In short
Low libido is treated by finding its cause, because almost every cause has its own specific treatment.
- Confirmed low testosterone: replacement improves desire reliably, more reliably than it improves erections.
- Medication, usually an SSRI: there are specific strategies, and stopping the antidepressant is not one of them.
- Depression: treated as depression. Desire usually follows.
- The relationship: couples counselling, which is often the treatment that works.
Testosterone given to a man whose level is normal does not help.
Treatment Overview
Treatment by cause
| Low testosterone | Replacement, once confirmed. The most reliably treatable hormonal cause |
| Raised prolactin | Treated in its own right, usually with medication |
| Thyroid disease | Both an underactive and an overactive thyroid cause it. Both correctable |
| Low oestradiol | Associated with low libido in men, and worth measuring |
| SSRIs and other drugs | Specific strategies exist. Antiandrogens, 5 alpha reductase inhibitors and opioids also contribute |
| Depression | Treated as depression, formally or with psychotherapy |
| Relationship factors | Couples counselling by someone skilled in this area |
| Alcohol and systemic illness | Addressed directly, which is more effective than anything added on top |
Where testosterone genuinely helps
In men whose levels are unequivocally low. Testosterone is an important regulator of sexual desire, and replacement improves libido, sexual activity and erectile function in men who are deficient.
In the TRAVERSE trial, testosterone significantly improved hypogonadal symptoms, sexual activity and sexual desire compared with placebo, though not erectile function. That distinction is the point: it is a desire treatment more than an erection treatment.
Where it does not help
In men with normal testosterone. Prescribing it on a single borderline result, without checking prolactin and thyroid function, is the most common error in this area and leaves the real cause untreated.
That is why a low result is repeated, with LH and prolactin, before any decision.
The antidepressant problem
SSRIs are the most common medication cause of low libido, and they are also treating the depression that itself causes low libido. Both cannot simply be ignored.
There are specific management strategies for SSRI associated sexual side effects, including changing to a different antidepressant. What does not work is stopping treatment without a plan.
Opioids
Sexual dysfunction is common in men on long term opioids, and those men usually have low testosterone as a consequence of the opioid.
Recognising that changes the approach: this is a medication effect with a hormonal consequence, not a primary hormonal disorder, and reviewing the pain management is part of the treatment.
The one that is hardest to raise
Interpersonal conflict is one of the more common and least acknowledged causes of male sexual dysfunction, and couples counselling by someone skilled in this area is frequently effective.
It will not show on any panel, and no dose adjustment will address it.
Who Is a Good Candidate?
- Desire has dropped and you want the cause identified rather than a default prescription
- You have been offered testosterone on a single borderline result
- Desire fell after starting an antidepressant, an opioid or a prostate medication
- Mood, energy and motivation have dropped alongside desire
- You are already on testosterone and it has not improved things
- Milky discharge from the breasts, which needs prolactin checked promptly
- Headache with changes in your visual fields
- Thoughts of self harm, or loss of interest in everything rather than only in sex, which need assessment now
What Happens During the Consultation
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1
Desire or erections, and which came first
They are separate problems with different treatments. Most men presenting with erectile dysfunction do not report low desire, so when both are present the chronology identifies the primary problem.
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2
The four hormones
Total testosterone, prolactin, thyroid stimulating hormone and oestradiol. A low testosterone is repeated with LH and prolactin before any treatment decision, because a single reading is not a diagnosis.
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3
Medication, alcohol and mood
SSRIs, antiandrogens, 5 alpha reductase inhibitors and opioids asked about specifically. Depression screened for properly, since it is a leading cause and often not volunteered.
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4
The plan, matched to the cause
Replacement where deficiency is confirmed, a medication change where a drug is responsible, treatment of depression where that is the driver, and referral for couples counselling where the relationship is.
Program Structure & Follow-Up
If testosterone is prescribed
- The diagnosis is confirmed on a repeat sample first, with LH and prolactin
- Effect on desire is reviewed, since that is what it treats most reliably
- Monitoring is ongoing rather than one off, and its schedule and cost are explained before you start
- Where erections are also a problem, a PDE5 inhibitor is usually added, because testosterone alone is less effective for that
If a medication is the cause
- Reviewed at four to six weeks after any change, both for sexual function and for the original condition
- The depression, pain or prostate symptoms being treated are not left unmanaged in order to solve the sexual problem
If nothing hormonal is found
That is a common and useful result. It moves the focus to mood, alcohol, fatigue, sleep and the relationship, all of which are treatable and none of which would have responded to hormones.
What a realistic timeline looks like
| Correcting thyroid or prolactin | Weeks to a few months |
| Testosterone replacement | Desire usually improves within weeks |
| Changing an antidepressant | Four to six weeks to judge |
| Counselling | Longer, and measured against your goals rather than a fixed interval |
Benefits, Limits & Safety
What responds well
Confirmed testosterone deficiency, raised prolactin, thyroid disease and medication effects all have clear treatments with predictable results.
Testosterone in particular improves libido reliably in deficient men, and the greatest gains are in those with more severe deficiency.
What does not respond
- Low desire in a man with normal testosterone. Adding testosterone will not help and carries its own risks
- Low desire driven by a relationship problem, which needs addressing rather than prescribing around
- Low desire that is one part of an untreated depression
Why the diagnosis is repeated before treating
Because testosterone replacement is not a trial you can casually stop. It requires monitoring, it can suppress your own production, and it has implications for fertility.
Starting it on a single borderline result is easy to do and difficult to undo, which is why confirmation with a repeat sample, LH and prolactin comes first.
The uncomfortable but useful finding
In a large series of men presenting with erectile dysfunction, testing only those with low desire or physical signs of deficiency would have missed 40 per cent of the low testosterone cases, including 37 per cent of those who responded to treatment.
So testosterone is measured broadly and treated narrowly, which is the opposite of how it is usually done.
Cause specific treatment works
Testosterone improves desire reliably where deficiency is confirmed. Prolactin, thyroid and medication causes all have their own effective treatments.
Confirm before treating
A low testosterone is repeated with LH and prolactin. Starting replacement on one borderline result is easy to do and difficult to undo.
When testosterone is not the answer
Normal levels, an untreated depression, a medication effect, or a relationship problem. None of these improves with testosterone.
Cost & Program Investment
The consultation and the hormone panel are quoted before anything is ordered. The panel covers testosterone, prolactin, thyroid function and oestradiol rather than a broad screen. If testosterone replacement turns out to be indicated, the ongoing monitoring and its cost are explained before you start rather than after, because it is a long term commitment rather than a trial.
Frequently Asked Questions
If your level is genuinely low, very likely. It improves desire more reliably than it improves erections. If your level is normal, it will not help and it carries its own risks.
Because a single low reading is not a diagnosis, and starting replacement is easy to do and hard to undo. The repeat is taken with LH and prolactin, which also identify other causes.
Not on your own. There are specific strategies for SSRI associated sexual side effects, including changing to a different antidepressant, and stopping without a plan risks the depression returning, which itself lowers desire.
Very. Sexual dysfunction is common with long term opioid use and those men usually have low testosterone as a consequence. Reviewing the pain management is part of the treatment rather than separate from it.
Testosterone, prolactin, thyroid stimulating hormone and oestradiol. All four have been associated with low libido in men, and checking testosterone alone misses the others.
Then the cause is likely mood, alcohol, fatigue, sleep or the relationship, and those are addressed directly. That is a real answer rather than a dead end.
It depends on the cause. Thyroid and prolactin correction takes weeks to months. Testosterone usually improves desire within weeks. A change of antidepressant needs four to six weeks to judge.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.