disease, depression, and medication effects, the underlying cause must be treated first. [90]