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Impact of Testosterone Replacement Therapy (TRT) on Low Libido

Written by

Science & Humans

Medically approved by

Maria Jacob

Last updated

Monday, August 23, 2021

Libido refers to sexual desire and overall sexual drive. Testosterone plays a center stage role in maintaining man’s libido. Variation in libido or sex drive is normal with sexual drive easing with age. That said, one man’s low libido is another’s height of sexual contentment.

What causes Low Libido?

Ageing brings down testosterone levels gradually. About 1% from thirty onwards and testosterone is the male hormone that defines male characteristics, builds muscle, impart a sense of well being, stay motivated & lean.

Injury, illness, hormonal abnormalities, medications taken for chronic conditions, depression, alcohol, drugs like opioid & marijuana abuse might play a part in decreased T-levels in the body. Sudden fall in testosterone, or prolonged lows should be looked at, as this might be an indication of underlying health issues.

Psychological & Environmental Factors

Sexual drive in a person itself varies with a lot of other factors like stress, career, illness, cultural issues, lack of partner, relationship problems, depression, adequate sleep, etc., affecting levels in libido. And as such there is nothing like a normal yardstick to measure libido. Typically, men identify low libido as a problem sometimes it is a partner determining low sex drive.

Although, testosterone levels solely do not determine sexual performance or sexual drive, low-T levels definitely reduces once ability for enjoying satisfying sex. TRT therapy comes to the rescue in such scenario where low-T is the casual factor of low sex drive.

What is considered Low-T?

Serum testosterone of 300 in an adult male is considered low, as per guidelines from the FDA.

A simple blood test starts the process for diagnosis which measures many aspects other than testosterone levels to determine suitability for testosterone therapy. Treatment options include creams which is topically applied daily and are the better option, and injections administered usually biweekly.



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What & when to expect from TRT Therapy?

TRT therapy raises testosterone levels externally which will improve libido, sexual desire, sexual thoughts and fantasies, and satisfaction after 3 three weeks to 30 days, and plateaus after 6 weeks. Some studies with men suffering from diabetes, visceral obesity & partial androgen deficiency reported improvement in libido with testosterone replacement in 3 months.

Another study that determined the effect of testosterone therapy on sexual function in non-obese ageing men with symptoms of androgen deficiency and low–normal serum testosterone levels showed T – levels improving as much as 30%, compared to men who received placebo . TRT therapy improved sexual desire, with other parameters unaffected by the treatment.

The study was a randomized, double-blinded study using transdermal testosterone and placebo for a duration of 12 months with 60 men aged 55 years and above, in good general health with total testosterone (TT) levels <15 nM

Risks & Side Effects

The risks of TRT is also low. Periodic monitoring for enlarged prostate, increased red blood cell counts, and vascular health is necessary.

A major side effect of TRT therapy is infertility and if desiring children, discuss with therapist for other treatment options which will not affect sperm generation. Or, start testosterone after conception.  

Effects on libido, sexual desire, sexual thoughts and fantasies and satisfaction with sexual life manifest themselves rather rapidly: after 3 weeks (68) or 30 days (14). Some studies have measured these effects only after 3 months (31).

Testosterone isn't the only fuel for a man's sex drive and performance. But low testosterone can reduce your ability to have satisfying sex. Lack of sex drive and erectile dysfunction are sexual problems that can result from low testosterone. If low testosterone is the cause, treating it can help.

Testosterone and the Causes of Low Libido

Researchers haven't unraveled the mystery of just how testosterone increases libido. It's normal for men's sex drive to slowly decline from its peak in their teens and 20s, but libido varies widely between men. What one man might consider a low sex drive, another might not. Also, sex drive changes within each man over time and is affected by stress, sleep, and opportunities for sex. For these reasons, defining a "normal" sex drive is next to impossible. Usually, the men themselves identify a lack of sex drive as a problem. Other times, their partner may consider it to be an issue.

Low testosterone symptoms don't always include feeling like you have no sex drive. Some men maintain sexual desire at relatively low testosterone levels. For other men, libido may lag even with normal testosterone levels. Low testosterone is one of the possible causes of low libido, however. If testosterone is lowered far enough, virtually all men will experience some decline in sex drive.

In a large study of men in Massachusetts, about 11% overall said they had a lack of sex drive. The researchers then tested all the men's testosterone levels. About 28% of men with low testosterone had low libido. These men were relatively young, with an average age of 47; older men might have worse sexual symptoms.

Low testosterone is only one of the causes of low libido. Stress, sleep deprivation, depression, and chronic medical illnesses can also sap a man's sex drive.

Low Testosterone and Erectile Dysfunction

Surprisingly, low testosterone by itself rarely causes erectile dysfunction, or ED. Low testosterone alone -- with no other health problems -- accounts for a small minority of men with erectile dysfunction.

Erection problems are usually caused by atherosclerosis -- hardening of the arteries. If damaged, the tiny blood vessels supplying the penis can no longer dilate to bring in the strong flow needed for a firm erection. Diabetes, high blood pressure, smoking, and high cholesterol are the three main causes of atherosclerosis and erectile dysfunction.


At the same time, low testosterone is a frequent accomplice to atherosclerosis in creating erectile dysfunction. In studies, as many as one in three men mentioning ED to their doctor have low testosterone. Experts believe that in men with other factors causing erectile dysfunction, low testosterone can strongly contribute, making a difficult situation even worse.

Strengthening the connection, low testosterone is linked in some way with many of the conditions that lead to erectile dysfunction:

  • Metabolic syndrome
  • Obesity
  • Endothelial dysfunction
  • Diabetes

Although low testosterone isn't known to cause them, the associations between other medical conditions and low testosterone can be significant.

Testosterone therapy improves sex drive and satisfaction with sex in many men. However, the long-term risks and benefits of testosterone replacement are unknown. Research trials on testosterone replacement in men are ongoing, although results are years away.

Who Should Get Testosterone Therapy?

Low testosterone is seen as a normal part of getting older. After age 30, men’s levels drop by about 1% each year. Testosterone replacement therapy can help restore them. It’s been shown to improve not just libido and your ability to have sex, but also bone density, muscle mass, mood, thinking skills, and heart disease. Your doctor may suggest it if you’ve been diagnosed with testosterone deficiency and have erectile dysfunction or a drop in your libido.

But if you want to have kids, he probably won’t suggest the treatment. It could lead to infertility.

Also, the U.S. Food and Drug Administration has only approved prescription testosterone products for men whose low T levels are caused by specific medical conditions. In other words, you can’t get them just because you’re getting older.

Further reading

How Does TRT (Testosterone Replacement Therapy) Impact Fertility ?

How Does TRT (Testosterone Replacement Therapy) Impact Fertility ?

TRT-induced infertility can be reversible by stopping treatment, using HCG/Clomid, freezing sperm, or inducing pregnancy via IVF/artificial insemination. ED, libido, musc ...

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How Does TRT Therapy Impact Chronic Fatigue?

How Does TRT Therapy Impact Chronic Fatigue?

Chronic fatigue syndrome is characterized by persistent fatigue and difficulty carrying out routine everyday tasks. TRT therapy is a tried-and-true method for raising tes ...

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Hypogonadism or Low-T in Younger Men and Testosterone Intervention

Hypogonadism or Low-T in Younger Men and Testosterone Intervention

Genital or acquired disorders can cause weariness and a lack of energy, while testosterone and HCG can help raise T levels without compromising sperm production, but exte ...

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