Low desire, or erectile dysfunction?
The consultation covers when desire began to fall, whether it occurs in every setting or only within a particular relationship, and whether morning erections are still present. Pictures in which desire is preserved but rigidity cannot be achieved are dealt with under erectile dysfunction.
Over time the two can feed one another: anxiety after repeated difficulty can reduce desire, and reduced desire can in turn make erections harder. Both are therefore assessed together.
Common causes
Low desire usually has more than one cause. The assessment investigates the following:
- Hormonal: low testosterone, raised prolactin, thyroid disease
- Medication: some antidepressants, blood pressure medicines, and drugs for hair loss and the prostate can reduce desire
- Sleep: sleep apnoea and chronic sleep deprivation affect both hormone balance and energy
- Chronic illness: uncontrolled diabetes, obesity, liver and kidney disease
- Psychological: depression, intense work stress, burnout and anxiety disorders
- Relational: unresolved conflict and difficulties in communication
- Substance use: excessive alcohol, smoking and certain substances
Assessment and approach
After a detailed history and examination, a morning total testosterone measurement is usually requested along with any hormone and metabolic tests judged necessary. Reviewing the medication a person takes is often the step that yields the quickest result; but no medicine should be stopped without consulting a physician.
The approach is set by the cause: correcting a hormone deficiency, planning any change of medication together with the prescribing physician, treating a sleep disorder, lifestyle changes and, where needed, psychological support are addressed together. Putting low desire aside on the assumption that “it will pass” can mean a treatable underlying cause is missed.
Frequently asked questions
Is low sexual desire always low testosterone?
No. Low testosterone is only one of the causes. Depression, sleep disorders, side effects of medication and relational factors come up at least as often.
I take an antidepressant — could that be the reason?
Some antidepressants can affect sexual desire and ejaculation. Do not stop the medicine on your own; the options should be weighed together with the physician who prescribed it.
Do erectile dysfunction medicines solve low desire?
No. These medicines do not create desire; they help an erection continue where stimulation is present. The cause of low desire has to be investigated separately.
Should I bring my partner to the consultation?
It is not required and is a matter of preference. Where the relational component stands out, planning the process together as a couple can be helpful.