Low sex drive (loss of libido)

Low Sex Drive (Loss of Libido)

Low sex drive, also known as loss of libido, refers to a reduced interest in sexual activity. It is a common issue that can affect both men and women at different stages of life. The condition may be temporary or persistent and is often influenced by a combination of physical, psychological, and social factors.

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Causes of Low Sex Drive

1. Physical and Medical Causes

• Hormonal imbalances:

  • Low testosterone in men

  • Reduced estrogen or progesterone in women, especially during menopause

  • Thyroid disorders

• Chronic illnesses:

  • Diabetes, cardiovascular disease, chronic kidney or liver disease

• Medications:

  • Antidepressants (SSRIs, SNRIs, tricyclics)

  • Antihypertensives (beta-blockers, diuretics)

  • Antipsychotics

  • Chemotherapy drugs

• Pain conditions:

  • Endometriosis, fibroids, pelvic inflammatory disease in women

  • Chronic prostatitis or testicular pain in men

• Fatigue and sleep disorders:

  • Sleep apnea, chronic insomnia, shift work fatigue

• Substance use:

  • Excessive alcohol, smoking, or illicit drugs

2. Psychological Causes

• Stress (work, financial, personal)

• Depression and anxiety

• Relationship conflicts

• Past trauma or sexual abuse

• Poor body image or self-esteem issues

3. Lifestyle Factors

• Lack of exercise

• Poor diet and obesity

• Excessive alcohol or recreational drug use

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Symptoms and Presentation

• Reduced interest in initiating or engaging in sexual activity

• Lack of sexual thoughts or fantasies

• Difficulty becoming aroused

• Emotional distress due to lack of intimacy

• Strain in relationships

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Evaluation and Diagnosis

A healthcare provider may use:

• History and physical exam – assessing medical conditions, medications, lifestyle, and relationship factors.

• Laboratory tests – hormone levels (testosterone, estrogen, thyroid, prolactin).

• Psychological evaluation – screening for depression, anxiety, or relationship problems.

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Treatment Options

1. Lifestyle Modifications

• Exercise regularly to boost energy, mood, and circulation.

• Adopt a healthy diet to improve overall well-being.

• Limit alcohol and avoid recreational drugs.

• Improve sleep hygiene.

2. Psychological and Relationship Interventions

• Counseling or therapy for stress, anxiety, or depression.

• Couples therapy to address relationship issues.

• Mindfulness and relaxation techniques.

3. Medical Treatments

• Hormone therapy:

  • Testosterone replacement in men with clinically low testosterone.

  • Estrogen therapy in postmenopausal women (sometimes combined with progesterone).

• Adjusting medications: Switching from SSRIs to alternatives with fewer sexual side effects (e.g., bupropion).

• Treating underlying medical conditions: Proper management of diabetes, hypertension, thyroid disease, etc.

4. Medications Used in Specific Cases

• For men:

  • PDE-5 inhibitors (sildenafil, tadalafil) may improve erectile function but not necessarily desire.

• For women:

  • Flibanserin (for premenopausal women with hypoactive sexual desire disorder).

  • Bremelanotide (injectable, for premenopausal women).

Typical Doses (examples):

• Testosterone replacement (men): Testosterone gel 50–100 mg daily, or injections 75–100 mg intramuscular every week.

• Estrogen therapy (women): Estradiol 1–2 mg orally daily, or patches 0.05 mg twice weekly.

• Flibanserin: 100 mg orally once daily at bedtime.

• Bremelanotide: 1.75 mg subcutaneous injection, at least 45 minutes before anticipated sexual activity.

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Precautions

• Hormone therapy carries risks such as cardiovascular disease, prostate cancer risk (men), and breast cancer or blood clots (women).

• Flibanserin should not be taken with alcohol due to severe hypotension risk.

• Sexual health treatment should be individualized, addressing both physical and emotional causes.

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Drug Interactions

• SSRIs and SNRIs may reduce sexual desire.

• Antihypertensives (e.g., beta-blockers, thiazides) may impair sexual function.

• Antipsychotics (risperidone, haloperidol) may raise prolactin and suppress libido.

• CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) interact dangerously with flibanserin and bremelanotide.

• Alcohol significantly interacts with flibanserin.