Hypoactive Sexual Desire Disorder (HSDD) in Men
Get back to being you.
Losing sexual desire does not define you, nor does it mean that “something is wrong with you.” Often, it is a signal that something needs attention, understanding, and care. Desire can change throughout life due to many factors, and when it persists, it may cause confusion, frustration, or distance in a relationship. The good news is that understanding what is happening is the first step toward restoring wellbeing and reconnecting with yourself and your sexuality.
WHAT IS HSDD DISEASE?
Restoring desire is restoring wellbeing.
Characterized by a persistent decrease or absence of sexual desire. It manifests as:
Lack of interest in sexual activity and absence of sexual fantasies or erotic thoughts for more
than six months. Some men can experience sexual aversion, an active rejection of sexual activity accompanied by anxiety or negative feelings.
It can be early onset (present from the beginning) or late onset (after a period of normal
desire), generalized (in all situations) or situational (only with certain partners or contexts).
It is a very common and personal experience that can significantly affect quality of life and
intimate relationships.
MORE THAN 1 IN 3 MEN OVER THE AGE OF 45 HAVE THIS CONDITION.
When to Seek Help
Personal Distress
When a man experiences significant anguish, worry, or dissatisfaction with his own sexuality, regardless of what his partner thinks. Subjective distress is a key diagnostic criterion.
Abrupt Changes in desire
A sudden decrease in previously normal sexual desire suggests medical, psychological, or pharmacological causes that require urgent investigation.
Negative impact in Quality of Life
When it affects self-esteem, generates anxiety, depression, social isolation, or significantly limits sexual life.
Relational conflicts
If low desire causes conflict with a partner, generates mutual resentment, emotional distance, or is significantly affecting the relationship, joint consultation is especially valuable.
If you recognize one or more of these signs, early evaluation can make a significant difference.
Most Common Causes
Causes include biological factors (hormonal, neurological, cardiovascular), medical conditions (diabetes, hypertension, sleep apnea), pharmacological factors (antidepressants, antipsychotics), psychological factors (depression, anxiety, trauma), and relational factors (partner conflict, poor communication). There is no single cause; multiple factors frequently coexist.No existe una sola causa, frecuentemente coexisten múltiples factores.
Factores Psicológicos y relacionales:
Learn More
These are the most common factors with the greatest impact on sexual desire:
Psychological Factors
Major depression is one of the most frequent psychological causes. It reduces general interest in pleasurable activities (anhedonia), including sex.
Generalized anxiety affects the hyperactivation of the sympathetic nervous system, which inhibits sexual response. Constant worry interferes with sexual focus.
Post-traumatic stress disorder/sexual trauma, especially childhood sexual abuse, generates aversion, dissociation, and hypervigilance during intimacy.
Low self-esteem and body image issues generate shame, physical insecurity, and the belief of not being attractive.
Sexual performance anxiety generates fear of failure, pressure to “perform,” and a perpetuated anxiety cycle that causes avoidance of sexual intimacy.
Relational Factors
Chronic partner conflict generates accumulated resentment, frequent arguments, and lack of conflict resolution. Sex begins to be seen as an obligation in a battlefield.
Lack of emotional intimacy generates emotional disconnection, poor communication, and the feeling of “living with a stranger” without emotional connection, which decreases sexual desire.
Addictive sexual behaviors also generate low desire toward the partner.
55-65%
Medical Factors
Learn More
The most common medical causes are
Hypogonadism/testosterone deficiency (15-20%):
Physiological decrease of testosterone with age, primary (testicular) or secondary (pituitary) hypogonadism. Testosterone is fundamental for maintaining sexual desire. It mainly affects men over 50, although it can occur earlier.
Diabetes mellitus (8-12%):
Affects through diabetic neuropathy, endothelial dysfunction, and vascular complications. Reduces both desire and erectile function.
Other medical causes are related to:
Hypertension and cardiovascular disease.
Obstructive sleep apnea syndrome.
Dyslipidemia/elevated cholesterol.
Hypothyroidism.
- Hyperprolactinemia.
Chronic kidney disease.
Advanced liver disease.
Medications
Some medications such as SSRI antidepressants (Fluoxetine, paroxetine, sertraline) are very common causes of low desire and erectile dysfunction. Paradoxically prescribed for depression, which already reduces desire.
30-40%
Lifestyle Factors:
Learn More
Certain habits can directly influence sexual desire:
Chronic alcohol abuse damages the testicles and affects neurological function.
Drugs like opioids, cocaine, and methamphetamine affect dopamine and sexual function.
Smoking affects vasculature and erectile function, reduces testosterone.
Overweight/obesity is associated with insulin resistance, testosterone reduction, and depression.
Sedentary lifestyle/lack of exercise reduces testosterone, increases depression, and affects self- esteem.
15-25%
Comprehensive Medical Evaluation
A comprehensive evaluation must consider all areas simultaneously to identify and treat multiple concurrent factors.
1.
Detailed Sexual and Clinical History
2.
Psychosocial and Relational Assessment
3.
Complete Medical and Hormonal Evaluation
4.
Evaluation of Physical and/or Mental Comorbidities
5.
Diagnostic Synthesis and Identification of Contributing Factors
Medical and Sexological Treatment
Sexual desire disorders are treatable conditions, and the most effective approach combines medical evaluation with sexological intervention. While the medical focus is on identifying and correcting potential physical or hormonal causes, the sexological approach addresses desire, emotional response, anxiety, self-esteem, and relationship dynamics. Combining both approaches helps restore sexual motivation, intimate connection, and overall wellbeing.
Medical Treatment
- Complete Hormonal Evaluation: Analysis of testosterone levels, thyroid function, and other relevant hormonal markers.
- Medication Adjustment: If HSDD is caused by medication side effects, alternatives are evaluated or doses are adjusted under medical supervision
- Hormone Therapy: When indicated, hormone replacement therapy (HRT) with testosterone is prescribed under supervision.
- Treatment of Underlying Conditions: Management of diabetes, hypertension, thyroid problems
- Lifestyle Optimization: Recommendations on exercise, nutrition, and sleep to improve overall and sexual health.
- PRP and Regenerative Therapy: Innovative procedures to improve vascular function and sensitivity.
Sexological Treatment
- Sexual Psychoeducation: Educating the patient and partner about sexuality, demystifying erroneous beliefs that limit desire.
- Couples Therapy: Improving communication, managing unresolved conflicts, and rebuilding emotional and physical intimacy.
- Cognitive Restructuring Techniques: Identifying and modifying negative thought patterns that inhibit sexual desire.
- Practical Intimacy Exercises: Implementing gradual activities (sensate focus, sensual massage) to reconnect with the body and the partner without performance pressure. (Homework for the couple to practice at home)
- Stress and Anxiety Management: Relaxation techniques, mindfulness, and EMDR when there is associated trauma.
- Exploration of Fantasies and Desires: Helping the man reconnect with his sexuality in a safe and authentic way.
INTEGRATED APPROACH
Men choose Prada & Ortiz Men’s Sexual Health Center because our programs work.
Reclaim your vitality.
📞 Contact us today for a confidential consultation.
Bilingual Services: We provide services in both Spanish and English, ensuring clear and respectful communication.
Prada & Ortiz Men’s Sexual Health Center employs an integrated approach to Sexual Dysfunction treatment combining medical, psychological and sexological expertise to achieve lasting results.
We believe strongly that sexual dysfunctions require care addressing the medical, psychological, and sexological aspects to restore biological functions, rebuild connection, confidence, and increased pleasure in both you and your partner’s sexual life.
Our specialists — Dr. Ortiz and Dr. Yaz — offer discreet, evidence-based care with compassion and expertise.
TAKE THE FIRST STEP:
Comprehensive evaluation of biological and emotional factors
Personalized treatment plan (Sexual medicine + Sex therapy)
Professional guidance from a multidisciplinary team
Confidential, judgment-free environment
FREQUENTLY ASKED QUESTIONS
We want you to experience this process with peace of mind.
Is having a very high sex drive the same as being a sex addict?
No. High sexual desire is a normal variant when there’s control, satisfaction, and no negative consequences. Sexual addiction involves loss of control, compulsive behavior despite harm, and an inability to stop even when wanting to, often followed by shame or guilt. We evaluate whether the behavior enhances your life or damages it.
I've lost interest in sex but I still love my partner. Does this mean something is wrong with our relationship?
Not necessarily. Low desire (HSDD) often has medical causes: low testosterone, medications (especially SSRIs), diabetes, thyroid disorders, or chronic fatigue. A hormonal panel can identify treatable conditions.
Desire and love are separate systems. You can deeply love someone and still experience low libido due to stress, depression, performance anxiety, or unresolved personal issues. Couples therapy helps explore whether the cause is relational or individual.
My partner says I think about sex too much and wants me to see a doctor. Is there something wrong with me?
Wanting frequent sex isn’t inherently problematic. We look for signs of compulsivity: Do you feel unable to control urges? Are there negative consequences at work, in relationships, or legally? Is there escalation (needing more stimulation over time)? Context matters. What’s “too much” for one couple may be normal for another. We assess whether your desire causes distress to you or your partner, and whether there’s an obsessive quality interfering with daily life or intimacy.
Can stress and anxiety really kill my sex drive, or is that just an excuse?
Absolutely. Chronic stress elevates cortisol, which directly suppresses testosterone production. Anxiety activates the sympathetic nervous system (“fight or flight”), which inhibits the parasympathetic response needed for arousal and erection. Additionally, psychological stress creates mental “noise” that makes it hard to be present during intimacy.
I watch pornography frequently and now I have trouble getting aroused with my partner. Are these connected?
Possibly. Excessive pornography can alter dopamine pathways, requiring increasingly intense stimulation for arousal. Over time, the brain may become desensitized.This can manifest as erectile difficulty or delayed ejaculation with a real partner. We evaluate whether there’s a physiological component or if it’s primarily behavioral.Treatment involves gradual reduction, Sensate Focus exercises with your partner, and rebuilding arousal pathways through real connection rather than screen-based stimulation.
Resources
Medical Disclaimer
This website is for informational purposes only and is not designed to provide medical advice. All information presented is intended for informational purposes only and not for the purpose of rendering medical advice. The content on this website, including text, blog posts, FAQs, educational materials, graphics, images, and information, is not intended to act as a substitute for professional medical advice, or to diagnose, treat, cure, mitigate, or prevent any disease or serious medical condition. Statements made on this website have not been evaluated by the Food and Drug Administration. The information contained herein is not intended to diagnose, treat, cure, or prevent any disease. Some therapies available at Prada Ortiz Men& Sexual Health Center may not be approved by the U.S. Food and Drug Administration and are offered by licensed medical professionals in the State of Florida acting in their independent clinical judgment. Certain therapies may be characterized as novel or experimental; their safety and efficacy may not be fully established by conventional means. While we endeavor to provide accurate information about the therapies we offer, we make no guarantees regarding their effectiveness or suitability for your unique needs. An individual patient's results to the treatments described on this website may vary. Testimonials reflect real experiences and opinions of our patients, apply solely to the relevant individual, and are not necessarily representative of all patients. Not all patients will have the same experience, and some treatments may be unsuccessful. Testimonials are not intended to make claims that our services diagnose, treat, cure, mitigate, or prevent any disease. Prices and services may vary and are subject to change without prior notice. Terms and restrictions may apply. Our doctors offer 10 minutes of free consultation. Prada & Ortiz Men& Sexual Health Center is committed to protecting your privacy in accordance with the Health Insurance Portability and Accountability Act (HIPAA). We maintain strict
confidentiality of all patient information and medical records. For more information, please request a copy of our Notice of Privacy Practices. Do not rely on this website to diagnose or treat any medical condition. This content is not ,intended to replace an evaluation with a qualified healthcare professional. Medical services at Prada & Ortiz Men& Sexual Health Center are provided by licensed healthcare professionals in the state of Florida. If you have a medical emergency, call 911, contact your doctor, and/or go to a hospital immediately.
BY ACCESSING AND USING THIS WEBSITE, YOU ACKNOWLEDGE THAT YOU HAVE
FULLY READ AND AGREE TO ACCEPT EACH OF THE TERMS SET FORTH HEREIN.
© 2025 Prada & Ortiz Men's Sexual Health Center | Centro de Salud Sexual Masculina Prada &
Ortiz
All Rights Reserved | Todos los Derechos Reservados
Miami, Florida