What it is
Male hypoactive sexual desire disorder is persistently or recurrently low or absent sexual desire and sexual thoughts in a man, to a degree that causes him distress. It is diagnosed only when the reduction is persistent and genuinely distressing, taking into account the man's age and life circumstances, since desire naturally varies and tends to decline somewhat with age.
A strong cultural stereotype holds that men always want sex and are always ready for it. This is untrue, and the stereotype does real harm, because it adds shame and silence to an already difficult experience and can make a man feel that low desire is a failure of masculinity. Low desire in men is a real, recognised and not uncommon condition, distinct from erectile difficulty (which is about the physical erection rather than desire itself), and it usually has identifiable and treatable causes.
What it can involve
A man may notice little interest in sex, few sexual thoughts or fantasies, and reduced initiation, sometimes alongside low energy or low mood more generally. It can strain relationships, particularly where a partner interprets it as rejection or as a sign the man is unfaithful or no longer attracted to them, when the real cause lies elsewhere. The distress is often compounded by the difficulty of talking about it, given the stereotype that makes low desire feel especially shameful for men.
How common is it
Low sexual desire in men is more common than the stereotype suggests, increasing with age but present at all ages, and frequently linked to physical health, mood and life stress. It is substantially under-reported and under-treated, largely because of embarrassment and the assumption that it cannot or should not happen to men.
What causes it
The causes are usually physical, psychological or relational, often in combination. Physical contributors include low testosterone, other hormonal or medical conditions, chronic illness, fatigue, sleep problems (including sleep apnoea), excessive alcohol, and the side effects of some medicines, including certain antidepressants. Psychological factors include depression, which very commonly lowers desire, anxiety, stress, and low mood. Relationship factors, conflict, loss of connection, or difficulties in the relationship, also reduce desire. Because depression and low testosterone are both common and treatable causes, identifying them is especially worthwhile.
How it is diagnosed
A doctor explores the nature, duration and context of the low desire and the distress it causes, reviews general health, mood, sleep, alcohol and medicines, and may check testosterone and other factors with blood tests. Screening for depression is important, since it is a frequent and treatable cause. The assessment distinguishes low desire from erectile difficulty, since the two are different and sometimes confused, and considers the relationship context. A respectful, matter-of-fact approach helps overcome the embarrassment that keeps many men from seeking help.
How it is treated
Treatment addresses the underlying cause, and the outlook is good when the cause is found. If low testosterone is confirmed by proper testing, a doctor may consider hormone treatment, which is prescribed and monitored carefully and only when genuinely indicated. If depression is the driver, treating it often restores desire, and where an antidepressant is the cause, the prescriber may adjust it. Improving sleep, reducing alcohol, managing chronic illness and addressing stress all help. Psychological and relationship approaches, including therapy and couple work, help where emotional or relational factors are involved. As with the other conditions here, combining medical and psychological approaches often works best.
Low sexual desire in the African context
Low sexual desire in men is rarely talked about here, and because cultural expectations often assume men always want sex, a man whose desire has fallen may feel confused or ashamed and stay silent. Yet it is common and frequently has clear, treatable causes: low testosterone, diabetes, thyroid problems, depression, stress, exhaustion, relationship strain, alcohol, and the effects of some medicines, several of them common in our setting. Because some of these are medical, low desire is worth a check-up rather than embarrassment. Understanding it as a health and life matter, not a failure of manhood, and looking for the cause, is what leads to effective help.
Getting help and support
Finding the cause is the key, and a calm approach helps.
- See a doctor, since causes such as low testosterone, thyroid problems, diabetes, and depression are treatable.
- Review medicines with a prescriber rather than stopping them yourself, since some lower desire.
- Address stress, exhaustion, alcohol, and low mood, which commonly reduce desire.
- Work on the relationship and communication with a partner, gently and without blame.
- Seek a clinician or therapist experienced in sexual health where it persists or causes distress. Our find a therapist page can help.
When to seek help
See a doctor if persistently low sexual desire is causing you distress. This is a legitimate health matter, not a failure of manhood, and it often points to something treatable such as low testosterone or depression. A proper assessment can identify the cause and guide effective treatment, and addressing it can benefit your overall health and your relationship as well.
Sources
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
- Rastrelli, G., & Maggi, M. (2017). Erectile dysfunction in fit and healthy young men: Psychological or pathological? Translational Andrology and Urology, 6(1), 79-90.
- McCabe, M. P., et al. (2016). Risk factors for sexual dysfunction among women and men: A consensus statement. The Journal of Sexual Medicine, 13(2), 153-167.
- Corona, G., et al. (2013). Low sexual desire in men. Best Practice & Research Clinical Endocrinology & Metabolism, 27(4), 541-558.