The experience of diminished or absent sexual interest can generate in men profound distress, confusion, and feelings of inadequacy, significantly affecting well-being and quality of life.
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What is hypoactive sexual desire disorder (HSDD)?
Hypoactive Sexual Desire Disorder (HSDD) is defined as a persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity, causing distress or interpersonal difficulties. It is not simply a matter of "not being in the mood," but rather this lack of desire causes suffering for the individual or problems in their relationship.
It involves a subjective discrepancy between the sexual desire that the person feels and the one they would like to have, causing frustration and distress.
Who is affected?
Although hypoactive sexual desire has historically been researched and discussed more in women, it is a condition that affects both sexes.
HSDT in women
In women, the interaction between hormonal, psychological (such as body image, history of abuse) and relational factors (quality of communication and emotional intimacy) is emphasized more.
HTSD in men
It typically manifests as a marked decrease or absence of spontaneous sexual thoughts or fantasies, as well as a lack of sexual initiative. Unlike erectile dysfunction, here the desire itself is absent. The man may feel no interest in either masturbation or partnered sex. It is a problem that men often hide out of shame, which delays them seeking help.
Age and life stages
It's normal for sex drive to fluctuate throughout life. A gradual decline with age is common, but not inevitable or pathological. Decreased libido can occur in young men (linked to stress, excessive pornography use, or psychological problems), in middle age (work-related stress, relationship monotony, or emerging health problems), and in older men (linked to medical conditions, medication, or hormonal changes). Age is a factor, but not the sole determining factor.
Causes and risk factors
Physical causes
It can be caused by low testosterone levels, thyroid problems or high prolactin, by chronic diseases such as diabetes, hypertension, cardiovascular and neurological diseases such as multiple sclerosis, by the use of antidepressants (especially SSRIs), antihypertensives, antiandrogens and some cholesterol medications, by alcoholism, smoking and the use of recreational drugs that can damage the vascular and nervous system, or by fatigue and sleep.
Psychological causes
It can be a consequence of suffering from depression and anxiety, chronic stress, low self-esteem and negative body image, having suffered from sexual trauma or having an excessive concern about sexual performance.
Social and relational causes
This can occur if there are unresolved conflicts, a lack of communication, or a loss of trust (infidelity) in the relationship, due to routine, a lack of emotional intimacy, and resentment. When interaction focuses solely on penetration and the ability to play and explore together is lost, desire can fade.
Negative or repressive messages about sexuality during upbringing can also generate guilt and internal conflicts, and the abusive use of pornography can make sexuality with a real partner seem less exciting.
Symptoms and signs
It manifests as an absence or marked reduction of spontaneous sexual thoughts or fantasies, lack of interest in initiating sexual activity or responding to the partner's advances, indifference to sexual stimuli that were previously exciting, and avoidance of situations that could lead to sexual contact.
It often includes feelings of frustration, worry, sadness, anxiety, or guilt due to this lack of desire. These symptoms must last for at least six months to be considered a persistent disorder.
How does it impact the couple's relationship?
The person with HSDD may feel guilty and pressured, while their partner may interpret the lack of desire as personal rejection, a lack of love, or a lack of attraction. This creates a negative cycle: the partner complains or pressures, the man feels more anxious and pressured, his desire decreases even further, and the emotional distance increases. In many cases, this threatens the stability of the relationship.
It may interest you: stress in couples.
Medical evaluation and diagnosis
A doctor will rule out physical causes. Medical history, medications, lifestyle habits, and symptoms will be reviewed. Tests will be done to measure levels of free testosterone in men, luteinizing hormone (LH hormone), prolactin and thyroid function.
A psychologist or sexologist explores the emotional state, presence of anxiety or depression, couple dynamics, sexual history, possible traumas, and the subjective meaning of the problem. If possible, an interview is conducted with the couple to understand the dynamics of the relationship.
Difference between low sex drive and hypoactive sexual desire disorder
A low sex drive is a normal variation that can be constitutional (always having a moderate libido) or situational (due to temporary stress). It does not cause significant distress or relationship problems.
Sexual dysfunction is a clinical disorder that does cause distress and impairment. The person feels that their sex drive is not what they would like it to be. The diagnosis is based on the distress caused by the situation, not on a "standard" sexual frequency.
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How can hypoactive sexual desire be treated?
Medication and hormonal therapies
Testosterone replacement therapy is only effective and indicated if hypogonadism is confirmed. It is not recommended if levels are normal, as it can have serious side effects.
If a medication is suspected as the cause, the doctor may consider changing the dose or the type of medication. And although there are no medications specifically approved for male HSDD as there are for women, in some cases medications that act on neurotransmitters related to desire (such as dopamine) can be used, always under strict medical supervision.
Psychological or sexual therapy
Individual therapy is used to address anxiety, depression, stress management, sexual trauma, self-esteem, and negative beliefs about sexuality.
Couple therapy is essential to improve communication, rebuild emotional intimacy, manage conflicts, and eliminate pressure on the sexual act.
And specific sex therapy includes techniques such as sensory reorientation, exercises to increase body awareness and acceptance, and psychoeducation about the human sexual response.
Changes in lifestyle
Regular physical exercise improves circulation and increases levels of testosterone It's natural and reduces stress. A diet rich in zinc, vitamins, and antioxidants promotes hormonal and vascular health. Prioritizing rest is also essential for regulating hormones and restoring energy.
It is recommended to learn techniques such as mindfulness, yoga or meditation to reduce stress, moderate alcohol and tobacco consumption, and reconnect with your partner, dedicating time to pleasurable non-sexual activities, fostering physical affection without coital purpose (caresses, hugs) and regaining complicity.
It may interest you: 15 foods that increase testosterone.
Is there a cure? Prognosis and evolution
The prognosis for TDSH is generally favorableEspecially when the underlying cause is identified and treated, many men experience a significant improvement or complete recovery of their sex drive. A cure doesn't always mean returning to a youthful, constant desire, but rather achieving a satisfying level of desire that doesn't cause distress and is compatible with a fulfilling sexual and relational life.
The outcome depends on the main cause (hormonal or medication-related problems usually have a better prognosis), the duration of the problem (the longer it goes untreated, the more entrenched it may be), the man's motivation and, if there is a partner, his involvement in the treatment and his consistency in following the therapeutic guidelines and lifestyle changes.
Frequently Asked Questions (FAQs)
How long must a lack of sexual desire last to be considered HSDD?
According to clinical diagnostic criteria, symptoms must be persistent for a minimum of six months to be considered a disorder, and must cause significant distress.
Can stress cause HSDD?
Yes, chronic stress is one of the most common causes of temporary or persistent HSDD. The body, in survival mode, prioritizes functions unrelated to reproduction.
Can it affect fertility?
HSDD itself does not directly affect semen quality. However, if the cause is hypogonadism (low testosterone), this underlying condition can affect sperm production. Additionally, very infrequent sexual intercourse can reduce the chances of conception.
Can it be treated without medication?
Yes, when the causes are psychological, relational, or lifestyle-related, psychological/sexual therapy and habit changes can be completely effective.
Is it the same as sexual dysfunction?
No. Sexual dysfunction is an umbrella term that includes problems with desire (HD), problems with arousal (such as the erectile dysfunction), orgasm problems (premature or delayed ejaculation) and pain problems. In HSDD, the problem lies at the beginning of the response cycle, in desire.
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Conclusion
Hypoactive sexual desire in men is more common than many realize. It's a multifactorial disorder with physical, psychological, and relational roots that deserves serious attention and treatment. With a comprehensive medical evaluation, appropriate psychological support, and partner involvement, it's possible to regain a satisfying sex life, emotional well-being, and intimate connection.
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