Testosterone and Sex Drive: Exploring the Connection

Testosterone is a quintessential male sex hormone, and it’s responsible for driving the development of your reproductive organs during puberty and regulating your sex drive throughout your entire life. If you’re experiencing low testosterone, sometimes due to the condition hypogonadism, you may notice changes to your libido, sexual performance, body composition, and overall mood.

Below, find out more about the role testosterone plays in your sex life, signs that your levels of the hormone may be lower than ideal, and research-backed interventions for boosting your hormonal and sexual health at once.

When Seth and Anna first married, they couldn’t keep their hands off each other. They had steamy mornings, middle-of-the-night sex, even midday quickies. Their intimacy wasn’t just physical, either. They confided in each other, planned big for the future, and even argued affectionately.

No longer newlyweds, their sex life calmed a bit, but they found a regular cadence that suited both of them. They were happy and pretty consistent—until they weren’t.

About eight years into marriage, Anna noticed a shift in Seth. He never initiated sex anymore and sometimes made excuses when she gave him a suggestive glance that always worked in the past. He didn’t want to talk about sex—or much else, for that matter. He was suddenly closed off, pessimistic, and quick to anger over trivial issues.

They hadn’t even reached their 10th anniversary, and Anna wondered whether this is how their future would look.

Seth was initially reluctant to ask his doctor about his missing libido, but he finally worked up the courage and was glad he did. After a simple blood test, Seth discovered the culprit behind his low sex drive: low testosterone. Though no man wants to hear his hormone levels are out of whack, Seth felt something he hadn’t felt for a long time: relief.

According to Peter J. Stahl, MD, SVP of Men’s Sexual Health & Urology at Hims & Hers, testosterone is a leading player when it comes to regulating a man’s sex drive. And it all starts in the brain. “In the brain, testosterone and related hormones play key roles in molecular pathways that drive sexual desire,” says Dr. Stahl.

In fact, the pathways that regulate your libido include several regions of the brain, like the temporal lobe, hypothalamus, amygdala, midbrain, preoptic, prefrontal, and frontal areas, as well as the cingulate gyrus. These areas contain androgen receptors that respond to androgens (or male hormones) like testosterone. The hypothalamus and limbic system have the highest amount of androgen receptors and are the regions most involved in driving sexual desire. These regions also help synthesize the androgens themselves.

Testosterone is physiologically active throughout the male reproductive and sexual organs, and Dr. Stahl says the hormone also regulates fertility, ejaculation, orgasm, and erectile function—all factors that may be affected if your levels dip too low. But low libido is typically among the first signs of low T.

“The first manifestation of low T is usually low libido because the brain is more sensitive to testosterone deficiency than the body,” says Dr. Stahl. “The resulting loss of sexual desire can be really bothersome on its own.  It can also indirectly cause problems getting and keeping erections because desire is an important part of the male sexual response. When testosterone levels decline further, though, it can directly impair ejaculation, orgasm, and erections.”

Research has shown that normal testosterone levels (between 300 and 1,000 ng/dL) are essential for normal sexual desire, noting several findings: In aging men, in particular, serum testosterone levels relate significantly to the magnitude of sexual desire they report feeling. Higher testosterone levels have also been linked to increased sexual desire. And among men who have hypogonadism, testosterone replacement therapy (TRT), was associated with a significant improvement in sexual desire.

While low T can affect your sex life in a number of ways, including low libido and erectile dysfunction, it can also impact other areas of your life.

Besides sexual dysfunction, signs and symptoms of low testosterone include:

• Fatigue

• Testicular shrinkage

• Sleep disturbances

• Loss of muscle mass

• Decreased bone density

• Increased body fat

• Less body hair

• Mood swings

• Hot flashes

• Memory trouble

• Reduced red blood cell count (anemia)

A number of health conditions and lifestyle habits can impact your testosterone production, leading to low sexual desire and other telltale symptoms.

A clinical testosterone deficiency is also called hypogonadism. To figure out the root cause of your situation and treat you appropriately, your healthcare provider must first determine whether you have primary or secondary hypogonadism. Primary hypogonadism originates from a problem in the testicles. Secondary hypogonadism stems from a brain-signaling issue.

Causes of primary hypogonadism include:

• Klinefelter syndrome

• Undescended testicles

• Infections like mumps orchitis

• Hemochromatosis (a genetic disorder in which the body stores too much iron)

• Cancer treatment

• Normal aging

Causes of secondary hypogonadism include:

• Pituitary disorders or tumors

• Kallman syndrome

• HIV/AIDS

• Obesity

• Stress

While low libido is a common symptom of low testosterone, it’s essential to rule out nonhormonal reasons why your sexual function isn’t what it used to be.

Other potential causes of low libido include:

• Psychosomatic stress

• Mental health conditions like depression and anxiety

• Cranial nerve diseases

• Urinary disorders

• Drug use (recreational as well as certain prescription medications)

• Type 2 diabetes

• High blood pressure

• High cholesterol

• Obesity

Other hormonal imbalances, like increased levels of estrogen and prolactin, may also negatively impact your sex drive.

The goal of TRT is to restore testosterone to normal levels by supplying the body with testosterone. Increasing your levels of testosterone (when you are deficient) can help improve your libido and resolve other undesirable symptoms of low testosterone.

Here’s what you should know about TRT:

• TRT comes in many forms. TRT formulations include testosterone gels, creams, injections, patches, pellets, and pills. Each method offers benefits and risks to discuss with your doctor. Find out more about the different types in our guide to TRT.

• TRT can be highly effective. Studies show that TRT can significantly improve sexual function long-term compared to placebo, specifically sexual desire and sexual activity in addition to hypogonadal symptoms.

• There are side effects and risks. Risks and side effects of testosterone replacement therapy include infertility, skin irritation, acne, prostate enlargement, breast growth, fluid retention, worsened sleep apnea, risk of transfer to partners or children, and hair loss.

Alternatives to TRT

Not to be confused with testosterone supplements or boosters, there are other oral testosterone treatments that can help boost your hormone levels. Simple lifestyle changes can also support testosterone production and overall well-being.

• Oral medications for low T. Prescription medications sometimes prescribed off-label for low testosterone include clomiphene (Clomid^®), aromatase inhibitors like anastrozole (Arimidex^®), and human chorionic gonadotropin (hCG).

• Oral medications for erectile dysfunction. Your provider may also recommend treating common symptoms of low T, like erectile dysfunction (ED). The most common ED medications include sildenafil (generic Viagra^®) and tadalafil (generic Cialis^®). Hims also offers access to a 2-in-1 medicine for ED and testosterone support, Sex Rx + Testosterone Support.

• Lifestyle changes. Making lifestyle changes that support your overall health can have a positive effect on your hormones, mood, libido, and more. Aim to eat a well-rounded diet of nutritious foods, stay active, get better sleep, and lower your stress levels to support testosterone production and whole-body health. Get more ideas by reading this guide on how to increase testosterone naturally.

Testosterone is one of the key players in a man’s overall health, including sexual health. If you think you could benefit from support in improving your sexual function, seek medical advice from a healthcare professional today and explore treatment plans.

Remember:

• Low testosterone is a top cause of low sex drive in men. Testosterone plays a central role in regulating libido, and low sex drive is typically the first sign of low T.

• Testosterone replacement therapy can significantly improve libido and sexual function in some men. Research shows TRT can help restore sexual desire in men with low testosterone, but it comes with potential risks and side effects that should be discussed with a healthcare provider.

• Lifestyle changes and alternative medical interventions can also support healthy testosterone levels. In addition to TRT, alternative medications like Clomid and ED medication, along with lifestyle factors such as better sleep, exercise, and stress reduction can help improve hormone levels and overall sexual health.

Want more ideas on how to support your testosterone balance? Check out the top 11 foods that boost testosterone, explore the connection between low T and hair loss, and learn more about other potential causes of low libido in men.