Low Libido in Men: 21 Causes and What Actually Fixes Each

Low libido in men, or low sex drive, is a lasting drop in interest in sex. You have fewer sexual thoughts and less wish to start it, and it is not the same as erectile dysfunction.

About 1 in 5 men aged 40 to 70 report it. The usual causes are stress, depression, medicines, poor sleep, sugar, fear of failing in bed, relationship strain and low testosterone. Most are treatable.

Written and medically reviewed by Dr Shah Dupesh, MBBS, DCE, FASM, Consultant Andrologist & Sexologist, Chennai · Published: 29 October 2026 · Last reviewed: 29 October 2026

Hello! Vanakkam and Namaste. This is Dr Shah Dupesh, consultant sexologist in Chennai.

Men rarely walk in and say “low libido”. Instead, they say “Doctor, I just don’t feel like it any more”. A few tell me, “I have lost interest in sex”.

Sometimes the wife makes the appointment. He sits quietly while she explains that months have passed without any closeness.

Some are newly married and frightened that something is wrong with them. Others are in their forties, working twelve-hour days. They cannot remember the last time they wanted sex.

Many have already bought a “testosterone booster” online. Some have also been told by a gym trainer that they need injections.

So let me be blunt. Low libido is a symptom, not a disease. It always has a cause, and usually more than one.

In fact, low testosterone is only one of 21 causes I check for. And I rarely start a man on testosterone.

In this guide I walk you through the 21 causes and the tests that find yours. Then I show you what brings desire back, and what wastes your money. But first, let me clear away what you have probably been told.

🧠 Seven things you have probably been told wrong about low libido

Before the causes and the cures, let me clear up seven wrong ideas. I undo these in my clinic more than any others. Each one sends men down the wrong road for months.

1. “Low libido means low testosterone”

Not usually. In a 15-year study of Boston men, testosterone and libido were linked across the whole group.

But a man’s own report of low libido was only a modest guide to his own level (Travison, 2006). In my clinic, stress, mood, medicines and the relationship come up far more often.

2. “A real man always wants sex”

Desire rises and falls in every man. One survey asked 5,255 men about a single year. In that year, 14.4% had a distressing loss of interest lasting two months or more (Carvalheira, 2014).

So you are not broken. Instead, something is pressing on your desire.

3. “Testosterone injections will fix it”

Injected testosterone switches off your own sperm production. In a WHO trial, 65% of fertile men had no sperm at all by six months (WHO Task Force, 1990). Moreover, there is no clear evidence that it helps desire when your level was normal to begin with.

In men who are not clearly deficient, the benefit is uncertain (Corona, 2014a). I never use injections or tablets of testosterone.

4. “Herbal sex-power capsules are natural and safe”

Many are neither. For example, look at the supplements the US regulator flagged as secretly adulterated.

Almost half were sold for sexual enhancement, and nearly half of those hid sildenafil (Tucker, 2018). In other words, you may be taking a prescription drug without knowing the dose.

5. “Losing semen through masturbation drains your desire”

This is the oldest fear in Indian clinics. For example, in a general clinic in southern India, men most often blamed semen loss for their sexual problems (Thangadurai, 2014). Semen is not a store of strength.

The worry, however, is real, and worry itself flattens desire. I take these fears apart one by one in my guide to masturbation side effects.

6. “It is just age, nothing can be done”

Desire does fall slowly with age (Araujo, 2004). But even among men aged 40 to 70, about four in five did not report low libido (Travison, 2006). So a sudden drop, at any age, is a sign to look for a cause, not to give up.

7. “Low libido is the same as erectile dysfunction”

They are different problems that often travel together. Low libido is about wanting sex; ED is about the erection.

Yet among 3,714 men at a sexual-medicine clinic, low libido stood alone in only 5.1% (Corona, 2013a). Because of that overlap, treating it means looking at all three, as you will see.

Jump straight to your worry:

🔎 What is low libido in men?

Let me start with the libido meaning, in plain words. Libido is your sex drive: how often you think about sex, feel drawn to it, and want to start it.

Low libido means that drive has dropped and stayed low. It is also called low sex drive in men, decreased sex drive or loss of libido.

Many men simply call it no interest in sex. As a result, you have fewer sexual thoughts and fantasies, and you rarely start sex.

Doctors use “low sexual desire” as the umbrella term (Rubio-Aurioles, 2013). Sometimes it lasts and causes real distress or strain in the relationship. Then the formal name is hypoactive sexual desire disorder, or HSDD (Brotto, 2010).

Psychiatrists’ current manual uses six months or more as the yardstick. So a man with a lower drive than his friends, who is content, does not have a disorder.

Low libido, ED or PE: how to tell them apart

However, low libido is easy to confuse with two other problems men bring to me. Here is how I tell them apart.

The last row matters most. In real life, these three often occur together (Corona, 2013a).

They can also feed each other, which is why I always ask about all three. Read more in my guides to erectile dysfunction and premature ejaculation.

Put simply, do you still wake with erections but not want sex? Then the problem is more likely desire than blood flow. Either way, I check both.

✅ How do you know if a man has a low libido?

Low libido is quiet. There is no pain and no lump.

So men often notice it late, or the partner notices first. These are the signs I ask about.

• Fewer sexual thoughts: days or weeks go by without thinking about sex.
• You rarely start sex: your partner always makes the first move, or nobody does.
• Avoidance: staying up late, working late, or “being too tired” so that sex does not come up.
• Less masturbation and fewer fantasies than was normal for you.
• Sex feels like a duty: you go along with it but do not look forward to it.
• Fewer morning erections: this one points towards a hormone or blood-flow cause (what morning erections tell you).

A quick self-check

Answer these six questions honestly. They are the same ones I start with in clinic.

1. Has your desire been clearly lower than your normal for more than three months?
2. Does it bother you, or is it causing tension with your partner?
3. Have your morning erections become rare?
4. Have you felt low, anxious or hopeless most days?
5. Did you start any new tablet, or stop a gym supplement, around the time it began?
6. Are you avoiding sex because of trouble with erections or finishing too fast?

Did you answer “yes” to the first two? Then it is worth a proper assessment. The other answers point me to the likely cause.

For example, a “yes” to question 3 points me to the hormone tests below. A “yes” to question 5 points me to your medicines and, after steroids, your hormones.

⏱️ What is a normal sex drive for a man?

There is no normal number for men’s sex drive. No study has found a “correct” number of times a week a man should want sex. So anyone who quotes one is guessing.

Your own past is the best measure: what matters is a clear drop from what was normal for you. The same is true of timing, as I explain in how long sex really lasts.

Most couples come to me because of a mismatch, not a number. In Britain’s national sex survey, 23.4% of men in a relationship said one partner wanted sex more than the other (Mitchell, 2013). That gap, more than any count, is what causes the fights.

Is it normal to not want sex?

Yes, for a while. A lack of interest in sex for a few weeks is normal. For example, desire dips with exams, a new baby, a death in the family or a hard month at work.

It becomes a problem when it lasts for months, or when it upsets you or your partner. It is also a problem when it arrives suddenly, for no clear reason.

Equally, a man who has never felt much desire and is not troubled by it is not ill. Doctors call it a disorder only when it bothers the man or the couple (Brotto, 2010). So I treat what troubles you, not a statistic.

Sex drive after 40, 50 and 60

Your sex drive after 40 does change, but gradually. In a nine-year study of men aged 40 to 70, desire, sexual activity and erections all declined.

The fall was also faster at older ages (Araujo, 2004). Age was also a clear factor in lack of interest among 13,618 men aged 40 to 80 across 29 countries (Laumann, 2005).

But age alone rarely explains a man who has lost interest completely. After all, testosterone falls slowly. In one Boston study, 24% of men had a reading below 300 ng/dL.

Yet only 5.6% had truly symptomatic low testosterone (Araujo, 2007). So when a 45-year-old tells me desire vanished in six months, I look for a cause.

So, how do you increase sex drive for men over 40, 50 or 60? Start with the causes below, especially sugar, sleep, weight and medicines. Age itself is my last explanation, not my first.

📊 How common is low libido in men, really?

Low sex drive in men is far more common than men admit. Here are the figures from the best studies I trust.

Different studies, ages and definitions, so read each bar on its own.

Low libido, men aged 40 to 70 (Boston)19%

Distressing lack of interest for 2+ months in a year14.4%

Low libido at age 50 (Bavaria)7.2%

Low sexual desire at age 45 (Germany)4.7%

Source: Travison, 2006; Carvalheira, 2014; Herkommer, 2024; Meissner, 2019

The spread looks wide because each study asked a different question. Still, the message is clear: you are far from alone.

Among 2,500 fifty-year-old men in Bavaria, 30% had at least one sexual problem. In that study, men with ED had about twice the odds of low libido (Herkommer, 2024).

India has no good population figure yet; our data come from clinics, not national surveys. Asian studies of low desire vary so widely that no single number can be quoted (Irfan, 2020).

In my own clinic, however, low desire is one of the commonest reasons couples see me. Often, though, it hides behind another complaint.

🧩 Why am I not interested in sex? 21 causes of low libido in men

Why is my sex drive so low? That is the question behind every visit. Here are the 21 causes I look for, in five groups.

Most men I see have two or three at once. So read the whole list, not just the first item.

Very often, the cause is not one dramatic disease but a pile-up. For example, poor sleep, rising weight, a stressful job and an argument that never got settled.

Before the list, match your own clues to the five groups. Here is the pattern I see in my clinic.

How strongly each clue points to each group of causes. Most men tick more than one row.

On a phone, swipe sideways to see all five groups.

	Hormones	Body and health	Medicines and habits	The mind	The relationship
Sudden onset	likely	weak	strong	strong	likely
Fewer morning erections	strong	likely	possible	weak	weak
Low mood or poor sleep	possible	likely	possible	strong	possible
A new tablet	possible	weak	strong	weak	weak
Trouble with erections or finishing fast	possible	likely	possible	strong	possible
Tension with your partner	weak	weak	weak	possible	strong
Big waist or diabetes	strong	strong	weak	possible	weak
Past steroid use	strong	weak	weak	weak	weak

weak linkpossiblelikelystrong

Source: Dr Shah’s clinical pattern; see the causes below

Read across your row. A “strong” cell tells you which group to read first, but it is a guide, not a diagnosis.

Still, only the history, the examination and the tests confirm the cause. Now let me take the causes one by one.

Part 1: Hormones (causes 1 to 5)

Hormones come first because men ask about them first. But they explain fewer cases than you would think.

1. Low testosterone

Testosterone is the main hormone behind male desire (Corona, 2016). When it is truly low, only three symptoms reliably track it: low sexual desire, poor morning erections and ED (Wu, 2010). That large European study set a clear bar for late-onset low testosterone.

It needed three sexual symptoms, a total testosterone below 11 nmol/L (about 320 ng/dL) and a low free testosterone. Indian labs, however, usually report in ng/dL.

But there is no single cut-off that suits every man. In one andrology clinic, loss of libido became more common below 15 nmol/L (about 430 ng/dL) (Zitzmann, 2006). Each man’s own threshold for symptoms also differs (Kelleher, 2004).

So I never treat a number alone. I treat a man with symptoms and a confirmed low level.

I explain the full picture in my guide to low testosterone symptoms.

2. High prolactin

Prolactin is a pituitary hormone. When it is high, it switches desire off. One study looked at 2,146 men with sexual problems.

Severely raised prolactin was strongly tied to low desire, even after allowing for testosterone and other factors (Corona, 2007). Desire usually returns once prolactin is brought down (Corona, 2024).

It is uncommon, but I check it in every man with low libido. Interestingly, mildly raised readings were often normal on a repeat test (Corona, 2007). So I always recheck before acting.

3. An underactive or overactive thyroid

The thyroid sets your body’s speed. In one small study, nine of 14 men with an underactive thyroid had low desire. Rechecked 8 to 16 weeks after their thyroid levels were corrected, most men’s sexual problems had improved (Carani, 2005).

An overactive thyroid can lower desire too (Carani, 2005). Thyroid disease often affects erections as well (Krassas, 2008).

4. Steroids and “gym testosterone”

This is a growing problem among young men in Chennai gyms. Anabolic steroids shut down your own testosterone. In some men, it then stays low for years after stopping.

Former users were tested about 2.5 years after stopping. They still had lower testosterone, and 40.1% reported decreased libido (Rasmussen, 2016).

Can high testosterone cause low libido, then? Indirectly, yes. When outside testosterone stops, your own production can take a long time to recover.

Moreover, look at the muscle-building supplements US regulators caught with hidden drugs. Nearly 9 in 10 contained steroids (Tucker, 2018).

5. Excess body fat and the oestrogen balance

Fat tissue converts testosterone into oestrogen. That is not all bad, because a little oestrogen is needed for desire too.

In a careful trial, both low testosterone and low oestrogen lowered sexual function (Finkelstein, 2013). The real trouble comes with a large waist, where testosterone falls as fat rises.

But the good news is that weight loss raises testosterone. The more weight lost, the bigger the rise (Corona, 2013b).

I cover the practical plan in how to increase testosterone naturally. Men with this pattern often also develop breast tissue (gynecomastia), which is another clue.

Part 2: Body and health (causes 6 to 9)

The second group is about your general health. These causes are silent, so men rarely connect them with their sex life.

6. Diabetes and high sugar

Diabetes is one of the causes I find most often hiding behind low desire in my Chennai clinic. For instance, in one study, a third of men with type 2 diabetes had low testosterone of the pituitary type (Dhindsa, 2004). In another, 58.4% of men with newly diagnosed diabetes who noticed a sexual change had low desire (Corona, 2014b).

That is why an HbA1c test is part of every low libido work-up I do. Are you a man with diabetes, asking how to raise your sex drive? Here is the honest answer: sugar control comes first, and I check your testosterone too.

7. Poor sleep and sleep apnoea

Men who snore loudly, stop breathing at night and wake tired often have obstructive sleep apnoea. Low libido is often reported by men with apnoea.

In a small study of 10 such men, night-time testosterone was lower than in men without apnoea (Luboshitzky, 2002). A full night without sleep also lowers testosterone (Su, 2021).

Interestingly, treating apnoea with a breathing machine did not reliably raise testosterone (Cignarelli, 2019). Weight loss, on the other hand, does (Corona, 2013b). Even so, better sleep lifts energy and mood, and desire follows.

8. Long-term illness and pain

Any long illness drains energy and desire. That includes heart disease, high blood pressure, high cholesterol, kidney or liver disease and chronic pain. Britain’s national survey shows the link.

Men who rated their health as poor had more than twice the odds of low sexual function (Mitchell, 2013). Fear after a heart attack (“will sex strain my heart?”) is another quiet cause, and I talk it through with men.

9. Age

As above, desire declines slowly with age (Araujo, 2004). Age becomes the explanation only after the other causes have been ruled out. Indeed, in my practice, many men in their sixties regain good desire once sugar, sleep and medicines are corrected.

Part 3: Medicines and habits (causes 10 to 13)

The third group is the one most often missed. That is because men do not think to mention their tablets or their evening drinks.

10. Antidepressants

Antidepressants are among the commonest medical causes of low desire. When patients were asked directly, 25.8% to 80.3% reported sexual side effects, depending on the drug (Serretti, 2009). In a study of 1,022 people, 62.4% of men were affected (Montejo, 2001).

Low libido on sertraline (Zoloft) is real and common. In fact, in that review, sertraline was among the drugs with the highest rates (Serretti, 2009).

But never stop an antidepressant on your own. Some, like bupropion and mirtazapine, carry much less sexual effect.

A switch or dose change is often possible (Serretti, 2009; Segraves, 2014). I work this out with the man, and with his psychiatrist where needed.

11. Hair-loss and prostate tablets

Finasteride and dutasteride are widely used by young Indian men for hair loss. Across 17 trials, decreased libido was clearly more common in older men taking them for the prostate. But in men taking them for hair loss, the rise was not significant (Liu, 2016).

Even so, a small number of men report sexual side effects that persist after stopping (Irwig, 2011). Did your desire fall after starting one of these? Tell me, because it is worth reviewing.

12. Other medicines

Several other drug groups can also lower desire. For example, regular opioid painkillers lower testosterone (Bawor, 2015). Antipsychotics can raise prolactin, and so can benzamide stomach tablets such as levosulpiride and metoclopramide (Corona, 2007).

Levosulpiride is often combined with acid tablets in India. Domperidone can raise prolactin too.

In my practice, spironolactone, some anti-epileptics and hormone treatments for the prostate can also play a part. So can chemotherapy and the antifungal ketoconazole.

Beta-blockers are often blamed, but the evidence is weaker than men think. Across 15 trials, beta-blockers added only about five reports of sexual problems per 1,000 patients a year (Ko, 2002). In fact, men who were simply told about sexual side effects reported ED far more often (Silvestri, 2003).

So do not stop a heart tablet. Ask me instead, and if needed I will adjust it with your physician.

The rule is simple: never stop a prescribed medicine on your own. Bring the strip to your appointment instead.

13. Alcohol, cannabis and tobacco

Alcohol relaxes you in small amounts, but heavy drinking does the opposite. In a north Indian study of alcohol-dependent men, 54.4% had problems with desire (Pendharkar, 2016). Smoking damages erections in a dose-dependent way (Allen, 2018).

Daily cannabis use is linked to orgasm and timing problems (Smith, 2010). A link with ED has also been reported, but it remains uncertain (Pizzol, 2019). If you use any of these daily, cutting down is one of the cheapest treatments there is.

Part 4: The mind (causes 14 to 18)

Desire begins in the brain. So the fourth group is about mood, stress and the stories men carry about sex.

14. Depression

Can depression affect a man’s sex drive? Very much so, and it runs both ways. In long-term studies, depression raised the risk of later sexual problems.

In turn, sexual problems raised the risk of later depression (Atlantis, 2012). Over 40% of depressed men reported lower sexual interest before taking any medicine (Kennedy, 1999).

In an Indian psychosexual clinic, depressed men were also more likely to report lack of libido (Rajkumar, 2015). So when desire is gone, I always ask about sleep, appetite, energy and enjoyment of life.

15. Stress, anxiety, burnout and past trauma

Can burnout affect libido? Yes.

In a large three-country survey, professional stress was the reason men gave most often for losing interest in sex (Carvalheira, 2014). A mind busy with deadlines, EMIs and family responsibilities has no room left for desire.

Anxiety works the same way. In the same Indian clinic, about one in four men with sexual problems had an anxiety disorder. Usually, the anxiety came first (Rajkumar, 2015).

Past sexual abuse, or a frightening early sexual experience, can do the same. Men almost never mention it unless asked.

Yet it can switch desire off for years. I ask gently, and counselling helps.

16. Fear of failing in bed

This is the cause I most often uncover once the blood tests come back normal. I explain it fully in “The thing most clinics miss” below.

A man who has had a few failed erections, or who finishes very fast, starts to dread sex. To avoid the embarrassment, the brain simply stops wanting it.

He calls it low libido; underneath, it is ED or PE. Shame about body shape or penis size feeds the same fear.

17. Heavy porn use

Here I must be careful, because the research is mixed. In coupled men with low desire, frequent masturbation with porn went with sexual boredom and low intimacy.

It was a pattern “dissociated” from desire for the partner (Carvalheira, 2015). Yet another set of studies found little link between porn and sexual problems in young men (Landripet, 2015).

My clinical view sits between these. Porn does not cause low libido in every man. But in men who use it daily, desire for a real partner often fades, and a break helps.

It can also set expectations of sex that no real partner matches. I discuss this in porn-induced erectile dysfunction.

18. Guilt and worry about semen loss

Many Indian men grow up believing that losing semen weakens the body. As I said at the start, it was the commonest explanation men gave in a south Indian clinic study (Thangadurai, 2014).

It creates guilt after masturbation and fear after a night emission. Then the mind starts to avoid anything sexual.

Semen is made every day, and losing it does no harm. I explain this in my guide to Dhat syndrome and sexual tiredness.

Part 5: The relationship and daily life (causes 19 to 21)

The last group is the one men find hardest to talk about. But it is often the root.

19. Conflict, resentment and distance

Unspoken anger is a powerful desire-killer. Britain’s national survey linked low sexual function in men with two things.

One was not being happy in the relationship. The other was not being able to talk about sex with the partner (Mitchell, 2013).

Men in long relationships told researchers that feeling desired fed their desire. Rejection and emotional distance, on the other hand, drained it (Murray, 2017).

In a large clinic study, “primary” low libido, with no medical cause, went hand in hand with relationship and family trouble (Corona, 2013a). That is why I like to see the couple together, at least once.

20. Pressure, no privacy, and sex on a schedule

Some pressures are very Indian. A joint family with thin walls and no privacy. Relatives asking when the baby is coming.

Couples trying to conceive who have sex only on “ovulation days” because a chart says so. In my clinic, desire often disappears when sex becomes a task with a deadline.

Long relationships and routine lower interest too (Carvalheira, 2014). Novelty, time together and a little playfulness matter more than any tablet.

Men rarely admit it, but loss of libido after a baby, or after kids, is common in my clinic. Broken sleep, an exhausted couple and no time alone all press on desire. So protecting sleep and private time is where I start.

21. Loss of libido after marriage: attraction and adjustment

In arranged marriages especially, desire may take time to build. Not feeling drawn to the partner was one of the factors linked with low interest in the cross-cultural survey (Carvalheira, 2014).

This is not a fault in either person. Indeed, it is very common in the first months.

Time, honest talk and sometimes a few counselling sessions help a great deal. Have years passed with little or no intimacy? Then start with my roadmap in how to fix a sexless marriage.

All 21 causes at a glance

Here are all 21 causes on one page: how I find each one, and what fixes it.

⚡ Why has my husband suddenly lost his libido?

Wives often ask me this, and the word “suddenly” is an important clue. A slow fade over years points to age, weight, sugar and routine. A sudden drop over weeks or months points elsewhere.

When desire vanishes suddenly, I think first of these:

• A new medicine, especially an antidepressant, a hair-loss tablet or a strong painkiller.
• Depression or a major stress: a job loss, a bereavement, a business crisis.
• A relationship rupture: a fight that was never resolved, or a trust issue.
• A new erection or timing problem that he is too embarrassed to mention.
• Stopping steroids or gym supplements.
• A hormone problem such as high prolactin or a thyroid change.

When to see a doctor promptly

Book an appointment soon, rather than waiting, if low libido comes with any of these:

• new headaches, or blurring or loss of side vision (this can point to a pituitary problem);
• milky discharge from the nipples, or breast swelling;
• testicles that have become smaller or softer, or a lump or swelling in a testicle, especially with breast swelling in a young man;
• heavy low mood, or thoughts of harming yourself: do not wait for an appointment, read the note just below;
• trouble conceiving.

If your low mood is heavy, or you have had thoughts of harming yourself, please do not wait. Do not stay alone. Tell someone close to you right now, and speak to a doctor today.

These thoughts are more common in men with sexual problems and low mood (Rajkumar, 2015), and they are treatable. You can call my clinic on 97907 83856.

🚩 The thing most clinics miss: check erections and timing first

Here is the pattern I see every single week. A man comes in saying “my libido is gone”. He wants a testosterone test, and he is sure it will be low.

Then I ask about erections and how long he lasts. That is when the real story comes out.

Indeed, the research backs this up. Among men seeking help for ED who never mentioned desire, 30.8% still scored low for desire on a questionnaire (Cilio, 2024). Among 428 men with ED, four in ten had some loss of sexual interest (Corona, 2004).

That is why, in my practice, I treat ED or premature ejaculation first whenever they are part of the picture. Often, I also prescribe medicines to improve the erection or the timing.

Both problems can take away a man’s confidence, and with it, his desire. My comparison of sildenafil and tadalafil explains the ED tablets.

🩺 How low libido is diagnosed: the tests I do

Diagnosis starts with a conversation, not a blood test. I ask when it began, and whether it happens with your partner or across the board.

Then I ask about erections, timing, mood, sleep, alcohol, gym supplements and every tablet you take. Expert standard procedures say the work-up must cover mood, the relationship and hormones (Rubio-Aurioles, 2013).

Next, I examine you: weight and waist, blood pressure and body hair. I also check the breasts for gland tissue, and the size and feel of the testicles.

The blood tests, and why timing matters

Testosterone must be measured fasting, early in the morning, and repeated if low (Bhasin, 2018). That is not a formality.

In men aged 30 to 40, testosterone was 20% to 25% lower at 4 pm than at 8 am (Brambilla, 2009). A sugary drink lowered it by a quarter within two hours (Caronia, 2013).

Men sampled on three mornings and three afternoons; figure shown for men aged 30 to 40.

8 am sample100%

4 pm sample20 to 25% lower

Source: Brambilla, 2009

In the same study, some men read below 300 ng/dL in the afternoon. About half of them were normal on every morning test (Brambilla, 2009).

So an afternoon test, or one taken after a sugary drink or breakfast, can label a normal man as “low”. I still see this mistake often. It has started many men on testosterone they never needed.

The tests I order

This is the panel I ask for, and why each test is on it.

What counts as low testosterone?

European and American guidelines both define low testosterone as a low level plus matching symptoms, never a number alone (Salonia, 2025; Mulhall, 2018). I follow the same rule.

In numbers, a large Boston population study and the TRAVERSE trial both counted total testosterone below 300 ng/dL (10.4 nmol/L) as low (Araujo, 2007; Pencina, 2024). The trial also asked for two such readings. Borderline results are where free testosterone decides (Bhasin, 2018).

Most men need nothing more. If prolactin is clearly high on a repeat test, I first check for medicines that raise it (Corona, 2007). If none explains it, I arrange a pituitary scan to find out why.

🛠️ Low libido treatment: how to fix a very low libido

There is no single libido tablet for men. Treatment means finding the causes and fixing them, one by one. Here is the order I follow in my clinic.

The order I follow in clinic. Most men need two or three of these steps.

1

Find every causeHistory, examination and fasting morning blood tests.

↓

2

Fix erections and timing firstIf ED or PE is part of the story, treat it; confidence brings desire back.

↓

3

Review medicinesSwitch or adjust antidepressants, hair-loss tablets and others with the prescriber.

↓

4

Treat the mind and the relationshipDepression, anxiety, psychosexual therapy, couple sessions.

↓

5

Correct hormones and healthProlactin, thyroid, sugar, weight and sleep.

↓

6

Low testosterone ladderLifestyle, then herbals, then aromatase inhibitors; gel only as a last option.

Source: Dr Shah’s clinical protocol; Rubio-Aurioles, 2013

Each step deserves a little explanation. One rule first: every medicine on this page is started only after an examination and tests, on a doctor’s prescription. Please do not buy any of them on your own.

1. Treat erection and timing problems first

If ED or PE is part of the story, I treat it first, as explained above. I use medicines to improve the erection or the timing. Once sex stops being frightening, interest usually returns.

2. Review your medicines

Is an antidepressant, hair-loss tablet, painkiller or prolactin-raising drug involved? Then I work with you, and your other doctors, to switch or adjust it. Some antidepressants carry far fewer sexual effects (Serretti, 2009).

3. Counselling, psychosexual therapy and treating depression

I counsel men and couples in my clinic myself. That means treating depression and anxiety, and working through relationship problems.

It also means psychosexual therapy, including cognitive behavioural therapy (CBT). This helps with performance fears, guilt and the semen-loss worries many Indian men carry.

I also teach couples to take the pressure off sex and rebuild closeness step by step. Here is how psychosexual counselling works.

Let me be honest about the evidence. The controlled trials of talking therapy for low desire were in women.

A critical review found none of them adequate yet (Pyke, 2015). Good trials in men are still missing.

So my confidence in counselling comes from my own clinic, where I see it work week after week. Because depression and sexual problems feed each other (Atlantis, 2012), I treat the mood and the desire together. Where an antidepressant is needed, I choose one that spares sexual function where possible (Serretti, 2009).

4. Correct prolactin, thyroid, sugar, weight and sleep

Raised prolactin is brought down with a tablet, usually cabergoline. I also find out why it was high, and desire usually returns (Corona, 2024). Thyroid treatment reverses many sexual problems within a few months (Carani, 2005).

Weight loss raises testosterone (Corona, 2013b). These are some of the most satisfying fixes in andrology.

5. Low testosterone: my treatment ladder

Only when testosterone is confirmed low, twice, in the morning, do I treat it. Even then, I start at the bottom of the ladder. The next section explains each rung.

🪜 If your testosterone is truly low: my treatment ladder

My rule is simple: fix the causes first, and use testosterone rarely. Most men with a low reading improve with weight loss, better sleep, less alcohol and better sugar control. If they do not, I climb this ladder, one rung at a time.

How is low testosterone confirmed, and what symptoms go with it? Both are in my guide to how low testosterone is diagnosed.

Here is each rung, and what the evidence says about it.

With that rule in place, here is how I climb the ladder.

Rung 1: Lifestyle and the causes

In my experience, weight loss is the strongest lever. A review looked at 24 studies of obese men.

Both diet and surgery raised testosterone, and the more weight a man lost, the more it rose (Corona, 2013b). Sleep, alcohol and sugar control come next.

Rung 2: Ashwagandha and velvet bean extract

I use ashwagandha (Withania somnifera) and velvet bean extract (Mucuna pruriens, known in Ayurveda as kapikachhu). Two small eight-week trials tested ashwagandha root extract in healthy men.

It improved desire scores compared with placebo (Mutha, 2025; Khanna, 2026). However, a trial in older overweight men found a modest hormone rise but no clear gain in sexual well-being (Lopresti, 2019).

Velvet bean raised testosterone and lowered prolactin in infertile men in a Lucknow study (Shukla, 2009). But no placebo trial has measured libido. So I use these as a gentle early step, not as a promise.

I prescribe them as standardised extracts after a consultation, not as random online products. That matters, because one in five Ayurvedic medicines bought online contained lead, mercury or arsenic (Saper, 2008).

Natural does not mean risk-free. Ashwagandha has rare reports of liver injury.

So stop it and see me if you notice nausea, itching, dark urine or yellow eyes. I also avoid it in men with an overactive thyroid.

Velvet bean contains natural L-dopa, the same chemical used for Parkinson’s disease. So I do not give it to men on antipsychotics, MAO-inhibitor antidepressants or Parkinson’s medicines. Nor do I give it to men with a history of psychosis.

Rung 3: Letrozole or anastrozole

These tablets block the enzyme that turns testosterone into oestrogen. So your body’s own testosterone rises. In older men, anastrozole raised testosterone from 343 to 572 ng/dL, about 11.9 to 19.8 nmol/L (Leder, 2004).

In 12 severely obese men, weekly letrozole brought low testosterone back into the normal range. But free testosterone overshot the normal range in 7 of them (Loves, 2008).

Two honest cautions. First, this use in men is off-label and needs monitoring.

Oestrogen must not fall too far, because too little oestrogen lowers desire itself (Finkelstein, 2013). So I check oestradiol; testosterone can also overshoot.

Second, raising the number did not improve sexual scores in the one small trial that measured them (Leder, 2004). That is why I use these selectively, alongside the other steps.

Rung 4: Testosterone gel, as a last option

When testosterone is clearly low and the steps above have not worked, I consider a testosterone gel. It is applied to the skin.

In the large trials of men with proven low testosterone, gel improved sexual desire and activity, a “moderate benefit” (Snyder, 2016; Pencina, 2024). Improvement, when it comes, tends to show within about a month (Wang, 2000).

Two safety rules come with the gel. First, it rubs off.

Apply it to the shoulders or upper arms, let it dry, wash your hands and keep the area covered. Skin contact can pass testosterone to your wife or children, which matters most if she is pregnant.

Second, before starting I check your haemoglobin (haematocrit) and, over 40, your PSA. I then repeat them during treatment.

Guidelines advise against the gel in some men (Bhasin, 2018). That includes men trying for a baby soon, and men with prostate or breast cancer or a raised haematocrit. It also includes untreated severe sleep apnoea, uncontrolled heart failure, and a heart attack or stroke in the last six months.

But testosterone reliably helps desire only when it was truly low. In men who were not clearly deficient, the benefit was uncertain (Corona, 2014a).

What I never use: injections and testosterone tablets

Testosterone replacement comes as gels, skin patches, injections, tablets or capsules, and implanted pellets. In my practice I use only the gel, and only as a last option. I never use injectable or oral testosterone.

Injections shut down sperm production powerfully (WHO Task Force, 1990). For a man with low libido, I find the gentler steps above safer and usually enough.

👶 Trying for a baby? Read this before any treatment

This section is the most important part of the article for young married men. Any outside testosterone, whether injection, gel or a “booster” containing it, can switch off sperm production.

In the WHO contraception trial, weekly testosterone injections left 65% of men with no sperm within six months (WHO Task Force, 1990). Recovery after stopping usually takes months, and in some men up to two years (Liu, 2006). That is why the Endocrine Society advises against testosterone in men planning a pregnancy soon (Bhasin, 2018).

Medicines such as clomiphene raise a man’s own testosterone rather than replacing it (Katz, 2012; Huijben, 2022). They are off-label and not right for everyone.

I decide this with each couple who are trying. If fertility is a worry, my guide to low sperm count is a good next read.

🌿 How to increase sex drive in men naturally

How can a man regain his libido without medicines? Often, by fixing the everyday things that quietly drain it.

So, here is how to increase sex drive naturally. I give every man these steps, in order of how much they help in my clinic.

What genuinely helps

1. Lose the extra waist. Weight loss raises testosterone in overweight men, and the more weight lost, the bigger the rise (Corona, 2013b).
2. Protect your sleep. Aim for seven to eight hours. Even one full night (24 hours) without sleep lowers testosterone (Su, 2021). Get loud snoring checked.
3. Move every day, and add strength training twice a week, but do not overdo it. Exercise lifts mood, energy and erections. Interestingly, training did not raise testosterone in inactive men (Potter, 2021). And the very hardest endurance training went with lower libido (Hackney, 2017).
4. Cut alcohol to a minimum. Heavy drinking goes with desire problems (Pendharkar, 2016).
5. Stop smoking. It harms erections, and with them, confidence (Allen, 2018).
6. Bring stress down. Stress is the most common reason men give for losing interest (Carvalheira, 2014). Even a daily walk, ten minutes of yoga or slow breathing, and a fixed switch-off time help.
7. Take a break from porn if you use it daily, and see whether desire for your partner returns.
8. Make time for each other. Feeling desired fuels desire in men (Murray, 2017). A weekly evening out, without phones, does more than any capsule.
9. Check zinc and vitamin D only if you may be low. Zinc raised testosterone in a small study of zinc-deficient older men (Prasad, 1996). Vitamin D did nothing for men with normal testosterone (Lerchbaum, 2017).
10. Eat a Mediterranean-style diet, the Indian way: vegetables, fruit, dal, nuts and fish, with less white rice and sweets. It helps your weight and sugar, which helps desire.

What does not help

Some popular advice does nothing, or harms. Men often ask me for a food to increase sex drive.

Here is the honest answer: no food works fast. Oysters, chocolate and “aphrodisiac” foods have no good trials behind them for desire in men.

Cold showers and fasting for days do not raise libido either. Neither does extreme endurance training; in fact, it can lower it (Hackney, 2017).

Equally, avoiding masturbation to “save” semen does not build desire. If anything, the guilt and anxiety make it worse. My guide to semen retention benefits explains what abstinence really does and does not do.

And do not wait it out. Months of silence harden into avoidance, and most causes are easier to fix early.

💊 Libido supplements for men: what the evidence shows

What supplements can increase libido in men? This is one of the commonest questions I get, usually with a photo of a capsule bottle. Here is an honest summary of the trials.

Overall, a review looked at 32 trials of 13 herbs. Only 9 showed a rise in testosterone, and only 6 were of low risk of bias (Smith, 2021).

So most “boosters” are unproven. Whatever you consider, take it only on a doctor’s prescription, never off the shelf or from a gym.

Sources for the table (Mutha, 2025; Khanna, 2026; Lopresti, 2019; Shukla, 2009; Neychev, 2005; Kamenov, 2017; Gonzales, 2002; Shin, 2010; Steels, 2011; Lee-Ødegård, 2024; Prasad, 1996; Lerchbaum, 2017; Tucker, 2018; Saper, 2008).

The danger in “herbal” sex-power products

As I said above, sex-power products are the supplements most often caught with hidden drugs, mainly sildenafil (Tucker, 2018). Ayurvedic products bought online can also carry lead, mercury or arsenic (Saper, 2008).

So if a capsule gives you a sudden, strong erection within an hour, it probably contains a drug. With nitrate heart tablets such as isosorbide or nitroglycerin, hidden sildenafil can drop your blood pressure dangerously. Buy only from reputable makers, and tell me everything you take.

🔁 Can low libido be cured, and how long does it take?

Yes, in most men, because most causes can be fixed. The timeline follows the cause.

Here is roughly what I see in my clinic. Only the prolactin, thyroid and gel lines come from studies.

• Fear of ED or PE: often within weeks of the erection or timing improving.
• A medicine change: in my experience, usually weeks to a few months after the switch. A few men’s symptoms persist after stopping finasteride, though (Irwig, 2011).
• High prolactin: desire usually improves within months of treatment (Corona, 2007).
• Thyroid: sexual problems had improved when men were rechecked 8 to 16 weeks after thyroid levels normalised (Carani, 2005).
• Testosterone gel: gains tend to appear within about a month (Wang, 2000).
• Weight, sleep and stress: steady improvement over two to three months.
• Relationship work: varies from couple to couple; it is slower, but the results last.

Can it come back? Yes, if the cause returns: weight regained, stress rebuilt, a medicine restarted. That is why I teach men to recognise their own early signs.

💞 My husband has a low sex drive: how can I help him?

What can you do if your husband has low libido? First, please do not take it as rejection. In my experience, the wife usually blames herself.

She feels less attractive, or suspects an affair. Far more often, he is stressed, low, frightened of failing, or unwell.

The partner’s side matters in medicine too. In one clinic study, the partner’s illness or low desire was itself linked with low desire in the man (Corona, 2006). So this is a couple problem with a couple solution.

What to do if a man is not interested in sex

• Choose a calm moment, not the bedroom, to talk. Start with care: “I miss being close to you.”
• Ask about stress, sleep, mood and any new medicines, gently.
• Take the pressure off. For a few weeks, agree on closeness without any expectation of sex.
• Come to the appointment together if he agrees. I see couples together, and it shortens the journey.

What are the side effects of a lack of sex in a relationship?

Months without intimacy often bring distance, irritability, misunderstanding and self-doubt on both sides. Yet it is fixable at almost any stage. My guide to the sexless marriage covers this in depth.

Is it the wife whose desire has faded? Then my page on female sexual problems is the right place to start.

📅 When to see a doctor for low libido

Low libido is worth a proper assessment if:

• it has lasted more than three months and bothers you or your partner (you do not need to wait for the six months doctors use to label it);
• the drop began suddenly, or soon after starting a new medicine;
• erection problems, finishing too fast or fewer morning erections come with it;
• you have diabetes, a big waist, loud snoring or low mood;
• steroids or gym “testosterone” are, or were, part of your routine;
• a baby is planned in the next year or two;
• headaches, vision changes, nipple discharge, a testicular lump or shrinking testicles come with it (book promptly).

Which doctor should you see?

An andrologist or a sexologist, who can check hormones, erections, timing, mood and the relationship together.

In my clinic in T Nagar, Chennai, the first visit covers your history, an examination and the morning blood tests. Everything you say stays private.

If you recognise yourself in these notes, you are in good company. Most of these men are doing well a few months later.

❓ Low libido in men: your questions answered

Short answers to the questions men search for most. The detail is in the sections above.

🎯 The bottom line

Low libido in men is common, and it is a symptom, not a verdict. Stress, mood, medicines, sugar, sleep, weight, hormones, the relationship and fear of failing in bed can all switch desire off. Most men have more than one.

The fix starts with finding every cause, with a proper fasting morning blood test and an honest conversation. I treat erection and timing problems first, review medicines, counsel the couple, and correct the hormones. When testosterone is truly low, I climb my ladder slowly and keep testosterone gel as the last option.

I hope this has answered your worry. This is Dr Shah, consultant andrologist in Chennai.

If your desire has gone quiet, call me on 97907 83856 or message me on WhatsApp. Nothing you say leaves the room.

Private consultation

Get your desire back, one cause at a time

A practising andrologist in Chennai. I check hormones, erections, timing, mood and the relationship together, then treat them in the right order.

Book a Consultationor call +91 97907 83856

References

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Testosterone therapy, fertility and alternatives

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Steroids, alcohol, tobacco and cannabis

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Ashwagandha and velvet bean

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Tribulus, maca and fenugreek

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