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Low Libido in Women: Hormonal, Psychological, and Medication-Related Causes

Reduced sexual desire is the most commonly reported sexual problem in women, and its frequency rises during the perimenopausal period. The problem is that the causes are often layered — hormonal, psychological, medication-related, or relationship-based — and treating just one without recognizing the others rarely brings full improvement. We check what meta-analyses show about the scale of the problem, testosterone therapy, and the effect of antidepressants on sexual desire.

PZdr Piotr ZielińskiSeptember 4, 202614 min read
Table of contents

TL;DR — key takeaways

The most common sexual problem in women, rarely discussed openly

Reduced sexual desire (low libido) is, according to available epidemiological data, the most commonly reported type of sexual dysfunction in women — more frequent than arousal disorders, orgasm difficulties, or pain during intercourse. Despite how common it is, this problem is rarely the subject of an open conversation with a doctor, partly because patients don't know whether it's even a "medical issue," and partly because the causes tend to be complex and don't reduce to one simple explanation.

This article organizes three main categories of causes — hormonal, psychological, and medication-related — based on available meta-analyses and systematic reviews. Related topics, like hormonal changes during menopause, are covered more broadly in our knowledge base — here we focus specifically on the mechanisms of reduced libido and what intervention studies show.

This article doesn't replace a gynecological or psychological consultation

Reduced libido can have many overlapping causes at once. The information below is educational and doesn't replace individual evaluation by a doctor (gynecologist, endocrinologist) or a psychologist/sex therapist.

The scale of the problem — what the systematic review shows

Prevalence and correlates of female sexual dysfunction and sexual distress in reproductive-aged women: a systematic review and meta-analysis

Moderate evidence

Heshmatnia F, Azizi M, Milani H, Nikbakht R, Kheiri M, Tolomehr H, Shahhosseini Z · BMC Women's Health · 2025

The meta-analysis included 20 studies (mostly cross-sectional) covering a total of 36,777 reproductive-aged women, published between 2015 and 2024. The pooled prevalence of female sexual dysfunction was 47.81% (95% CI 39.19-56.43%), with a range across individual studies from 20.6% to 95.0% — reflecting differences in measurement tools and study populations. Sexual desire disorder ranged from 8.0% to 91.0% depending on the study. The authors identified five main categories of factors associated with sexual dysfunction: sociodemographic (older age, higher BMI, longer marriage duration), reproductive (childbirth, breastfeeding), interpersonal (relationship dissatisfaction, partner's sexual difficulties), psychological (anxiety, depression, stress), and medical (chronic disease, psychotropic medications).

View study

A wide spread of results makes clear conclusions difficult

The spread in prevalence between studies (20.6% to 95.0%) is very large, indicating significant methodological heterogeneity — different measurement tools, definitions of dysfunction, and study populations. The pooled figure of 47.81% itself should be treated as a rough average estimate, not a precise, universal number.

Hormonal causes — not just menopause

Declining estrogen during the perimenopausal period is one of the best-documented causes of reduced libido — it leads both to decreased desire and to atrophy of genital tissues, which can additionally cause pain during intercourse and secondarily deepen avoidance of sexual activity. But menopause isn't the only hormonal mechanism — reduced thyroid function, elevated prolactin, or testosterone imbalances (which also play a role in libido in women, though at much lower concentrations than in men) can have a similar effect independent of menopausal age.

Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data

Strong evidence

Islam RM, Bell RJ, Green S, Page MJ, Davis SR · The Lancet Diabetes & Endocrinology · 2019

The meta-analysis included 36 randomized controlled trials with 8,480 women. Testosterone therapy significantly improved sexual function in postmenopausal women with distressing low desire: sexual desire (standardized mean difference, SMD=0.36), frequency of satisfying sexual events (+0.85 events), sexual pleasure (+6.86 points), and orgasm capability (SMD=0.25), alongside reduced sexual distress (SMD=-0.27). Acne and excess hair growth were observed more frequently in the testosterone group, though no serious adverse events were recorded. Oral administration worsened the lipid profile (raised LDL, lowered HDL), while non-oral routes (e.g., transdermal) had a neutral effect on lipids. The authors emphasized that long-term safety, including effects on the musculoskeletal system and cognitive function, requires further research.

View study

Testosterone therapy in women requires medical supervision

Despite documented efficacy, testosterone therapy in women with reduced libido isn't approved in every country for this specific indication, and its long-term safety isn't fully understood. The decision for such therapy should be made exclusively with a doctor (gynecologist or endocrinologist), after ruling out other causes and assessing individual risk.

Medication-related causes — not just contraception

SSRI antidepressants (selective serotonin reuptake inhibitors) and related medications are one of the best-documented medication-related causes of reduced libido — and at the same time one of the most often overlooked in conversations about causes, because patients and doctors usually focus on mood improvement rather than sexual side effects.

Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis

Moderate evidence

Serretti A, Chiesa A · Journal of Clinical Psychopharmacology · 2009

A meta-analysis of randomized controlled trials assessing antidepressant-related sexual dysfunction found rates ranging from 25.8% to 80.3% depending on the medication evaluated. Sertraline, venlafaxine, citalopram, paroxetine, and fluoxetine were among the medications with the strongest impact on sexual function, while agomelatine, bupropion, mirtazapine, and nefazodone showed no significant difference from placebo. The analysis did not break out results separately for women and men, nor for individual domains of sexual dysfunction (desire, arousal, orgasm), which is a significant limitation when trying to apply this data specifically to the problem of reduced libido in women.

View study
Myth

If an antidepressant improves mood, then reduced libido while taking it must be a "psychological effect," not a pharmacological one.

Fact

SSRI-related sexual dysfunction has a documented pharmacological mechanism (among others, effects on serotonergic and dopaminergic signaling), independent of whether mood improves or not. Importantly, these symptoms can be persistent and don't always resolve with continued use, and in rare cases can persist even after discontinuation.

Other medications and substances that can reduce libido

  • Hormonal contraceptives — in some women they lower free testosterone levels by raising SHBG (sex hormone-binding globulin)
  • Antihypertensive medications, especially certain beta-blockers
  • Anticonvulsants and certain antipsychotics
  • Excessive alcohol use and certain psychoactive substances
  • Chemotherapy and certain hormone therapies used in cancer treatment

Psychological and relationship-based causes

According to the Heshmatnia et al. meta-analysis, psychological factors (anxiety, depression, chronic stress, history of sexual assault) and interpersonal ones (relationship dissatisfaction, partner's sexual difficulties, lack of emotional closeness) are among the main categories associated with sexual dysfunction in women, alongside purely hormonal or medical factors. In clinical practice, these categories rarely occur in isolation — chronic stress can lower libido both directly (via cortisol's effect on the hypothalamic-pituitary-gonadal axis) and indirectly, by worsening sleep quality, mood, and the relationship with a partner.

This overlap of causes has practical therapeutic significance: treating only one dimension of the problem — for example, correcting hormone levels without addressing chronic stress or relationship difficulties — rarely brings full improvement if the other factors aren't addressed simultaneously.

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How diagnosis is approached in practice

CategoryWhat's worth checking
HormonalEstrogen level (in the context of menopausal age), thyroid hormones, prolactin, possibly total/free testosterone
Medication-relatedReview of currently taken medications, including hormonal contraception and antidepressants, for known side effects
PsychologicalAssessment of anxiety, depression, chronic stress symptoms — possible psychological or sex therapy consultation
Relationship-basedQuality of communication with partner, relationship satisfaction, possible partner sexual difficulties
General medicalChronic diseases, pain during intercourse (dyspareunia), history of gynecological procedures

Categories of causes of reduced libido and example diagnostic directions

It's worth starting with a medication review

Since medication-related sexual dysfunction is one of the easier causes to identify (and sometimes reversible after a medication change), a good first step is often reviewing currently taken medications together with the treating doctor, before starting more complex hormonal or psychological diagnostics.

What the intervention-effectiveness data shows

Interventions with varying levels of research support

  • Testosterone therapy in postmenopausal women with distressing low desire — supported by a meta-analysis of 36 RCTs, but requires medical supervision and isn't approved everywhere for this indication
  • Switching to an antidepressant with less impact on sexual function (e.g., bupropion) — a possible option, but only after consulting the treating doctor, never through self-discontinuation
  • Local estrogen therapy for atrophy and pain related to vaginal dryness during menopause — a separate indication from general reduced libido, but often co-occurring
  • Psychological or sex therapy when anxiety, depression, or relationship components predominate
  • Reducing chronic stress and improving sleep hygiene as supplementary, though less directly studied in the context of libido, general health interventions

Limitations of the available data

What these studies don't prove

The meta-analysis on the scale of the problem (Heshmatnia et al.) relies mainly on cross-sectional studies, which show correlations rather than causal relationships, and is characterized by very high heterogeneity between studies. The testosterone meta-analysis (Islam et al.) involved mainly postmenopausal women with a specific diagnosis of distressing low desire — its results shouldn't automatically be generalized to younger women or to reduced libido without accompanying distress. The antidepressant meta-analysis (Serretti and Chiesa) didn't break out data separately for women, limiting the precision of conclusions specific to this group.

QuestionShort answer
How common is reduced libido in women?Very common — a meta-analysis of 20 studies puts pooled sexual dysfunction prevalence at 47.81%, with a wide range between studies
Does testosterone therapy help?Yes, in postmenopausal women with distressing low desire — confirmed by a meta-analysis of 36 RCTs, but requires medical supervision
Do antidepressants lower libido?Yes, to varying degrees depending on the drug — sexual dysfunction rates reach 25.8-80.3% depending on the medication
Is the cause usually singular or complex?Usually complex — hormonal, medication-related, psychological, and relationship factors often co-occur
Where should diagnosis start?With a review of currently taken medications, followed by hormonal and psychological assessment

Low libido in women at a glance

Our editorial recommendation

Reduced libido in women is common and multidimensional enough that trying to find one universal cause rarely produces an accurate answer. The available data show three solidly documented pathways — hormonal (with testosterone therapy as an option supported by an RCT meta-analysis), medication-related (particularly SSRI antidepressants), and psychological/relationship-based — which often overlap in clinical practice. The most honest approach is systematic evaluation across all three areas, rather than assuming upfront that the problem is "just hormonal" or "just psychological."

In my practice, the most common mistake isn't poor treatment, but treating only one layer of the problem — we correct hormones while overlooking an antidepressant taken for years, or a relationship where sex has been a taboo topic for months. Diagnosing reduced libido requires patience, not a single blood test.

Dr. Piotr Zieliński, VitMode editorial team

Frequently asked questions

No — menopause is one of the best-documented causes, but not the only one. Reduced libido can also result from thyroid disorders, prolactin levels, medications being taken (including contraception and antidepressants), chronic stress, anxiety, depression, or relationship difficulties.

A meta-analysis of 36 randomized controlled trials (Islam et al., 2019) showed improved sexual function without serious adverse events, though acne and excess hair growth were observed more frequently. Long-term safety requires further research, and therapy should only take place under a doctor's supervision.

According to the Serretti and Chiesa meta-analysis (2009), sertraline, venlafaxine, citalopram, paroxetine, and fluoxetine showed the strongest impact on sexual function, while bupropion, mirtazapine, and agomelatine showed no significant difference from placebo.

No — changing or discontinuing an antidepressant should always be discussed with the treating doctor, due to the risk of depression relapse or withdrawal symptoms. Switching to a medication with a different side-effect profile is a possible option, but requires medical supervision.

Chronic stress can lower libido both directly, through cortisol's effect on the hormonal axis regulating reproductive function, and indirectly — by worsening sleep, mood, and relationship quality, which further compounds the problem.

In some women, yes — they can raise SHBG (sex hormone-binding globulin) levels, which lowers free, biologically active testosterone. This effect varies individually and depends on the specific formulation.

A good starting point is a gynecologist or family doctor, who can order basic hormonal tests and review current medications, and refer further to an endocrinologist, sex therapist, or psychologist as needed, depending on the factors identified.

Sources

PZ

dr Piotr Zieliński

Specialist physician in endocrinology, scientific consultant

Piotr has practiced endocrinology for more than fifteen years, mostly in male hormonal disorders and metabolic health. He joined VitMode as a scientific consultant because, as he jokes, he got tired of explaining the same testosterone questions at every appointment and decided to write the answers down properly, once. He reviews content on hormone therapy, supplement pharmacology and drug interactions, making sure articles never turn into encouragement to self-supplement in situations that genuinely need diagnostics and medical supervision. His professional motto — "evidence first, enthusiasm second" — has come up more than once with a patient who arrived with a supplement plan they found online.

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Related knowledge base entries

Kobieta w średnim wieku ćwicząca z hantlami w domu4.6

Menopause

The permanent cessation of menstruation caused by the ovaries ceasing function — a turning point involving significant metabolic, cardiovascular, and bone changes that calls for deliberate prevention.

Zdrowie kobietStrong evidence
Zmęczony mężczyzna zasypiający przy biurku w pracy4.5

Cortisol

The main stress hormone — essential for short-term survival, but problematic when chronically elevated.

HormonyStrong evidence
Zestresowana kobieta przeciążona pracą w biurze4.6

Chronic Stress

Short-term stress is a natural, adaptive body response — the problem is when it becomes chronic. A large meta-analysis of data from nearly 200,000 people found a concrete number for how much chronic job stress raises coronary heart disease risk.

HormonyStrong evidence
Umięśniony sportowiec w stroju treningowym4.7

Testosterone

The primary anabolic hormone — its natural level depends heavily on sleep, resistance training, body composition and fat mass.

HormonyStrong evidence
Kobieta leżąca na kanapie i trzymająca się za brzuch4.7

Endometriosis

A chronic disease affecting about 10% of women of reproductive age, still diagnosed with a multi-year delay on average — despite pain severe enough to significantly disrupt daily functioning.

Zdrowie kobietStrong evidence
Lekarz konsultujący pacjenta podczas wizyty w klinice4.6

Hypothyroidism

One of the most common hormonal disorders, especially in women — it slows metabolism and is often mistaken for chronic fatigue or 'ordinary' weight gain.

ChorobyStrong evidence

Comments (2)

  • KW

    Kasia W. 2 weeks ago

    Very clearly explained, especially the interactions section — I hadn't seen it laid out this well anywhere else.

  • MT

    Marek T. a month ago

    Are you planning to update this with the newest study from this year? I saw an interesting meta-analysis.