Cuando un hombre pierde el deseo por su esposa – Causas y soluciones

Do this within two weeks: obtain baseline labs – total and free testosterone, SHBG, TSH, fasting glucose/HbA1c, prolactin, CBC and CMP – and review current prescriptions and supplements, including SSRIs, beta blockers, finasteride and recreational substances. These objective results help separate endocrine or metabolic drivers from relationship or psychological drivers; aim to have results and a medication reconciliation here so the treating clinician can recommend adjustments or referrals.

Address mood and behavior concurrently: reduced sexual interest isnt solely a biological problem. Screen for depression, anxiety, sleep apnea and alcohol dependence; use PHQ-9 and GAD-7 scores as quick baselines and repeat after 6 weeks of intervention. Cognitive behavioral therapy and targeted sex therapy improve outcome metrics in randomized trials; refer to a licensed therapist if scores remain moderate or worse. Practical steps to reduce physiological impact include stabilized sleep (7–9 hours), limiting nightly alcohol to zero–one drinks and treating obstructive sleep apnea if found.

Concrete communication tasks to do this week: set a 30‑minute meeting with the spouse, use “I” statements, list three concrete changes each is willing to try, and agree measurable benchmarks (frequency of physical affection, date nights, sleep hygiene). Everyone involved should keep a log of mood, libido and medication changes; this makes clinical finding of patterns faster and reduces misinterpretation of intent. If resentment or chronic conflict has been present, prioritize a couples session within one month.

Medical escalation and expected timelines: if labs show low testosterone or thyroid abnormality, endocrine referral within 2–4 weeks; if erectile dysfunction is present despite normal labs, urology referral and PDE5 inhibitor trial may be indicated. For primarily psychological drivers, expect partial improvement in 6–12 weeks with therapy and medication adjustments; if no measurable change after three months, reassess diagnostic assumptions. A patient I treated described “mine began after a major job change” – that temporal clue redirected work stress as the primary contributor.

Practical note on data and sources: clinical images and summaries available from sources such as getty illustrate common comorbidities but are not a diagnostic substitute. Unfortunately, abrupt shifts in intimacy often have multiple simultaneous aspects – biological, psychological and relational – so plan parallel tracks of assessment and intervention to improve outcomes and regain stability.

How to measure whether a man’s desire has dropped

Measure immediately and quantitatively: document baseline sexual initiation frequency and subjective desire scores, administer validated scales (SDI‑2 and IIEF), run targeted labs (total testosterone, morning LH, TSH, fasting glucose and HbA1c) and a PHQ‑9; if erectile complaints appear, order nocturnal penile tumescence or vascular studies at a specialist clinic and repeat assessments at 8–12 weeks.

• Weekly logs (objective): number of intimate encounters, number of times he initiated, number of morning erections – keep for at least 12 weeks to detect trends.
• Self-report metrics: 0–10 daily desire rating and SDI‑2; a sustained drop ≥30% in scale score or a ≥50% fall in initiation frequency across 3 months indicates a clinically meaningful decline.
• Clinical tests: total testosterone <300 ng/dL suggests hypogonadism; HbA1c ≥6.5% diagnoses diabetes; abnormal PHQ‑9 ≥10 indicates moderate depression that can affect libido.
• Differential clues: preserved nocturnal erections with low daytime desire points toward psychological causes; absent nocturnal erections with vascular findings points toward organic erectile dysfunction.

Assess context and contributors:

• Medication side: review prescriptions (SSRIs, beta‑blockers, finasteride) as common libido reducers; check recent dose changes or new drugs.
• Health events: recent surgery, new diagnosis of diabetes, chronic pain or major life stressors were often temporally associated with declines in desire in multiple academic studies.
• Relationship signals: track changes in communication frequency, time spent together, and expressed needs toward closeness; record examples of decreased affectionate gestures or avoidance of intimate talk.

Action thresholds and referral plan:

1. If objective logs show a sustained decline by the numeric thresholds above, initiate labs and PHQ‑9 immediately and schedule a clinic referral within 4 weeks.
2. If labs show low testosterone or uncontrolled glucose, treat medical condition first; then reassess desire after 8–12 weeks of therapy.
3. If tests are normal but desire remains low and nocturnal erections are intact, prioritize psychological evaluation, couples therapy, and sex therapy focused on communication and esteem issues.

Practical prompts to use yourself and with a partner:

• Ask directly: “What changed in the last 3 months that might explain this?” – note answers and dates.
• Keep a neutral log rather than blame: record objective events and numbers throughout the monitoring period.
• Seek combined support: medical evaluation and parallel relationship work reduce the chance a treatable problem becomes a relationship breaker.

Red flags requiring urgent attention: sudden loss of libido with erectile pain or weight loss, new diabetes diagnosis, or suicidal thinking on PHQ‑9 – then contact primary care or emergency services for rapid management.

Simple behavioral checklist for decreased sexual interest

Implement a weekly 15-minute check-in with your partner to talk about energy, mood and sexual interest; use that slot to ask what each wants and how much effort feels realistic.

Measure frequency of intimate contact before and after major life events, which makes it possible to spot when declines happen and whether they are transient fluctuations or persistent lack.

Log three concrete signs over four weeks: number of initiated touches, number of conversations about intimacy, and number of refusals; these measures indicate whether avoidance is behavioral, emotional or medical.

Assess medical and lifestyle aspects: check blood pressure, diabetes control, medications, alcohol intake and heart symptoms – each can be a libido breaker or cause erectile dysfunction and should prompt further evaluation.

Watch behavioral style cues: patient, distracted, or irritable responses during affectionate moments actually indicate reduced interest more reliably than single rejections; note patterns while avoiding blame.

Utilicen objetivos concretos: aumenten los gestos afectuosos en un 30 % en cuatro semanas, añadan una conversación sincera por semana o reduzcan a la mitad las noches con alcohol; midan el cambio y revisen los resultados juntos.

Si varios signos apuntan a contribuciones biológicas (corazón, diabetes, medicamentos), organice una revisión médica; si los signos son principalmente conversacionales o emocionales, centre el esfuerzo en la comunicación y las actividades compartidas y considere la terapia de pareja si el progreso se estanca.

Mantengan un breve registro compartido y sean pacientes: los cambios pequeños y constantes hacen que las parejas se sientan más seguras, lo que a menudo hace que sea más probable que regrese el deseo; si no hay mejoría después de tres meses, busquen una evaluación adicional.

Preguntas para diferenciar la reducción del deseo del estrés o la fatiga temporales

Recomendación: lleve un registro de 14 días de marcadores concretos: horas de sueño, nivel de energía (1–10), erecciones matutinas, cambios de humor, cambios en la medicación y presión laboral; luego responda a la siguiente lista de verificación para separar la fatiga/el estrés a corto plazo de la libido baja a largo plazo.

1. Sueño y recuperación física

   • ¿Ha dormido menos de 6 horas la mayoría de las noches durante las últimas 2 semanas?
   • ¿Te sientes bastante agotado durante todo el día, necesitando siestas para funcionar?
   • ¿Te han resultado más difíciles los entrenamientos físicos o la intimidad física después de la actividad?
   • ¿Su frecuencia cardíaca en reposo es persistentemente más alta que su línea de base normal?
   • ¿Nota mareos, desmayos u otros signos que podrían indicar problemas de presión arterial o azúcar en la sangre?

2. Factores de estrés y entorno

   • ¿Ha aumentado la presión laboral últimamente, o una fecha límite dominante ha creado noches de insomnio?
   • ¿Ha tenido nuevas exigencias financieras, de cuidado o legales que no han disminuido después de unos días?
   • ¿Sientes que tu mente está ocupada con imágenes o preocupaciones no sexuales durante los momentos íntimos?
   • Después de un evento estresante importante, ¿su libido disminuyó inmediatamente y se mantuvo baja durante menos de un mes?

3. Estado de ánimo, relación y autoimagen

   • ¿Son los cambios de humor, la irritabilidad o la baja motivación el principal cambio, en lugar de un cambio en quién te atrae?
   • ¿Ha disminuido drásticamente la autoestima debido a un revés reciente, y podría eso estar causando retraimiento?
   • ¿Aún quieres cercanía pero no puedes despertar interés sexual ni sentir excitación?
   • ¿Sigue siendo agradable el afecto físico (tomarse de las manos, besarse) cuando el deseo sexual se reduce?

4. Medicamentos, alcohol, sustancias y salud

   • ¿Se comenzó a tomar un nuevo medicamento en el último mes, o hubo un cambio de dosis antes de la caída?
   • ¿Existen efectos secundarios listados para ese medicamento que incluyan disminución de la libido o cambios en la erección?
   • ¿Ha aumentado el consumo de alcohol, cannabis u otras sustancias después de un período estresante?
   • ¿Se ha hecho análisis de sangre o revisiones cardiovasculares recientemente? ¿Algún resultado anormal de tiroides, testosterona o glucosa en sangre?

5. Patrón y curso temporal

   • ¿El cambio ocurrió repentinamente después de un evento específico o gradualmente a lo largo de muchos meses o años pasados?
   • Si la situación que causaba estrés se aliviaba durante una semana, ¿comenzaba el deseo a recuperarse sin intervención?
   • ¿Están los días de intereses bajos agrupados en torno a períodos de alta presión en lugar de ser constantes a lo largo de las semanas?
   • ¿Sigues teniendo pensamientos sexuales en otros contextos (porno o fantasías), pero no con tu pareja?

Guía de interpretación: si 6+ respuestas apuntan a interrupción del sueño, mayor presión, medicación reciente o colapso del estado de ánimo a corto plazo y el patrón es de menos de 4 semanas, el problema es muy probablemente estrés/fatiga temporal. Si los cambios son graduales, persisten más allá de 6-8 semanas, están vinculados a marcadores de salud crónicos (análisis de sangre anormales, variabilidad de la frecuencia cardíaca baja sostenida, signos endocrinos) o informa una falta constante de excitación en todos los contextos, considere una evaluación clínica.

• Acciones inmediatas: mejorar el sueño (apuntar a 7–9 horas), reducir los estimulantes después de las 15:00, limitar el alcohol a <2 bebidas en días de mucho estrés, programe un bloque de descanso de 48 a 72 horas para ver si la libido se recupera.
• Si se sospecha de la medicación, hable con el médico que la prescribe sobre alternativas o el momento de la dosis; esté atento a los efectos secundarios sexuales documentados como un источник conocido en la información del medicamento.
• Solicitar análisis de laboratorio básicos (CBC, TSH, glucosa en ayunas, perfil lipídico, testosterona) y controlar la presión arterial; los resultados anormales crean razones objetivas para derivar a cardiología o endocrinología.
• Si las respuestas apuntan a tensión en la relación en lugar de puro cansancio, prueba un plan de intimidad de baja presión: contacto afectuoso breve, permiso explícito para detenerse en cualquier momento y evitar hablar de rendimiento.

Si los cambios específicos (mejora del sueño, reducción de sustancias, revisión breve de la medicación) no producen una mejora apreciable en 2–4 semanas, programe una consulta médica o de salud mental para descartar causas biológicas y analizar la terapia; no espere más de 8 semanas sin evaluación.

Cómo los cambios en la frecuencia difieren de una verdadera pérdida de la libido

Mida el cambio: mantenga un registro simple de eventos sexuales, pensamientos sexuales espontáneos y contexto durante 6 meses; si el bajo interés persiste en diversas situaciones y se acompaña de dificultades eréctiles, fatiga persistente, dolor o nuevos síntomas de estado de ánimo, programe una evaluación clínica (NHS: https://www.nhs.uk/conditions/low-sex-drive/).

La frecuencia puede disminuir sin una verdadera pérdida de deseo. Los factores comunes incluyen la presión laboral, el tiempo dedicado al cuidado entre turnos, enfermedades agudas, medicamentos temporales, el alcohol o conflictos con la pareja. Estos cambios situacionales a menudo desplazan la actividad hacia períodos específicos y luego se recuperan después de que se resuelven los factores estresantes. Un patrón que varía con ciclos como viajes, plazos o el cuidado de un recién nacido indicaría una reducción situacional en lugar de una caída global de la libido.

El deseo sexual hipoactivo verdadero muestra características específicas: reducción de pensamientos sexuales espontáneos, poco o ningún interés en el sexo con ninguna pareja o en ningún contexto, y persistencia durante al menos seis meses en múltiples ocasiones. La guía diagnóstica de fuentes académicas y psiquiátricas exige duración de los síntomas y angustia asociada; la ausencia de angustia o causas externas claras a menudo contradice un trastorno primario del deseo.

La evaluación clínica debe incluir preguntas específicas sobre la función eréctil, el dolor durante el coito, la sensación de evitación y si alguien no pudo o no quiso participar a pesar de las oportunidades. El examen físico y los análisis de sangre deben incluir testosterona matutina, estrógeno cuando sea relevante, prolactina, función tiroidea y glucosa y lípidos en sangre porque las afecciones cardíacas y metabólicas a menudo afectan la libido. La revisión de la medicación es esencial: los ISRS, algunos medicamentos para la presión arterial y los productos antihistamínicos pueden reducir el deseo.

Pasos prácticos para intentar antes de etiquetar una verdadera pérdida de libido: reducir la privación del sueño y la fatiga, limitar el alcohol, programar tiempo íntimo juntos, probar lubricantes u otros productos para reducir el dolor y practicar una comunicación abierta sobre las necesidades sexuales. Si las parejas aprendieron patrones de evitación, la terapia de pareja puede restablecer la conexión. Si los problemas de erección persisten o los marcadores sanguíneos son anormales, derive a un centro de salud sexual o clínica de cardiología para una evaluación adicional.

Utilice umbrales concretos: las disminuciones situacionales que se resuelven en semanas o pocos meses generalmente no reflejan una pérdida biológica; la falta persistente de interés sexual en todos los contextos durante seis meses o más, con hallazgos de laboratorio o de examen que lo confirmen, sí indica un trastorno que puede necesitar tratamiento médico o psicosexual. Ofrezca consejos a corto plazo (dormir mejor, menos estimulantes, intimidad programada) mientras organiza una evaluación adicional si existe preocupación o angustia continua.

Señales que justifican una evaluación profesional

Busque una evaluación combinada médica y de salud mental cuando la libido disminuya en más de un 50 % durante tres meses y la intimidad, el estado de ánimo, el rendimiento laboral o el sueño se vean afectados; documente la frecuencia, el contexto y el grado para medir la gravedad.

Umbrales concretos que a menudo indican la necesidad de derivación: cambio persistente que dura >12 semanas; testosterona total matutina <300 ngdl on at least two samples; phq-9 score ≥10 suggesting moderate depression; erectile failure in ≥50% of attempts or absence nocturnal erections separate nights. note that ssris and antipsychotics reduce libido ~30–50% users, heavy alcohol use (>14 bebidas estándar/semana) se correlaciona con un mayor riesgo.

Busque signos físicos que indiquen la posible existencia de un factor médico: aumento de peso inexplicable, reducción de la masa muscular, ginecomastia, fatiga, sofocos, nueva disfunción eréctil o marcadores metabólicos como glucosa en ayunas ≥126 mg/dL o HbA1c ≥6,5%. La apnea del sueño, el hipotiroidismo y la hiperprolactinemia son causas comunes y tratables; se recomiendan un panel endocrino (testosterona total matutina, SHBG si es necesario, TSH, prolactina), un perfil metabólico básico, un panel de lípidos y HbA1c.

Relationship indicators that suggest specialty input include persistent avoidance of intimacy, increased criticism, changING sexual scripts between partners, or repeated statements that attraction is the same but behaviour has stopped; those patterns often reflect underlying stress, unresolved conflict or comorbid psychiatric illness. Measure interaction frequency and affect on a weekly log over 4–6 weeks to give clinicians objective data.

Immediate actions to discuss with a clinician: review current medications with the prescriber, screen for depression and anxiety, obtain targeted labs, and consider sleep study if daytime sleepiness or high BMI present. If medical tests are normal, refer to a certified sex therapist or couples counsellor; a urology or endocrine consult will then address abnormal labs or persistent physiologic deficits.

Patient tracking improves diagnostic yield: record daily drive on a 0–10 scale, number of intimate attempts, presence of erections, substance use and stressors. This log will help clinicians discover patterns and learned associations between pressure, mood and sexual response.

Expect timelines: medication-related low libido probably improves within 6–12 weeks after adjustment; hormonal replacement or targeted medical treatment may show physically measurable improvement within 8–12 weeks, while psychosexual therapy often requires 8–20 sessions. Use objective measures and follow-up labs to determine higher-risk trajectories and next steps.

Clinical teams frequently use validated instruments and bedside measures rather than assumptions; supplying concrete data, concise history and a short symptom log will accelerate understanding and appropriate care. (getty)

Medical, hormonal and medication-related causes to check

Obtain morning total testosterone (drawn 7–10 AM) and repeat on a separate day; total <300 ng/dL on two same assays indicates biochemical hypogonadism and needs endocrinology referral, especially when libido has dropped over months or years.

Review current medications with the prescribing clinician: SSRIs (sertraline, paroxetine), SNRIs, 5‑alpha‑reductase inhibitors (finasteride), opioids, spironolactone, some antihypertensives and isotretinoin all probably causing sexual side effects such as decreased desire, erectile dysfunction, delayed ejaculation or anorgasmia.

Do not stop prescriptions abruptly; only cease or switch as told by the prescriber and consider alternatives more compatible with sexual functioning (bupropion, mirtazapine, changing antihypertensive class) or dose reduction under supervision; insurance policy may require prior authorization for some options.

Order LH, FSH, prolactin, TSH and free T4, fasting glucose or A1c and lipid panel: prolactin >20 ng/mL suggests hyperprolactinemia, TSH outside 0.4–4.0 mIU/L indicates thyroid dysfunction and A1c ≥6.5% means diabetes that commonly coexists with sexual issues and reduced testosterone production.

Assess stress, mood fluctuations and past psychiatric history; chronic pain or pelvic pain that feels severe will reduce spontaneous wanting and creates pressure during intimacy, so refer to a sexual medicine center when pain persists beyond expected timeframes.

If labs are normal then evaluate chronic conditions (diabetes, cardiovascular disease) and review symptom chronology over past months to years; persistent low libido despite normal testing probably requires combined medical and psychosexual interventions to keep intimacy alive.

Expect partial improvement within 6–12 weeks after medication change or targeted endocrine therapy, with larger gains by 3–6 months when lifestyle measures are added: 5–10% weight loss, resistance training, 7–9 hours sleep, reduced alcohol and smoking; use PDE5 inhibitors when erection issues coexist but note they are not compatible with nitrates and require the right specialist input.

Which blood tests to request and what abnormal results mean

Recommendation: Order morning (08:00–10:00) fasting total testosterone, free testosterone (direct or calculated), SHBG, LH, FSH, prolactin, TSH and free T4, morning cortisol, fasting glucose and HbA1c, CMP (liver, kidney, electrolytes), lipid panel, CBC, vitamin D, and PSA in older patients.

Total testosterone quite low when <300 ng/dL (≈10.4 nmol/L); interpret whether the low result is reproducible with a repeat morning draw. Compare LH and FSH: high gonadotropins point to primary testicular failure, low or inappropriately normal values indicate secondary hypogonadism and require pituitary assessment and medication review.

Prolactin >20 ng/mL suggests hyperprolactinemia and prompts pituitary imaging; markedly elevated prolactin can make someone less interested in sexual activity. TSH >4.0 mIU/L with low free T4 shows hypothyroid physiology that reduces sexual drive; low morning cortisol (<5 μgdl) raises concern about adrenal insufficiency while very high cortisol (>25 μg/dL) suggests excess cortisol exposure.

Fasting glucose ≥126 mg/dL or HbA1c ≥6.5% meets criteria for diabetes; insulin resistance and diabetes are related to reduced erectile function and lower libido. Measure resting blood pressure – readings >130/80 mmHg qualify as hypertension and many antihypertensive agents change sexual response and sexual feeling.

SHBG shifts alter the relationship between total and free testosterone: low SHBG (obesity, insulin resistance) can make total appear low despite adequate free levels; high SHBG (liver disease, some medications) can raise total while reducing free fraction. Expect fluctuations in hormones with acute illness, opioid or steroid exposure, sleep disruption and weight change; sometimes repeating tests after 2–4 weeks is helpful.

Lab results must be integrated with history: low labs often correlate with reduced sexual drive and less horny feeling, but psychosocial issues frequently contribute. Ask whether the patient wants treatment, whether a partner or someone close has noticed changes, and what kind of treatment the patient is interested in. Patients may say “it’s mine” about their symptoms; clinicians should not dismiss that report or worry solely about numbers. nagoski said subjective context matters – interpret objective abnormalities between labs and behavior, address things such as sleep apnea, medications, diabetes management, and blood pressure control, and recognize that even small hormonal fluctuations can make a meaningful difference in sexual drive.

Common prescription drugs that blunt sex drive and alternatives to discuss

Ask prescriber to review current medication list and prioritize adjustments that restore sexual desire while maintaining safety.

SSRIs (sertraline, paroxetine, fluoxetine) and SNRIs (venlafaxine, duloxetine) commonly cause lower arousal, delayed orgasm and decreased libido; academic reviews report sexual side effects in roughly 30–70% of treated patients. Practical alternatives include switching to bupropion or mirtazapine, or adding bupropion as an adjunct; if depression control relies on an SSRI, dose reduction or trial of vortioxetine can produce different results. источник: peer‑reviewed summaries learned these rates.

Antipsychotics that elevate prolactin (risperidone, paliperidone) reduce testosterone and sexual interest; consider aripiprazole or quetiapine as alternatives with lower prolactin impact, or discuss endocrine referral if prolactin remains high. If prolactin suppression isnt the issue but sedation is constant, dose timing or switching to a less sedating agent can reduce fatigue and improve spontaneous arousal.

Opioids (methadone, oxycodone) and some anticonvulsants (valproate, carbamazepine) blunt libido and impair testosterone. For chronic opioid therapy, buprenorphine may produce less hypogonadism; assess morning testosterone, prolactin, TSH and HbA1c right away if sexual changes appear. Diabetes increases neuropathy risk and contributes to erectile problems and lower arousal, so optimize glycemic control as part of the plan.

Antihypertensives: older beta‑blockers and thiazide diuretics can cause erectile dysfunction in some patients. Swap to ACE inhibitors, ARBs or calcium channel blockers when clinically appropriate; nebivolol has a better sexual side effect profile than traditional beta‑blockers. Discuss these options with the clinician who manages cardiovascular health.

Finasteride and spironolactone produce persistent lack of libido and erectile issues in a minority of users; if sexual symptoms havent improved after stopping, evaluate anatomy and pain contributors such as pelvic floor dysfunction, vaginismus or chronic pelvic pain syndromes. Refer to pelvic physical therapy or a pelvic pain specialist when pain or anatomic pain generators are present.

Short‑term tactics to regain sexual function include adding tadalafil (5 mg daily or 10–20 mg PRN) for erectile problems, consideration of transdermal testosterone when documented hypogonadism exists, and use of bupropion to counter SSRI‑related sexual dysfunction. Avoid PDE5 inhibitors alongside nitrates; discuss cardiac risk prior to prescribing.

Assessment checklist: medication list that includes drug names and doses, labs (testosterone, prolactin, TSH, HbA1c), screening for fatigue, pain and mood symptoms, and sexual history that captures spontaneous versus situational arousal and times of day when interest peaks. If you havent had baseline labs, order them; learn whether changes began after a new drug started or dose increased, since timing often reveals the main reasons. Bring these results and thoughts to the prescribing clinician and sexual health specialist to make an evidence‑based plan that matches anatomy, health status and patient goals.