Dear Alice,

I recently went to a doctor to investigate my lack of libido. The blood tests indicated that I had a very low testosterone level and that the solution was to get a shot every two - three weeks for the rest of my life. Should I seek a second opinion as to the cause of this condition?

— The Eunich

Dear The Eunich,

Sex drive (libido) can fluctuate during a person’s life and it varies from person to person — a change in libido or consistently low sex drive is only a problem if it's causing distress. It sounds like in your case, you were hoping to put your libido in drive by seeking guidance from a medical professional. The practitioner could be on the right track — hormones, such as testosterone, play a role in sexual desire and response. That said, a second opinion could help you make a more informed decision, as there are a number of potential factors that can cause low libido and a number of possible treatment options.

Hormonal changes can have an effect on sex drive — for example, testosterone production naturally declines for many men as they age, which can reduce libido. There's also a condition called male hypogonadism, in which the body produces less testosterone, that can lead to a lower sex drive. Among women, menopause and pregnancy can cause changes in estrogen production that sometimes decrease sexual desire. Along with hormone fluctuations and variations, low libido can stem from a number of causes, including but not limited to:

  • Sexual conditions (vaginal atrophy, pain during sex, erectile dysfunction, etc.)
  • Systemic illness (cancer, arthritis, chronic heart failure, etc.)
  • Medications (especially selective serotonin reuptake inhibitors also known as SSRIs)
  • Lifestyle habits (e.g., excessive substance use)
  • Bodily changes (surgery that affects body shape or sexual function, pregnancy, breastfeeding, etc.)
  • Fatigue
  • Sleep apnea

Hormone therapy is one treatment of physiological causes of low libido. Estrogen can help with vaginal atrophy symptoms, and testosterone therapy is sometimes a treatment for people with hypogonadism. Sometimes testosterone is also recommended off-label to women who are experiencing a low sex drive, but it’s not yet been approved by the U.S. Food and Drug Administration. Some of the side effects associated with women's use of testosterone include acne, additional body hair, and changes in their mood. While testosterone therapy can be effective in some cases (such as male hypogonadism), it hasn’t been proven beneficial for men with age-related testosterone decline or typical levels of testosterone. Testosterone treatment can also cause a number of side effects in men, including acne, testicle shrinkage, decrease in sperm production, increase in blood clot risk, and with long term use, a heightened risk of prostate cancer.

Other physiological treatments can include changing out medications that may have a side effect of lowering libido, prescribing medication that treats erectile dysfunction or low libido in premenopausal women, and lifestyle changes such as cutting down on alcohol, increasing physical activity, and staying well-rested.

While there are many potential physiological causes to consider, lower sex drive can also be a result of psychological factors, such as:

  • Anxiety
  • Depression
  • Stress
  • Low self-esteem
  • History of abuse
  • Previous negative sexual experiences
  • Hypoactive sexual desire disorder (HSDD) — a diagnosis for those who express lack of interest in sex and for whom this is distressing. People who experience a lack of sexual desire or interest, without feeling that it's a problem for them, may self-identify as asexual.

Therapy and medication are the go-to treatments for psychological causes of low libido.

Another possibility when it comes to low sexual desire is that it stems from relationship issues. Poor communication about sex, mismatch in sexual needs, lack of connection with a partner, and trust issues are among some of the factors that could lead to someone losing interest in sex. Working on communication and taking steps to spice things up can sometimes kick sex drives back into gear, and sex education or counseling can be helpful tools to add into the mix.

Because the of the vast range of reasons why people experience low sex drives and the variety of treatment options available, seeking a second opinion could help you decide what path may be best for you boost your libido.

Alice!

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