Loss of Sex-Drive

Loss of sex-drive can be a daunting presentation for established GP and registrar alike. This universal problem spans adulthood in both sexes. Conventional medical school teaching seems to fail to prepare the generalist; however, the didactically taught approach of systematic enquiry and examination is the key to successful management.

Published: 2nd August 2022 | Updated: 15th August 2022

Differential diagnosis

Common Diagnoses

  • Depression
  • Relationship Problems
  • Perimenopause
  • Excess Alcohol Intake (and Cirrhosis in Men)
  • Ageing

Occasional Diagnoses

  • Low Testosterone in Men
  • Hypothyroidism
  • Antihypertensive Treatment in Men
  • Hyperprolactinaemic Drugs in Men (e.g. Phenothiazines, Haloperidol)
  • Anti-Androgenic Drugs in Men (e.g. Cimetidine, Finasteride)
  • Anti-Androgenic Drugs in Women (e.g. Cyproterone)

Rare Diagnoses

  • Hypothalamic/Pituitary Disease
  • Renal Failure
  • Primary Testicular Disease or Damage
  • Adrenal Disease (Cushing’s and Addison’s Diseases)
  • Feminising Tumours in Men: Testis or Adrenal Gland

Ready reckoner

Key distinguishing features of the most common diagnoses

DepressionRelationship ProblemPerimenopause Alcohol Ageing
Excessive FatigueYesPossibleYesPossiblePossible
Irrational Mood SwingsYesPossibleYesPossibleNo
Facial FlushingNoNoYesPossibleNo
Alters with Different PartnerPossibleYesNoNoNo
Otherwise WellNoYesPossiblePossibleYes

Possible investigations

Likely: None.

Possible: FBC, U&E, LFT, TFT.

Small Print: Hormone profile.

  • FBC: May show evidence of general disease; MCV raised with significant excess alcohol.
  • U&E: Check for renal failure. Na+ and K+ deranged in adrenal disease.
  • LFT and γGT: Should reveal hard evidence of excess alcohol.
  • TFT: Will demonstrate hypothyroidism.
  • Hormone profile: FSH/LH, prolactin, oestradiol and testosterone may be useful in both sexes. Altered by primary endocrine disease, drugs and alcohol.

Top Tips

  • This is often a ‘by the way’ or ‘while I’m here’ symptom. It may be tempting to ask the patient to return for a further appointment, but bear in mind that this may mean a lost opportunity to help the patient.
  • General examination is important to detect rare causes. This also demonstrates that the problem is being taken seriously.
  • Avoid over-medicalising the situation if it is clearly a relationship problem.
  • Be prepared to revise or augment your diagnosis – the problem is often multifactorial.
  • Don’t forget iatrogenic causes and be prepared to undertake a trial without treatment.

Red Flags

  • Loss of sex drive may be the tip of the iceberg of significant pathology, such as depression or alcoholism – don’t be distracted into a superficial approach.
  • Depression and relationship difficulties can cause each other and coexist. A careful history will reveal whether antidepressants and/or psychosexual counselling is appropriate.
  • Investigations don’t often help – but lower your threshold for blood tests if the patient seems generally unwell and isn’t obviously depressed.
  • Early hypothyroidism closely mimics depressive illness.
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Website disclaimer

Pulse Reference is based on the best-selling book Symptom Sorter.

The experts behind Pulse Reference are Dr Keith Hopcroft who is the co-author of Symptom Sorter, a GP in Essex and Pulse’s editorial advisor and Dr Poppy Freeman, a GP in Camden and also a clinical advisor to Pulse.

This website is for clinical guidance only and cannot give definitive diagnostic information. Practitioners should work within the limits of their individual professional practice, seek guidance when necessary and refer appropriately.