What causes a low sex drive in women?

Relationship strain, stress, tiredness and low mood come first. Hormone shifts with pregnancy, breastfeeding and menopause, hormonal birth control, antidepressants, and pain during sex from vaginal dryness are the other common causes. Less often, high prolactin, an underactive thyroid or diabetes are involved.

What causes a low sex drive in men?

Stress, tiredness, the relationship, depression, alcohol and medicines are common in men too. Low testosterone is the leading hormone cause, and low libido is listed first among its sexual symptoms. Diabetes, obesity, opioid painkillers and a high prolactin can all lower testosterone.

How common is a low sex drive?

Cleveland Clinic says it “affects up to 1 in 5 men, and even more women, at some point in life.” It is common and often temporary.

What blood tests check for low libido?

There is no single libido test. Depending on the story, clinicians check total testosterone (in men, on two morning samples), sometimes free testosterone and LH, prolactin, TSH for the thyroid, and HbA1c or fasting glucose for diabetes. In women around menopause, FSH and estradiol are sometimes measured.

Can antidepressants lower sex drive?

Yes. The NHS lists low sex drive and difficulty reaching orgasm as common side effects of SSRI antidepressants. It also warns against stopping an antidepressant suddenly or without talking to your doctor first. A prescriber can talk through options.

Can birth control lower your libido?

It can for some people. The NHS and Cleveland Clinic both list hormonal contraception, such as the pill, patch, ring, implant or injection, as a possible cause. The NHS suggests seeing a GP if you think contraception is affecting your sex drive.

Do libido supplements work?

The evidence for herbal libido products is weak, and the FDA keeps a running list of sexual enhancement products sold as supplements that contained hidden drug ingredients, warning they “pose a serious health risk and are not guaranteed to work.” Finding and treating the cause is the reliable route.

Why is my libido so low? The common causes of a low sex drive

Q: Why is my libido so low?

The common reasons are stress, tiredness, problems in the relationship, depression or anxiety, drinking too much alcohol, and medicines such as antidepressants, some blood pressure drugs and hormonal birth control. Pregnancy, a new baby and menopause lower desire in many women, and low testosterone is the main hormone cause in men. Thyroid problems, diabetes and a high prolactin are less common medical causes that blood tests can check.

The distinctions

01
Low desire is different from a body that won't respond
Libido is wanting sex. Erection problems, vaginal dryness and trouble reaching orgasm are about the body's response. They often travel together, but they have different causes and different treatments: erection tablets such as sildenafil help blood flow and do not increase desire.
02
A low sex drive is only a problem if it bothers you
Sex drive varies a lot between people and across a life. Cleveland Clinic advises talking to a clinician when it bothers you or affects your well-being, not because it falls below some number.

A low sex drive (low libido) means feeling less interest in sex than you used to, and most of the time the cause is ordinary: stress, tiredness, the state of the relationship, low mood, alcohol or a medicine. ¹² Life stages play a big part, from pregnancy and a new baby to menopause in women and slowly falling testosterone in men. ¹³ A smaller share comes from medical causes a blood test can check: low testosterone, a high prolactin (a pituitary hormone), an underactive thyroid or diabetes. ¹⁶

When to get help now

Low desire itself is never an emergency. These are.

Call 911 or your local emergency number

An erection that is painful or lasts longer than 4 hours ¹⁰
Chest pain during or after sex, especially with dizziness, nausea or shortness of breath ¹⁰
Low mood with thoughts of harming yourself: call or text 988, the Suicide & Crisis Lifeline, any time ¹¹

See a doctor soon, the same day if you can

Milky discharge from the nipples, or periods that stop, without pregnancy ⁶
New headaches or changes in your vision with low desire ⁶
Low desire with enlarged breasts in a man, or loss of muscle and body hair ⁵
Pain during sex that keeps happening ¹
Low mood that has lasted more than two weeks

LifeFrom can't examine you or assess a symptom. If something feels seriously wrong, trust that and get care rather than waiting on a test.

What counts as a normal sex drive?

There is no normal number. Cleveland Clinic puts it this way: “Everyone's sex drive is different, and it can change throughout your life.” ¹ Desire rises and falls with health, age, stress, relationships and hormones. A drop is worth looking into when it bothers you or your partner, when it is new and unexplained, or when it comes with other symptoms such as tiredness, low mood or changes in your periods or erections. ¹

Low desire or a body that won't respond?

Libido is the wanting. Arousal and function are the body's part: erections in men, lubrication and orgasm in women. The two get tangled, because sex that hurts or fails to work tends to kill desire over time, but they are not the same problem. ¹ The MedlinePlus label for sildenafil, an erection drug, is blunt that it “does not cure erectile dysfunction or increase sexual desire.” ¹⁰ Telling a clinician which part changed first, the wanting or the working, points them toward the right causes.

Is it low desire, or a problem with the body's response?

Low desire (libido)Look first at stress, mood, sleep, the relationship, medicines and hormones

less interest in sex

What you noticeYou rarely think about or want sex

Common causesStress, depression, tiredness, medicines, menopause, low testosterone ¹

Tests that may helpTestosterone, prolactin, TSH, HbA1c ³⁶

Response problemsLook at blood flow, nerves, menopause changes and pain

erections, dryness, pain, orgasm

What you noticeYou want sex but the body does not follow, or it hurts

Common causesDiabetes, vaginal dryness, menopause, some medicines ⁷⁹

Tests that may helpHbA1c and glucose; a physical or pelvic exam ¹⁷

The two often overlap, and one can lead to the other. Sources: Cleveland Clinic; NIDDK; MedlinePlus.

What can cause it, most likely first

Ranked from most to least likely in adults in general. The order shifts with age, sex and history: menopause rises to the top for women in their late 40s and 50s, low testosterone for older men, and medicines for anyone who started one recently.

01
Stress and relationship problemsEverydaycommon
Stress from work, family or daily life, and problems in the relationship such as a lack of trust or closeness, are among the most common reasons desire drops. ¹ The NHS lists relationship problems, stress and anxiety first among its causes. ² No blood test reads these; talking, and sometimes couples or sex therapy, does.
02
Tiredness and poor sleepEverydaycommon
Physical fatigue is one of the mental and physical factors Cleveland Clinic lists, and caring for a new baby is a classic combination of exhaustion and hormone change. ¹² If you are worn out most days, the fatigue and can't sleep pages cover the causes and the tests for those.
03
Medicines, including antidepressants and birth controlEverydaycommon
Antidepressants, antipsychotics, some blood pressure medicines and chemotherapy can lower sex drive, and so can some hormonal birth control (the pill, patch, ring, implant or injection). ¹² The NHS lists low sex drive and trouble reaching orgasm as common side effects of SSRI antidepressants. ⁸ Opioid painkillers can lower testosterone in men. ³ Do not stop or change a medicine on your own; a prescriber can weigh the options.
04
Depression and anxietyMedicalcommon
Depression, low self-esteem and hopelessness can take desire with them, and anxiety does the same. ¹² No blood test diagnoses depression; a clinician asks about mood, sleep and interest in things you used to enjoy. If low mood comes with thoughts of self-harm, call or text 988 now. ¹¹
05
Alcohol and drugsEverydaycommon
Drinking too much alcohol or misusing drugs can lower sex drive. ¹²
06
Pregnancy, a new baby and menopauseMedicalcommon
Hormones shift sharply in pregnancy, after birth and while breastfeeding, and the tiredness of a new baby adds to it. ² Around menopause (usually between 45 and 55), estrogen falls, and “decreased interest in sex” and vaginal dryness with painful sex are common symptoms. ⁹ Hormone tests can support the picture, but menopause is usually recognized from age and periods.
FSH
A high FSH (follicle stimulating hormone) with a low estradiol fits menopause; in the years before, levels swing, so a provider may repeat the test. ⁹
Estradiol
A low estradiol after periods stop fits menopause; on its own one result says little while periods are still coming. ⁹
07
Low testosterone in menMedicalless common
Testosterone shapes libido in men, and low libido is listed first among the sexual symptoms of low testosterone. ³ Levels fall about 1% a year from the late 30s, and obesity, diabetes, opioids and pituitary problems can push them lower. ³ The Endocrine Society guideline says the diagnosis needs symptoms plus “unequivocally and consistently low” testosterone on repeated fasting morning tests. ⁴
Can be linked with Low testosterone
Testosterone, total
Below 300 ng/dL is usually called low in adult men, and it should be confirmed on a second morning sample because levels are highest in the morning and illness lowers them. ³⁴
Testosterone, free
The share not bound to proteins; a low free testosterone can matter when total sits near the cutoff. The guideline bases diagnosis on low total and/or free testosterone. ⁴
LH
With low testosterone, a high LH (luteinizing hormone) points to the testes, and a low or normal LH points to the pituitary or brain signal. ⁴
08
Thyroid problemsMedicalless common
An underactive thyroid is one of the health conditions linked with a lower sex drive, often alongside tiredness, weight gain, feeling cold and low mood. ¹¹⁴ Nearly 5 in 100 Americans aged 12 and over have hypothyroidism. ¹⁴
Can be linked with Hypothyroidism
TSH
A high TSH (thyroid stimulating hormone) points to an underactive thyroid; it is the usual first thyroid test. See how to read your thyroid panel.
Free T4
A low free T4 with a high TSH fits an underactive thyroid; the thyroid panel guide explains the other patterns.
09
DiabetesMedicalless common
In women with diabetes, nerve damage can lead to low sexual desire, vaginal dryness and painful sex. ⁷ Men with diabetes are more than 3 times as likely to develop erection problems and more likely to have low testosterone, especially if older and overweight. ⁷ See blood sugar explained for how the tests work.
HbA1c
A high HbA1c means blood sugar has been running high over recent months, the pattern linked with diabetes and with the nerve and blood vessel damage that affects sex. ⁷
Glucose, fasting
A high fasting glucose points the same way; it needs a fast beforehand. See blood sugar explained.
10
High prolactinMedicalrare
Prolactin is a pituitary hormone; too much of it lowers sex drive in women and men, and in men it comes with low testosterone and erection problems. ⁶ In women it can also cause irregular or missing periods and milky nipple discharge. ⁶ The cause is often a prolactinoma, a benign pituitary growth, or a medicine such as some antipsychotics, blood pressure drugs, anti-nausea drugs or opioids. ⁶
Prolactin
A high prolactin can be linked with a prolactinoma or with a medicine; if it is high and a medicine or other cause does not explain it, an MRI of the pituitary is the usual next step. ⁶
11
Pain or dryness during sexMedicalless common
Pain during sex, vaginal dryness and trouble reaching orgasm make sex stressful, and desire often fades as a result. ¹ Menopause, breastfeeding, diabetes and some medicines are common causes of dryness. ⁷⁹ No blood test checks pain with sex; a pelvic exam does. ¹

These are things a symptom like this can be linked with, not a diagnosis. Several can sit together, and a clinician who knows your history puts them in order for you.

Low sex drive in women

Women search for this far more than men, and Cleveland Clinic says low libido affects more women than men over a lifetime. ¹ For women, desire is often tied to how the rest of life is going: sleep, stress, how the relationship feels, body image and whether sex is comfortable. ¹ The hormone milestones carry a lot of weight. Pregnancy and the months after a birth, especially while breastfeeding, lower desire for many women, and the NHS suggests seeing a GP if sex drive has not returned to normal after pregnancy. ² Around menopause, falling estrogen brings “decreased interest in sex or changes in sexual response” along with dryness that can make sex painful. ⁹

Hormonal birth control deserves a mention because it is easy to overlook: the pill, patch, ring, progestogen-only pill, implant and injection can all lower desire in some people. ¹ Contraception changes are a conversation for your prescriber, since switching methods carries its own trade-offs. ²

Low sex drive in men

Men get the same everyday causes, and they are still the most common ones. ¹ Low testosterone gets the attention because it is testable, and because low libido and erection problems are its most specific signs. ³ It is a diagnosis that takes care: the American Urological Association treats a man as testosterone deficient “only when they meet both criteria,” low levels and symptoms together. ¹³ A single low reading after a bad night, an illness or in the afternoon is not enough, which is why two morning samples are standard. ³⁴

Can medicines cause a low libido?

Often. Antidepressants, especially SSRIs, are the best-known example: the NHS lists “problems with sex, such as low sex drive, finding it difficult to orgasm” among their common side effects, and notes that for some people these can carry on after stopping. ⁸ Blood pressure medicines, antipsychotics, opioids and hormonal contraception are the others to think about. ¹²³ The NHS is firm that you should not stop an antidepressant suddenly; it suggests agreeing a plan with your doctor. ⁸ A prescriber can talk through the options.

Can depression cause a low sex drive?

Yes, and it runs both ways: depression lowers desire, and the medicines that treat it can too. ¹⁸ Losing interest in sex alongside losing interest in food, friends or hobbies, poor sleep and feeling hopeless for more than a couple of weeks is worth raising with a clinician on its own. If you have thoughts of harming yourself, call or text 988; the Lifeline is “available 24/7/365” and conversations are free and confidential. ¹¹

The panel that checks these

If a clinician tests, the first round is usually total testosterone in men (fasting, in the morning, repeated if low), prolactin, TSH and HbA1c, because those read the medical causes that are treatable. ³⁴⁶ FSH and estradiol come in for women around menopause, and LH when a man's testosterone is low.

FSHPregnancy, a new baby and menopause
EstradiolPregnancy, a new baby and menopause
Testosterone, totalLow testosterone in men
Testosterone, freeLow testosterone in men
LHLow testosterone in men
TSHThyroid problems
Free T4Thyroid problems
HbA1cDiabetes
Glucose, fastingDiabetes
ProlactinHigh prolactin

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Getting a useful test

Say which changed first: desire, erections, dryness, pain or orgasm.
Bring every medicine and supplement, with start dates, including birth control and anything bought for libido or testosterone. ¹¹²
Testosterone is read from an early morning, fasting draw, and a result taken during or just after an illness can be misleadingly low. ³⁴
Prolactin can rise with some medicines, so tell the clinician everything you take; a high result is read with your medicine list. ⁶
High-dose biotin can distort thyroid tests, most often making TSH look falsely low; mention it. ¹⁵
One result is a snapshot; see why trends beat single readings.

What may help

Treating the cause is what helps most, and the NHS puts it plainly: “Treating the cause should help increase your sex drive.” ² The everyday steps below have the best support.

Start with the everyday things

Protect sleep and recovery; tiredness is one of the commonest causes. ¹
Keep alcohol moderate; heavy drinking lowers desire. ¹
Talk to your partner, and consider couples or sex therapy; the NHS lists counselling for relationship difficulties as a treatment. ²
Use a lubricant if dryness makes sex uncomfortable. ²
Aim for a healthy weight and stay active; obesity is linked with low testosterone in men. ³

No supplement has good evidence for raising libido, so none is listed here. Products sold for sexual enhancement have been found to contain hidden drug ingredients, and the FDA warns they “pose a serious health risk and are not guaranteed to work.” ¹² Supplements support general wellness. They don't treat the causes above, and if a test finds one, treating that comes first. If you take medicines, are pregnant or have a health condition, check with your clinician before starting anything.

Questions to ask your clinician

Could any of my medicines or my birth control be lowering my sex drive, and what are the alternatives?
Is this more likely low desire, or a problem with arousal, erections or pain?
Should we check testosterone (in the morning, twice), prolactin, TSH or HbA1c?
Could perimenopause or menopause explain this, and what are the options for dryness or pain?
Would counselling or sex therapy help, and can you refer me?

This page is general education, not medical advice or a diagnosis. A low sex drive usually has more than one cause, and the clinician who knows your history, your medicines and your results is the one to sort them out with you.

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Citations

Educational context only, not medical advice or a diagnosis. Always discuss your results with a clinician.

Why is my libido so low? The common causes of a low sex drive, and the tests that check them