Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes

It’s natural to sometimes lose interest in sex, but long-term low libido may have an underlying cause. It may stem from low testosterone, lack of sleep, depression or stress, substance use, and more. If changes in your sex drive concern you, a physician can offer more guidance.
Low libido describes a decreased interest in sexual activity. It’s common to lose interest in sex from time to time, and libido levels vary throughout life. It’s also normal for your interest not to match your partner’s at times. However, low libido for a long period may cause concern for some people. It can sometimes be an indicator of an underlying health condition.

* Low testosterone
Testosterone is an important male hormone. In men, it’s mostly produced in the testicles. Testosterone is responsible for building muscles and bone mass, and for stimulating sperm production.
Your testosterone levels also factor into your sex drive. Normal testosterone levels will vary. However, adult men are considered to have low testosterone, or low T, when their levels fall below 300 nanograms per deciliter (ng/dL), according to guidelines from the American Urological Association (AUA).
When your testosterone level decreases, your desire for sex also decreases. Decreasing testosterone is a normal part of aging. However, a drastic drop in testosterone can lead to decreased libido.

* Medications
Taking certain medications can lower testosterone levels, which in turn may lead to low libido. For example, blood pressure medications such as ACE inhibitors (Ramipril, Enalapril, etc.) and beta-blockers (Atenolol, propranolol) may prevent ejaculation and erection.
Other medications that can lower testosterone levels include:
* Chemotherapy or radiation treatments for cancer
* Hormones used to treat prostate cancer
* Corticosteroids
* Opioid pain relievers, such as morphine and oxycodone
* An antifungal medication called ketoconazole
* Cimetidine (Tagamet), which is used for heartburn and gastroesophageal reflux disease (GERD)
* Anabolic steroids, which may be used by athletes to increase muscle mass
* Certain antidepressants

* Restless legs syndrome (RLS)
Restless legs syndrome (RLS) is the uncontrollable urge to move your legs. A study found that men with RLS are at higher risk for developing erectile dysfunction (ED) than those without RLS. ED occurs when a man can’t have or maintain an erection. In the study, researchers discovered that men who had RLS occurrences at least five times per month were about 50 percent more likely to develop ED than men without RLS. Also, men who had RLS episodes more frequently were even more likely to become impotent.

Depression changes all parts of a person’s life. People with depression experience a reduced or complete lack of interest in activities they once found pleasurable, including sex.

*Chronic illness
When persons are not feeling well because of a chronic health condition, such as chronic pain, sex is likely low on their list of priorities. Certain illnesses, such as cancer, can reduce sperm production counts as well. Other chronic illnesses that can take a toll on your libido include type 2 diabetes, obesity, high blood pressure, high cholesterol, and chronic lung, heart, kidney, and liver failure

*Sleep problems
A study in the Journal of Clinical Sleep Medicine found that nonobese men with obstructive sleep apnea (OSA) experience lower testosterone levels. This in turn leads to decreased sexual activity and libido. In the study, researchers found that nearly one-third of the men who had severe sleep apnea also had reduced levels of testosterone. In another recent study in young, healthy men, testosterone levels were decreased by 10 to 15 percent after a week of sleep restriction to five hours per night.
The researchers found that the effects of restricting sleep on testosterone levels were especially evident between 2:00pm and 10:00pm the next day.

Testosterone levels, which are linked to libido, are at their highest when men are in their late teens. In older years, it may take longer to have orgasms, ejaculate, and become aroused. Erections may not be as hard, and it may take longer for your penis to become erect. However, medications are available that can help treat these issues.

Being distracted by situations or periods of high pressure may decrease sexual desire. This is because stress can disrupt hormone levels. Arteries can narrow in times of stress. This narrowing restricts blood flow and potentially causes ED. One study published in Scientific Research and Essays supported the notion that stress has a direct effect on sexual problems in both men and women. Another study of veterans with post-traumatic stress disorder (PTSD) found that the stress disorder increased their risk of sexual dysfunction more than threefold.
Stress is hard to avoid. Relationship problems, divorce, facing the death of a loved one, financial worries, a new baby, or a busy work environment are just some of the life events that can greatly affect the desire for sex. Stress management techniques, such as breathing exercises, meditation, and talking to a therapist, may help.
In one study, for example, men who were newly diagnosed with ED showed significant improvement in erectile function scores after participating in an 8-week stress management program.

*Low self-esteem
Self-esteem is defined as the general opinion a person has about self. Low self-esteem, low confidence, and poor body image can take a toll on your emotional health and well-being. If men feel that they’re unattractive or undesirable, it’ll likely put a damper on sexual encounters. Not liking what you see in the mirror can even make you want to avoid having sex altogether. Low self-esteem may also cause anxiety about sexual performance, which can lead to issues with ED and reduced sexual desire.
Over time, self-esteem issues can result in larger mental health problems, such as depression, anxiety, and drug or alcohol abuse — all of which have been linked to low libido.

*Too little (or too much) exercise
Too little exercise (or none at all) can lead to a range of health problems that can affect sexual desire and arousal. Getting regular exercise may reduce your risk for chronic conditions such as obesity, high blood pressure, and type 2 diabetes, all of which are associated with low libido.
Moderate exercise is known to lower cortisol levels at night and reduce stress, which can help increase sex drive.
On the other hand, over-exercising has also been shown to affect sexual health. In one study, higher levels of chronic, intense, and lengthy endurance training regularly were strongly associated with decreased libido scores in men.

Heavy alcohol drinking, or more than 14 mixed drinks in a week, has also been linked to a decrease in testosterone production. Over a long period, excessive amounts of alcohol can reduce your sex drive. The Cleveland Clinic recommends that men who consume more than three or more alcoholic beverages regularly should consider drinking less. The Centers for Disease Control and Prevention suggest that an average adult male should have two or fewer alcoholic beverages daily; any more than this can lead to long-term health deterioration.

*Drug use
In addition to alcohol, the use of tobacco, marijuana, and illicit drugs such as opiates has also been connected to a decrease in testosterone production. This can result in a lack of sexual desire. Smoking has also been found to hurt sperm production and sperm movement.

Physical and emotional side effects of low libido
A decreased sex drive can be very unsettling for men. Low libido can lead to a vicious cycle of physical and emotional side effects, including ED — the inability to maintain an erection long enough to have satisfactory sex.
ED may cause a man to experience anxiety around sex. This can lead to tension and conflicts between him and his partner, which may in turn lead to fewer sexual encounters and more relationship issues. Failure to perform due to ED can trigger feelings of depression, self-esteem issues, and poor body image.
Treating low libido often depends on treating the underlying issue. If low libido is caused by an underlying health condition, you may need to switch medications. If your low libido has psychological causes, you may need to visit a therapist for relationship counselling.