Low sexual desire (HSDD)
Also known as:
Hypoactive sexual desire disorder, low libido
Persistent low desire that causes distress. Usually multifactorial, and often treatable.
Written and reviewed by Farhan Tahir, MD · Last reviewed
VIDEO LESSON
What it is
Hypoactive sexual desire disorder means a persistent lack of sexual thoughts or desire that bothers you and is not fully explained by another condition, a medication or relationship problems. Desire changes are common in midlife; HSDD is defined by the distress, not a number.
Common contributors
• Pain from genitourinary syndrome of menopause
• Medications such as SSRIs and some blood pressure drugs
• Poor sleep, depression, anxiety and stress
• Thyroid disease and other medical conditions
• Relationship and body-image factors
How it's diagnosed
Through a careful conversation, sometimes using a brief validated screener. A testosterone level does not diagnose HSDD, because levels in women correlate poorly with desire.
Treatment
Address pain, medications, sleep and mood first. Sex therapy, CBT and mindfulness-based approaches have evidence. In postmenopausal women with HSDD, transdermal testosterone at doses that keep levels in the premenopausal range is the one use supported by international consensus. Flibanserin and bremelanotide are FDA-approved for premenopausal women.
Clinical pearls
• Use testosterone formulations dosed for women and recheck levels at 3 to 6 weeks.
• Treating vaginal pain often restores desire on its own.
Key studies and references
Trusted resources
• ISSWSH
Educational content only, written and reviewed by Farhan Tahir, MD. It does not replace individual medical advice. For sudden chest pain, trouble breathing or stroke symptoms, call 911.
AT A GLANCE
Category
Reproductive & sexual health
Also known as
Hypoactive sexual desire disorder, low libido
Reviewed by
Farhan Tahir, MD
Questions about your own care?
Dr. Tahir’s team offers consults through Youthful Medicine.
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