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It is generally assumed that if a man’s sexual drive is low, reduced levels of testosterone are to be blamed. But is it true in every case? Do all men suffering from decreased libido have low testosterone levels? Does libido only depends on testosterone?

It has been a general tendency to put the blame of reduced libido to decreased levels of testosterone. And with the advent of testosterone replacement therapy, physicians frequently encounter patients who want this therapy to increase their sex drive. But according to experts, although testosterone has a role in sex drive of a man, it is not the only reason behind a low libido.

On the contrary, many a times, it is seen that men experience a reduced sex drive even though their testosterone levels are normal. It has also been seen that even though there is a decline in the levels of testosterone with advancing age, it does not necessarily translate into a low sex drive.

What is testosterone?

Before understanding the role that testosterone plays in affecting the sexual drive of a man, let us understand what exactly testosterone is. It is the hormone produced in the testicles and is responsible for the development of secondary sexual characteristics in a male when he hits puberty. It plays an important role in the maintenance of the bone density, muscle mass and strength, distribution of fat in the body and the production of the red blood cells apart from the well-known role in the production of sperms and maintenance of sexual drive.

The levels of testosterone in a man are the maximum at the time of adolescence and early adulthood. The levels tend to reduce as the man ages. It is believed that it decreases at the rate of 1% every year after the age of 30. Apart from the normal aging process, the levels of testosterone are also reduced in case of any injury to the testicles, genetic abnormalities like Klinefelter’s syndrome, Chemotherapy or radiation therapy for treating some cancer in the body, medicines to treat prostate cancer, corticosteroid medications, inflammatory diseases like sarcoidosis, liver cirrhosis, alcoholism, etc. High stress levels can also take a toll on the testosterone levels in the body.

Symptoms of low testosterone

The main symptoms observed in a man with low testosterone levels in a reduction in his sex drive, problems with erection, depression and reduced power of concentration. There is a loss in the muscle mass and body hair, increase in the fat deposition, signs of osteoporosis, and changes in the levels of hemoglobin, cholesterol and lipids.

The only way to diagnose whether a patient is suffering from low testosterone is by measuring the blood levels of the hormone. Early morning sample is preferred as that is the time when the level of testosterone is at its peak.

Is Testosterone Responsible For Low Libido?

Although several studies have shown that a reduction in the levels of testosterone can reduce a man’s sex drive, it is not the only cause of low libido. There are no studies which throw light on how testosterone levels affect the sex drive.

There are instances when men are satisfied with their libido even with relatively low levels of testosterone. And, on the other hand, there are men who experience a low libido even with normal levels of testosterone.

So what exactly are the causes behind a low libido? Let’s examine.

Causes of low sex drive


One of the top most reasons behind low sex drive is stress. Stressful situation in the workplace can play havoc with your sex life. Chronic stress can lead to a drop in the androgen levels leading to problems like erectile dysfunction. Stress can also distract your mind away from sex resulting in low libido.


Depression and libido are complicatedly inter-related. Depression can lead to multiple changes in the normal biochemistry of the body resulting in a reduced libido. It is difficult for a person who is depressed to get interested in sex.


Medicines used to treat hypertension and depression can also affect libido. Antidepressants like SSRI fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) cause a decline in sexual functions or libido despite an improvement of depression. Similarly, use of tricyclic antidepressants and monoamine oxidase inhibitors can also lead to a decrease in libido.

Sleep deprivation

When you are deprived of sleep, you would rather catch up on it than indulging in sex. It is imperative for a healthy sexual life to have adequate sleep. Researchers say that sleep deprivation can lead to an increase in the level of cortisol which, in turn, leads to reduced libido.

Alcoholism and drug abuse

While small quantity of alcohol helps you in shedding your inhibitions, chronic alcoholism can impair your nervous system and give rise to fatigue. This leads to a fall in libido. Chronic alcoholism can also lead to liver cirrhosis. Liver is responsible for the metabolism of estrogen. Any disruption in the functioning of liver will eventually lead to estrogen –testosterone imbalance in the body resulting in reduced libido. Similarly, marijuana abuse depresses the pituitary gland which is responsible for stimulating the testicles to produce testosterone.

Erectile Dysfunction

ED is one of the commonest causes of reduced libido. And ED is caused due to atherosclerosis of the vessels. Atherosclerosed blood vessels supplying the penile tissue cannot dilate to bring in the increased amount of blood flow. Therefore, it becomes difficult to sustain the erection.

Metabolic conditions

Metabolic conditions like diabetes, high blood pressure and high cholesterol can lead to atherosclerosis of the blood vessels. This may lead to erectile dysfunction and reduced libido.

Testosterone accounts for only a minority of cases of erectile dysfunction. It is only when other causes of reduced libido are ruled out and one can safely conclude that the reduced libido can be attributed to the low levels of testosterone, that one must consider the option of testosterone therapy.

Always remember that what one man feels as a low sex drive might be perfectly normal for another. There are no clinical parameters to decide what should be the optimal frequency of sex. It is for the couples to decide what suits them best. However, if they are sure that they are suffering from a low libido due to reduced level of testosterone, they can consider replacement therapy. But one must always keep in mind the pros and cons of testosterone replacement therapy. 

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  • “The Relationship between Libido and Testosterone Levels in Aging Men”, by Thomas G. Travison, et al, published in 2006 in the Journal of Clinical Endocrinology and Metabolism, accessed on March 10, 2013
  • “Depression and Sexual Desire”, by Robert L. Phillips, et al, published in the August 2004 issue of the journal American Family Physician, accessed on March 10, 2013
  • “Low Testosterone and Sex Drive’, reviewed by Brunilda Nazario on June 12, 2012, published in WebMD, accessed on March 10, 2013.
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