Low Libido & Sexual Desire

What has changed for you?

You might recognise one or several of these:

• I rarely think about sex any more. Even situations that used to interest me barely register.
• I want intimacy, but my body doesn’t respond. Arousal, erections, lubrication or orgasm have become difficult.
• Desire disappeared after a treatment change. I noticed a difference after starting or adjusting an antidepressant, antipsychotic, hormonal treatment or another medicine.
• Sex has become uncomfortable or overwhelming. Pain, sensory sensations, trauma reminders or feeling watched or pressured make it difficult to enjoy.
• I feel disconnected from pleasure generally. The change came with low mood, exhaustion, poor sleep or reduced enjoyment of other activities.
• My desire depends strongly on the situation. I may enjoy sex once relaxed and engaged, but rarely feel the urge to initiate it.

Notice one detail: Does desire return when you’re alone, with a different kind of stimulation, or when you’re rested and comfortable? That can help distinguish a general change in sexual interest from a difficulty associated with a particular situation.

What might actually help?

If your sex drive changed after starting psychiatric medication

Start with a medication review—not by stopping treatment yourself. SSRIs and SNRIs can reduce desire or make orgasm harder. Some antipsychotics can also reduce sexual functioning, including by increasing the hormone prolactin.

What has helped in research? In a study of adults whose depression was well controlled but who had developed sexual problems while taking an SSRI, switching to vortioxetine improved a sexual-function questionnaire more than switching to escitalopram over eight weeks. The difference was about 2 points on that questionnaire, not a 2% improvement in libido (Jacobsen et al., Journal of Sexual Medicine, 2015).

In another trial, 218 women with SSRI-related sexual difficulties received either add-on bupropion or placebo. The bupropion group had better sexual-function scores after 12 weeks, including desire (Safarinejad, Journal of Psychopharmacology, 2011). Other trials have found less benefit, so this is an option to discuss, not a guaranteed fix.

Where to go: Your prescribing psychiatrist or clinician. Ask specifically about sexual side effects and whether a dose review, alternative medication or add-on treatment would be appropriate. Changes must account for the risk of relapse; some antidepressant changes require particular caution in bipolar disorder. Sexual problems occasionally persist after stopping an antidepressant and deserve medical attention rather than being dismissed (NHS antidepressant information).

If you take an antipsychotic

Ask whether prolactin should be checked. Raised prolactin can affect desire, erections, menstruation and other aspects of sexual health; sedation and other medication effects can contribute too.

Evidence: A small study of 52 people with antipsychotic-related high prolactin found improvements in sexual functioning after clinicians added or switched to aripiprazole. The study does not establish that this is the right change for everyone (study in Clinical Neuropharmacology, 2016).

Where to go: Your psychiatric team. Preserving psychiatric stability is essential when considering any change.

If hormone levels or physical changes may be involved

For men with possible testosterone deficiency: Loss of desire, fewer morning erections and low energy may justify testosterone testing. A diagnosis generally requires symptoms and repeatedly low morning blood levels. In trials involving older men with low testosterone, prescribed testosterone improved sexual desire modestly compared with placebo; it is not a general libido booster for men with normal levels (Snyder et al., New England Journal of Medicine, 2016; Endocrine Society guidance). If the main problem is an erection rather than desire, treatment may be different.

For women during or after menopause: Hot flushes, disrupted sleep, vaginal dryness or pain can interfere with desire. Treating discomfort may make sex enjoyable again, even if it doesn’t directly increase sexual interest. Vaginal moisturisers, lubricants and—when appropriate—local oestrogen are established options for dryness and pain (NICE menopause guidance).

For selected postmenopausal women with persistently low desire, specialist-prescribed transdermal testosterone has evidence of benefit. Across trials, it resulted in about one additional satisfying sexual experience per month compared with placebo, on average. Those results cannot simply be applied to people whose difficulty is caused by depression or psychiatric medication, and long-term safety remains incompletely established (Islam et al., The Lancet Diabetes & Endocrinology, 2019; ISSWSH clinical guideline, 2021).

If you use gender-affirming hormones: Desire may change after starting testosterone, oestrogen or androgen suppression. Discuss an unwanted change with the clinician managing your hormones; treatment goals and appropriate tests depend on your regimen and anatomy, not gender identity alone (WPATH Standards of Care, version 8).

Where to go: Your GP, sexual-health clinician, gynaecologist, urologist or endocrinologist, depending on the symptoms. Not everyone needs hormone tests; your history determines which are useful.

If sexual desire is low even without a clear medication or hormone cause

Consider specialist psychosexual therapy. It may include practical work on arousal, intimacy, attention to pleasurable sensations, communication, and factors that interrupt desire. For autistic people, sensory preferences and predictability may be particularly important; for people with PTSD, trauma-sensitive treatment and feeling safe may matter more than exercises aimed at increasing desire. We do not have a trustworthy percentage improvement for these specific neurodivergent or psychiatric groups.

What has helped in research? In a randomised study of 266 women seeking help for low sexual desire, online sex therapy based on CBT or mindfulness improved desire and reduced distress more than waiting for treatment. Benefits persisted for some participants at one year, but only around one in five met a stricter threshold for clinically significant improvement in desire. These findings do not establish the same effect in people with autism, PTSD or bipolar disorder (Velten et al., Journal of Consulting and Clinical Psychology, 2024).

Where to go: A properly qualified psychosexual therapist who is comfortable working with your diagnosis, sensory needs and medication history.

What about medicines marketed specifically for women’s low desire?

Flibanserin (Addyi) is an available prescription treatment in the United States for certain women under 65 with acquired, generalised low desire. In its clinical trials, women taking it reported roughly half to one more satisfying sexual experience per month than those receiving placebo, depending on the trial. It can cause dizziness, sleepiness and low blood pressure, and has important drug and alcohol precautions. Crucially, its US indication excludes low desire caused by a psychiatric condition, relationship problems or medication, so it is not an established treatment for antidepressant-related loss of libido (US prescribing information).

Where can you find help?

• AASECT referral directory — Search for certified sex therapists and counsellors; listings cover the US and some other countries.
• COSRT therapist finder — Find registered psychosexual and relationship therapists, primarily in the UK.
• NHS: Low sex drive — Free overview of common causes and routes to medical help.

A therapist directory confirms registration or certification criteria, not specialist expertise in autism, bipolar disorder or other conditions. Ask about that before booking. If the change followed a prescribed medicine, the prescriber is usually the most useful first contact.

One thing to do this week

Think back to when your desire changed. Note whether it happened alongside a new medicine, changes in mood or sleep, hormonal treatment, pain or sensory discomfort. Also notice whether the main difficulty is wanting sex, becoming aroused, or enjoying it once it begins.

Choose one next step based on the answer: request a medication review, raise a physical symptom with a clinician, or contact a suitably qualified psychosexual therapist. You do not have to solve every possible cause at once.

Never stop prescribed psychiatric or hormonal medicines abruptly. If sexual activity is painful, or the change is sudden and accompanied by other significant symptoms, seek a medical assessment.