Overview

Male hypoactive sexual desire disorder (HSDD) is a specific type of sexual dysfunction characterized by a chronic1 or recurring deficiency or absence of sexual fantasies and desire for sexual activity. This condition, once termed low libido, goes beyond having a low sex drive. 

For a diagnosis2 of HSDD, the lack of sexual desire must cause personal distress3 or difficulties in a person's relationships. The symptoms4 are not based on how often a person engages in sexual activity but rather on their interest and desire to do so.

The causes of HSDD are diverse, involving a combination of physical conditions, psychological issues, and relational dynamics. These factors may include chronic illnesses, hormonal imbalances, certain medications, depression, stress, and challenges within the individual's relationship. 

The manifestation of HSDD can vary from person to person and is subjective to each individual's expectations and desires. Despite its potentially significant impact on sexual function, quality of life, and relationships, male HSDD is often underrecognized and undertreated, often due to the reluctance of patients to discuss their symptoms and the general population's lack of understanding about this condition.

Note that HSDD is not asexuality, a valid and real sexuality in which a person experiences no or little sexual attraction. In asexuality, a person is often comfortable with their lack of sexual desire or interest. People with HSDD experience significant distress due to their symptoms and may have low libido. Some asexual people choose to have sex due to physical or romantic reasons. Asexuality is not a mental illness.

Symptoms

The symptoms of male hypoactive sexual desire disorder primarily revolve around a lack or decrease in sexual desire or interest. These psychological and physical symptoms relate to mental and physiological aspects of sexual activity. For a clinical diagnosis of HSDD, symptoms such as a reduced interest in sexual activity must persist for at least six months, significantly affecting the individual's emotional well-being and relationships.

Psychological symptoms

Below are some of the most common psychological symptoms of male hypoactive sexual desire disorder: 

  • Persistent or recurrent lack of interest in sexual thoughts or fantasies
  • Reduced or absent interest in initiating sexual activity, either with a partner or through masturbation
  • Being unresponsive to erotic cues or a lack of desire to respond to them
  • Difficulty feeling sexual excitement or pleasure
  • Lack of interest or pleasure during sexual activity, even when initiated

Physical symptoms

Below are some physical symptoms of HSDD: 

  • Decreased sexual activity, including reduced frequency of sexual activity, less frequent erections, or a lack of spontaneous erections
  • Absence of sexual arousal during any sexual activity
  • Reduced sexual sensations during sexual activity

Emotional and interpersonal symptoms

Emotional or interpersonal symptoms of HSDD may include the following: 

  • Distress, frustration, or worry over the lack of sexual desire and its impact on relationships
  • Strained relationships due to reduced sexual interest or activity
  • Avoidance of intimacy or sexual situations due to lack of interest

It can be vital not to confuse male HSDD with other sexual disorders. While erectile dysfunction, premature ejaculation, or other sexual performance challenges may coexist, they are separate conditions. For instance, a man with HSDD can have average sexual performance but lack desire for sexual activity.

The frequency of sexual desire one experiences can naturally vary between individuals and across different stages of life. The key factor in diagnosing HSDD is often whether the person is distressed by their lack of sexual desire and its impact on their quality of life or interpersonal relationships.

Causes

Male hypoactive sexual desire disorder can be caused by various factors that range from physical to psychological. These factors can often interact, creating a complex web of causality that may differ significantly from individual to individual.

Physical causes

Physical causes of male HSDD can include the following: 

  • Hormonal imbalances: A decrease in testosterone levels plays a crucial role in male sexual desire.
  • Chronic illnesses: Conditions like diabetes, heart disease, or neurological disorders can contribute to decreased sexual desire.
  • Medication side effects: Certain medications, including some antidepressants, antihypertensives, and hormonal medications, can decrease sexual desire.
  • Substance use: Alcohol or drug use can significantly decrease sexual desire over time.

Psychological causes

Psychological causes of male HSDD can include the following: 

  • Mental health issues: Conditions like depression, anxiety, or stress can decrease sexual desire.
  • Relationship problems: Conflict, dissatisfaction, or significant changes in a relationship can reduce interest in sexual activity.
  • Past sexual trauma or abuse: Traumatic experiences can lead to a persistent decrease in sexual desire.

Risk factors for developing HSDD include aging (due to natural decreases in testosterone levels), significant life changes or stressors, history of sexual or emotional abuse, and underlying medical or psychiatric conditions.

The interaction of these causes and risk factors can vary from person to person. Therefore, understanding the individual's specific context and personal history can be critical for accurate diagnosis and effective treatment of male HSDD.

Treatments

Treatment for male hypoactive sexual desire disorder can involve a multifaceted approach, including therapy, medication, lifestyle changes, and self-care strategies. The goal of treatment is often to increase sexual desire, improve sexual function, and reduce the distress and interpersonal difficulties associated with this condition. Individuals experiencing symptoms of HSDD are encouraged to consult with healthcare professionals who can offer a comprehensive evaluation and tailor treatment plans to their specific needs, which can improve both sexual health and overall quality of life.

Therapy 

Therapy is often a crucial part of treatment for male HSDD. Different therapeutic approaches can be effective, depending on the underlying causes of the disorder:

  • Cognitive-behavioral therapy (CBT):5 CBT may help individuals identify and change patterns of negative thoughts and behaviors that could contribute to their low sexual desire. It may also reduce anxiety and improve communication and relationship challenges. 
  • Sex therapy: This specialized form of therapy focuses on sexual function and may address specific sexual challenges, improve sexual communication, and enhance sexual skills and knowledge.
  • Couples therapy or relationship counseling: If relationship issues are contributing to a decrease in sexual desire, this type of therapy may improve communication, resolve conflicts, and enhance emotional intimacy.

Medication

In some cases, medication may be used to treat male HSDD, particularly when there are physical causes:

  • Testosterone therapy (TRT): If low testosterone levels contribute to decreased sexual desire, testosterone replacement therapy may be recommended. TRT can involve injections, patches, gels, or implants.
  • PDE5 inhibitors: While PDE5 medications are primarily used for erectile dysfunction, they can sometimes enhance sexual desire in men with HSDD, particularly when there's a coexisting erectile issue.
  • Bremelanotide: This is a subcutaneous injection that can be used as needed prior to sexual activity. Evidence suggests it significantly improves desire and significantly decreases the distress related to lack of desire.
  • Adjustment of current medication: If a person's current medication (like certain antidepressants or antihypertensives) is causing a decrease in sexual desire, their doctor may be able to switch them to a different medication with fewer sexual side effects.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The above information is not a replacement for medical advice or diagnosis.

The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content is providing generalized information, not specific for one individual. You should not take any action without consulting with a qualified medical professional.

Other treatment options

Depending on the individual's specific circumstances, other treatment options may be explored, such as the following: 

  • Treatment of underlying medical conditions: If a medical condition like diabetes or heart disease contributes to decreased sexual desire, treating the underlying condition may improve sexual desire.
  • Treatment of mental health conditions or symptoms: If depression, anxiety, or stress are significant factors, treating these underlying challenges may increase sexual desire.

Self-care

Self-care strategies can play a vital role in managing male HSDD. Self-care can include:

  • Lifestyle changes: Regular exercise, a balanced diet, reducing alcohol, and avoiding substances may improve overall health and potentially increase sexual desire.
  • Stress management: Techniques like mindfulness, meditation, yoga, and other relaxation methods may reduce stress and improve mood, potentially enhancing sexual desire. 
  • Improving sleep: Sleep hygiene can have a positive effect on mood, energy levels, and overall health, which can also influence sexual desire.
  • Open communication: Discussing feelings and concerns related to sexual desire with a partner may improve mutual understanding, reduce anxiety, and enhance intimacy.

Each person is different, and what works for one person might not work for another. The most effective treatment plans are often those tailored to the individual's specific symptoms, causes, and personal circumstances. Consultation with a healthcare professional can be crucial for determining the most appropriate treatment options.

Resources

Therapy can play a crucial role in managing and treating male hypoactive sexual desire disorder, and online platforms like BetterHelp have made it easier to meet with professional therapists. Online platforms often offer a network of licensed professionals specializing in various areas, including sexual health and relationships. Users can communicate with their therapist via message, live chat, phone, or video, providing flexibility. 

Beyond therapy, there are numerous other resources available for individuals experiencing HSDD, including but not limited to the following: 

The above resources provide a wealth of information, support, and professional contacts to help individuals navigate their journey with HSDD. However, contact healthcare professionals if you're experiencing symptoms of HSDD. They can guide you through diagnosis and treatment and help you connect with valuable resources.

Research

Emerging research continually enhances understanding of male hypoactive sexual desire disorder, its causes, and potential treatments.

In another recent study, researchers at the University of Texas at Austin investigated the psychophysiological response patterns in women with HSDD. While the study primarily focused on women, it emphasized the importance of examining both psychological and physiological aspects of sexual response in individuals with HSDD, highlighting the potential for multidimensional therapeutic interventions. This research suggests that treatments targeting psychological and physiological factors may be most effective for managing male HSDD. (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) replaced female HSDD with female sexual interest/arousal disorder.)

In another study published in Translational Andrology and Urology, researchers explored the potential role of neuromodulation in treating various sexual dysfunctions, including HSDD. Neuromodulation involves altering nerve activity through the targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body. The researchers found preliminary evidence suggesting that neuromodulation could effectively treat sexual dysfunctions, including HSDD. They emphasized the benefit of further research to validate these findings and develop targeted neuromodulation therapies.

These studies highlight the ongoing research efforts to better understand HSDD and explore new treatment possibilities. Such efforts can be crucial for improving the care and quality of life for individuals with this condition.

Statistics

Statistics on male hypoactive sexual desire disorder can provide insight into the prevalence and impact of this condition:

  • According to a study published in the Journal of Sex & Marital Therapy, HSDD affects approximately 15% of men aged 20 to 50 in the US. 
  • The United Brain Association states that the prevalence of HSDD tends to increase with age. The disorder is reported to affect up to 28.8% of men aged 65 to 74 and 30.4% of men aged 75 to 85.
  • According to research from the University of Texas at Austin, approximately one in three men with HSDD report distress about their lack of sexual desire. 
  • Studies show that cognitive-behavioral therapy (CBT) may be especially effective in treating male HSDD. 

These statistics underscore the widespread nature of male HSDD and its significant effects on those who experience it. It can be crucial for anyone experiencing symptoms of HSDD to know they are not alone and that help is available.

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Updated on June 24, 2024.
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