Sex File: Why do I have a low libido at such a young age?

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I've had no sex drive for months now. I'm a 26-year-old man but this isn't the first time it has happened. I do have an anxiety disorder that I know can affect libido, but it still seems strange for my age. I don't know if my mental health is the sole reason and I have no idea how to get my drive back.

A low sex drive can be caused by all sorts of things, from issues within the relationship to contextual factors such as work stress or unemployment. Although we hear much more about it in women, it is relatively common in men. In the third National Survey of Sexual Attitudes and Lifestyles (Britain), published in 2013, it was the most commonly reported sexual problem. 

In men aged 25 to 34, 14.9% reported a lack of interest in sex, which would surprise many. No sex drive is less common, and the distinction is important because a complete absence of interest in sex at your age is more likely to indicate an underlying physical or mental health issue. I would suggest talking to a doctor as soon as you can.

A doctor will ask you about pre-existing health issues or any medications you are taking. They will also ask you about stress levels, relationship issues, your mental health and any lifestyle choices, such as smoking or drinking, that might be having an impact. Although that might sound like an intimidating level of disclosure, diagnosing and treating low sexual desire is difficult because it can be caused by many things and there are a lot of confounding factors.

For example, a doctor treating a man for depression who is also suffering from decreased sexual desire and obstructive sleep apnoea would find it very difficult to work out whether sexual difficulties were being caused by depression, antidepressant treatment, relationship conflict caused by snoring or a combination of all.

Make sure too that you are clear about the difference between sexual desire and sexual function. Desire is your interest in sex. Function is your capacity to get and sustain an erection. In studies, people with mental health issues who had little to no sexual desire still had erections. So I suspect that, because you are suffering from anxiety, it is your sexual desire rather than function that is affected.

You probably already know about the relationship between sex drive and testosterone levels, and your doctor will recommend that you have a few blood tests to measure your levels and confirm a diagnosis. The normal range of blood testosterone is 300 to 1,000 nanograms per decilitre. 

However, if low testosterone is the issue, you would probably be feeling tired and experiencing mood changes. You would also have noticed loss of muscle mass and bone strength. Most people are aware that anabolic steroids have a negative impact on testosterone levels but so do several commonly prescribed medications.

Having said all that, low testosterone is unlikely to be the issue. Hypoactive sexual arousal disorder is more frequently associated with taking medication for medical conditions or with psychiatric disorders such as depression or anxiety. Since you have an anxiety disorder, that will probably be the first thing a doctor explores, although they will also be interested in general health and relationship difficulties.

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