Hypoactive Sexual Desire Disorder (HSDD), also called Male Hypoactive Sexual Desire Disorder (MHSDD), is a deficiency in sexual or erotic thoughts and a reduction in desire for sexual activity. Common treatments for HSDD include testosterone therapy and other medications, as well as sex therapy. Results for treatment may occur within 2-6 months; longer treatment may be necessary if medications are not deemed appropriate.
Men are more likely to report other sexual dysfunctions, such as Erectile Disorder (ED) or Premature Ejaculation (PE), than HSDD. This may be due in part to the common belief that men have consistently high sex drive, making it difficult for men to feel comfortable discussing or admitting to a lack of desire.1
Signs of Hypoactive Sexual Desire Disorder
Experiencing a significant drop in the frequency of sexual thoughts and fantasies, initiating sex less often, being less receptive to a partner initiating sex, and/or masturbating less frequently are all potential signs of Hypoactive Sexual Desire Disorder (HSDD).2 An important factor to note is that these changes in desire must cause significant distress to the individual in order to be considered a sexual dysfunction. Shifts in desire can be normal and are only problematic if they occur for an extended period of time and cause distress to the person experiencing them.
Hypoactive Sexual Desire Disorder (HSDD) can also exist over the lifespan of an individual, meaning that a man has never had a high desire for sexual activity or experienced frequent sexual thoughts or fantasies. Again, this is only problematic if the individual experiences distress over not having a higher libido. The normal range for libido within men is broad, despite the widespread assumption that all men experience consistently high desire.
Common stressors and phase of life shifts that can precipitate a drop in desire include:
- Work stress or other increase in responsibilities
- Significant weight fluctuation or other shifts in appearance of self or partner
- Grief/bereavement
- Change in sexual partners
- Sexual relationship of more than two years
- Marriage or cohabitation
- Childrearing
- Breakup or divorce
- Mood disorders, like depression or anxiety
- Aging and hormonal fluctuations
Also crucial to take into consideration is that libido discrepancy between partners is common. Despite the cultural assumption that men want sex and women don’t, women often experience a higher desire for sex than their male partners. This can cause shame and distress for both individuals.
Men can feel as if they should have a higher desire for sex because their partner does, even if his level of desire was not problematic prior to the current relationship. Libido discrepancy is not an inherently diagnosable issue and does not necessarily indicate that HSDD is present. Exploration of the sexual dynamic within a couple and in the individual is necessary before determining whether Hypoactive Sexual Desire Disorder is an appropriate diagnosis.
Symptoms of HSDD
The following criteria are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for the diagnosis of Male Hypoactive Sexual Desire Disorder:2
- Deficient or absent sexual/erotic thoughts or fantasies
- Lack of desire for sexual activity
- Symptoms occurring for a minimum duration of six months
- Symptoms causing significant distress to the individual
- Sexual dysfunction is not explained by substance use, medication, medical conditions, or other mental disorders
- Sexual dysfunction cannot be attributed to severe relationship distress or other significant stressors
Causes & Triggers of HSDD
Sexual desire is complex and not very well understood scientifically. However, many desire issues can be explained by mood disorders, relationship problems or other significant stressors. If these psychological factors are present, they should be addressed. Assessing for physiological issues, such as medication side effects or medical conditions is also important. Hormone fluctuations, particularly low testosterone, have been linked with low desire in men and can be treated.
Physiological factors that can cause low desire in men include:
- Side effects of medication, including antidepressants such as SSRIs
- Side effects of recreational drug use
- A drop in testosterone levels
- Pain, tension, or significant physiological issues from other medical conditions
Psychological factors that contribute to low desire in men include:
- Stress
- Trauma history/PTSD
- Mood disorders, such as depression or anxiety
- History of negative sexual experiences
- Sexual shame or cultural messages of sex negativity
- Body image issues
- Relationship longevity
- Relationship conflict
- Lack of affection/emotional bonding with a partner
Treatment of HSDD
Common medical approaches for treating low sexual desire in men include:
Testosterone Therapy
This could come in the form of a shot, patch, or topical gel. These may be prescribed for Erectile Disorder (ED) and/or Hypoactive Sexual Desire Disorder (HSDD) if a patient has abnormally low testosterone levels. Testosterone is most likely to be prescribed by a general practitioner, urologist, hormone specialist, or endocrinologist.
Buproprion (Wellbutrin)
Buproprion is an antidepressant that can be prescribed as a substitute for or supplement to other antidepressants (SSRIs) believed to cause a decrease in sexual desire. This is most likely to be prescribed by a psychiatrist, psychiatric RN, or general practitioner.
Other Medication
Oral medication for erectile dysfunction, such as sildenafil (Viagra) or tadalafil (Cialis), may be appropriate for low desire issues in concurrence with erectile dysfunction. This is most likely to be prescribed by a general practitioner, endocrinologist, or urologist.
Once physiological factors such as hormone levels and medical conditions have been assessed by a doctor, psychological issues are best addressed with an AASECT (American Association of Sexuality Educators, Counselors and Therapists) certified sex therapist (CST). Sex therapists are licensed mental health professionals, such as marriage and family therapists (LMFTs) or licensed professional counselors (LPCs), with additional training in the field of sex therapy.
Common therapeutic approaches in sex therapy for treating low sexual desire in men include:
- Psycho-education about factors which lead to decreased desire/arousal
- Prioritizing time for sex/intimacy in a couple (or masturbation for an individual)
- Shift in the context for when/how sexual activity occurs
- Increasing agency/control in the sexual experience for low-arousal partner
- Conflict resolution and communication strategies for couples
- Reduction in goal oriented/orgasm focused sexual activities
- Increase in sensation/pleasure focused sensual activities
- Sensation-focused exercises to cultivate awareness and improve communication for couples
- Mindfulness exercises to increase somatic awareness for individuals
Sex therapy can be sought as an individual who is experiencing sexual symptoms or as a couple impacted by lower desire in a male partner. A sex therapist will take a detailed sexual and psychosocial history to assess for psychological factors contributing to reduced sexual arousal. The clinician will explore the onset and context of the symptoms being experienced, especially any changes in the situations or cues that have stimulated desire/arousal in the past. Co-occurring psychological conditions, such as mood disorders, will also be assessed and treated.
How to Get Help for Hypoactive Sexual Desire Disorder
Discussing symptoms with your primary care provider is an important first step to ruling out any underlying medical issues. If warranted, your doctor will order any necessary tests or refer you to a hormone specialist, endocrinologist, urologist, psychiatrist or other appropriate physician. Hormone imbalances, mood disorders, and side effects of medication are common reasons for experiencing a drop in desire.
Seeking further treatment with a qualified mental health professional will also be essential for most situations involving a significant drop in desire that has lasted for six months or more. Even if the initial cause of sexual dysfunction was due to a medical issue that has been resolved, it is common to experience a psychological impact on sexual thoughts and interactions as a result of the disruption. Avoidance of sex or anxiety about sexual intimacy can occur, whether in the individual with Hypoactive Sexual Desire Disorder, in their partner, or in the relationship dynamic as a whole.
Sex therapy can be sought as an individual or a couple. To ensure that you receive adequate and knowledgeable care, make sure that your mental health practitioner is AASECT certified. “Sex therapist” and “sex therapy” are not protected terms; therefore any mental health provider can call themselves a sex therapist in their marketing. Additionally, most licensure requirements contain little or no instruction in human sexuality. AASECT certified providers receive an additional 18-24 months of training and a minimum of 300 additional hours of supervision in sex specific psychological issues.3
Typical rates for an AASECT certified sex therapist are on the upper end of private pay therapy fees. Most sex therapists see individual clients for 45-60 minute sessions at rates between $120-$180 and couples for 75-90 minute sessions at rates between $190-$310. These rates may vary widely based on the availability of certified sex therapists in your area and on general mental health costs in your state.
You can find an AASECT certified sex therapist by visiting their online directory.
HSDD Statistics
Depression, anxiety, and other psychiatric problems are strong predictors of loss of desire in men. Up to half of men with a past history of psychiatric symptoms may experience moderate to severe loss in desire, whereas 15% of men without a history of mental health issues will have Male Hypoactive Sexual Desire Disorder at some point in their lifetime.1
Most studies on low desire in men do not include the criteria of (1) symptoms occurring for a minimum of six months or (2) that low desire causes significant distress. Therefore it is difficult to accurately ascertain prevalence rates for Hypoactive Sexual Desire Disorder or Male Hypoactive Sexual Desire Disorder which meet the full diagnostic criteria. However, a 2009 U.S. study based on the self-report of 742 men aged 40-80 years old included a 4.8% response of occasional low sexual desire and 3.3% response of frequent low sexual desire. This low prevalence rate may be in part due to the stigma of low male sexual desire in U.S. culture; U.S. men are more likely to report physiological issues than subjective desire issues. Men in the same 2009 study reported significantly higher rates of early ejaculation (26.6%) and erectile difficulties (22.5%).1
The 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reports that Male Hypoactive Sexual Desire Disorder varies across cultures, ranging from 12.5% in Northern European men to 28% in Southeast Asian men ages 40-80 years old.2 This cultural disparity in symptoms may be due to self reporting and the cultural stigma of discussing low male sexual desire in some cultures. Cultural disparity may also be due to sex negativity and shame around sex where MHSDD is higher.
A 2007 meta-analysis of whether testosterone treatment improves sexual function concluded that testosterone may create moderate improvements in male libido, but that there were unexplained inconsistent results across trials and possible reporting biases that weaken those conclusions.4
Living with HSDD
Hypoactive Sexual Desire Disorder, now called Male Hypoactive Desire Disorder, is a diagnosis based on subjective experience. A major component of HSDD is the distress a person experiences from a loss in libido or a consistently low sex drive.2 Part of living with HSDD may be accepting the phase of life that one is in, including a natural drop in desire that comes with aging or the evolution of a relationship.
If you (or your male partner) believes that having an increase in sexual interactions is vital to your happiness, or to the health of your relationship, there are adjustments you can make to your sexual dynamic that are likely to increase satisfaction. Being willing to initiate sexual play, whether partnered or solo, before physiological arousal occurs can make a significant impact on the frequency of opportunities for sexual pleasure.
Assumptions that erections are the only indicator for attraction or arousal in a man can be counterproductive to positive sexual engagement. If a man has typically had erections in the past without much thought or effort, he may be disinclined to engage sexually when an erection is not already present. If sexual thoughts do not occur as frequently and physiological arousal is not as strong as it used to be, men may stop engaging in sexual touch altogether. A shift in the mindset around what sex is and how it progresses is necessary to find renewed satisfaction.
Many men experience “spontaneous desire” or arousal without much cueing or context. However, some men have more “responsive desire” or develop more responsive desire over the course of a lifetime.5 Engaging in sensual touch without erection, which may include more non-genital touch, can help to cultivate subjective arousal. Utilizing stimulation of erotic toys, such as vibrators or c-rings, can help the body to respond sexually. Cues such as erotic literature or pornography can mentally stimulate and focus a mind that is stressed out or distracted away from sex.
Letting go of the goal of erection and orgasm can reduce anxiety around sex and expand the sexual repertoire to include pleasurable touch and connection that may not involve climax. Creating time for sensual touch, either solo or with a partner, while removing any pressure to “perform,” can allow sexual play to become enjoyable again. Being patient in cultivating subjective arousal is crucial for reducing anxiety and increasing pleasure. Sexuality can be renewed by evolving into a new paradigm of how sexuality is experienced, rather than trying to “get back” to a way of having sex that no longer feels optimal or achievable.
Hypoactive Sexual Desire Disorder vs. Other Sexual Disorders
HSDD is one of many sexual disorders that may appear alongside or separate from other sexual issues. It is important to note the differences in symptoms in order to seek out appropriate treatment.6
HSDD vs. Male Hypoactive Sexual Desire Disorder (MHSDD)
In 2013 with the release of the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Hypoactive Sexual Desire Disorder was changed to Male Hypoactive Sexual Desire Disorder and differentiated from Female Sexual Interest/Arousal Disorder (FSIAD). Because of significant and crucial differences in how desire tends to manifest between men and women, those disorders were separated and redefined.
HSDD vs. Erectile Disorder (ED)
Hypoactive Sexual Desire Disorder is characterized by a lack of interest in sex and a lack of sexual thoughts and fantasies lasting for a period of six months or more. Erectile Disorder is characterized by a recurrent inability over a period of six months or more to achieve or maintain an adequate erection during partnered sexual activities. HSDD and ED may be co-occurring disorders. ED symptoms may trigger HSDD symptoms; the experience of consistently losing erections can cause a loss of interest in sexual activity.
HSDD vs. Premature Ejaculation (PE)
Hypoactive Sexual Desire Disorder is characterized by a lack of interest in sex and a lack of sexual thoughts and fantasies lasting for a period of six months or more. Premature Ejaculation is characterized by a man’s recurrent inability over a period of six months or more to feel in control of his orgasms, with climaxes occurring within one minute of penetration during intercourse. HSDD and PE may be co-occurring disorders. Anxiety over PE symptoms may trigger HSDD symptoms.
HSDD vs. Delayed Ejaculation (DE)
Hypoactive Sexual Desire Disorder is characterized by a lack of interest in sex and a lack of sexual thoughts and fantasies lasting for a period of six months or more. Delayed Ejaculation is characterized by a man’s recurrent inability over a period of six months or more to ejaculate during partnered sexual intercourse. HSDD and DE may be co-occurring disorders. Frustration with an inability to orgasm during partnered sex may result in a loss of interest in sexual activity.
Common Co-occurring Disorders
Other commonly co-occurring psychological conditions which can cause or interact with sexual dysfunction include:
- Major Depressive Disorder
- Persistent Depressive Disorder (Dysthymia)
- Cyclothymic Disorder
- Generalized Anxiety Disorder
- Panic Disorder
- Social Anxiety Disorder
- OCD
Psychiatric problems such as these are a significant predictor of male loss in desire. Up to half of men with a past history of psychiatric symptoms may experience moderate to severe HSDD. Addressing depression, anxiety or other psychological issues is crucial for positive outcomes in increasing male libido.
Additional Resources for Hypoactive Sexual Desire Disorder
You can find a sex therapist to support you at the American Association of Sexuality Educators, Counselors, and Therapists (AASECT). AASECT is the gold standard for certifying qualified professionals in the field of sexuality. You can find a provider in your area on AASECT’s Directory.
Not sure if you’re ready to speak with a professional? Find online support and information about sexual issues here:
