Hypoactive sexual desire disorder, also known by the acronym HSDD, is a clinical diagnosis for when a person loses interest in sexual activity for an extended period. Typically, the diagnosis is given after the problem has persisted for more than six months, and a person is frustrated or upset by their lack of interest.1 HSDD is a form of sexual dysfunction .
A Note on Language
The term HSDD is used for women; for men, the diagnosis is male hypoactive sexual desire disorder, abbreviated MHSDD. Because there is no different specific diagnosis for nonbinary or gender nonconforming people, and because treatment for MHSDD is similar to that for HSDD, in discussing this topic, we will include people of all genders who deal with hypoactive sexual desire.
Hypoactive Sexual Desire Disorder Symptoms
Hypoactive sexual desire disorder may look at a glance like experiencing low libido, something that occurs for many people at varying points throughout life. But it’s more serious than a passing waning of interest in sex or sexual expression. A diagnosis of HSDD centers around the persistence of symptoms for a duration of six months or more. The following are common HSDD symptoms.2
- Decreased frequency in thoughts about sex
- Lowered physical response to sexual stimulation
- Difficulty obtaining pleasure from sex
- Lack of motivation to initiate sex
- Avoidance of sexual situations
Diagnosis of HSDD
There isn’t a single clinical test that can be used to diagnose HSDD. However, there are numerous ways that a practitioner can diagnose the disorder. In order for this to occur, you will likely have to speak up about it first.
By sharing what you’ve been experiencing with your doctor or other provider, you’ll be giving them valuable information to know where to begin with testing.
Blood tests can help determine the cause of your HSDD. Your doctor may test your hormone levels, including testosterone, progesterone, and estrogen, and your thyroid hormone function. They may also look to rule out underlying causes of HSDD such as diabetes.
For people with vaginas, a practitioner may recommend a visit to the gynecologist. A physical exam by one can help determine if there are physical problems, such as thinning of the tissues in the vaginal walls, that are contributing to your lack of desire.
Causes of Hypoactive Sexual Desire Disorder
There are a variety of causes of HSDD. Here are the most common ones.
Hormone Replacement Therapy
The hormones given to trans women are notorious for causing a lowered sex drive, sometimes to the point of HSDD. This is because estrogen tends to work against one’s sex drive, while testosterone increases it, and HRT for trans women generally involves taking estrogen.
In studies, over 62% of women have experienced a decrease in sexual desire due to HRT, and 22% were diagnosed with HSDD.3
Menopause
HSDD occurs frequently in women who have gone through menopause.4
Stress and Anxiety
Research has shown that there is a significant relationship between increased stress and lowered libido. If you have been undergoing a prolonged period of stress and/or life problems, that may be the cause of your HSDD.5
Dysphoria and Body Image
The feeling of not being comfortable in your body can lead a person to feel less sexual in it. Both gender dysphoria and body image challenges can cause HSDD.
Sexual Abuse and Trauma
Rape trauma syndrome is a form of PSTD that can present after sexual assault, and it can persist for years. it can make a person fearful or avoidant of close contact with others, both in sexual and nonsexual contexts.
Medication
Numerous categories of medications are known for causing sexual dysfunction and lowered libido. This can persist if a person has to stay on the medication indefinitely or for a long period of time.
Medications that might affect sex drive include antidepressants, antipsychotics, and estrogen-based contraceptives.
HSDD Treatment Options
To treat HSDD, you may have to try more than one thing. Here are some of the ways it’s managed.
Patience
HSDD can sometimes go away on its own. If you’re in the process of adjusting to a medication, for example, your body may eventually adapt well enough that your previous desire levels return.
If you are experiencing HSDD due to extended life stressors, your interest in sex can come back once those problems have been resolved or moved on from.
Medication
Taking a medication that is known to increase sex drive may be beneficial. There are a number of medications that are employed for this purpose.
Testosterone can increase sex drive, so it is an option for some people. It would be counterintuitive for trans women, though, since their gender-affirming care typically seeks to minimize testosterone production. It may, though, be helpful for women moving through menopause.
There are also medications that are not comprised solely of hormones, but will affect them. These include Vyleesi6 and7 both of which were created to treat HSDD, and an O Shot, which is specifically for people with vaginas.
Lifestyle Changes
There are some lifestyle changes that can have a positive impact on HSDD, though trying them may be more of a trial and error process than something as concrete as taking a medication.
Exercise can help to balance hormones, in addition to helping the body produce more feel-good chemicals.8
Communicating with your partner(s) about your experience with HSDD can take the emotional charge out of it, and help normalize it, which may lead to less stress and anxiety around the problem.
Therapy
There are multiple forms of therapy that can be useful for HSDD, as just the act of talking openly about a problem can help to resolve it. A person might benefit the most from sex therapy, which can be conducted in person or online.
A sex therapist can help you work through why you are experiencing HSDD, as well as help you discern what behavioral or life changes can be made that could help the problem resolve.
For those who are experiencing HSDD because of sexual assault or trauma, finding a trauma-informed therapist may be the most beneficial.
How to Cope With Hypoactive Sexual Desire Disorder
Living with HSDD can be frustrating, and it can make you feel alienated from your loved ones—especially if sexual connection is a big part of your relationship with any of them. Know that HSDD can be resolved and is not necessarily a permanent condition. To obtain the help you need, be forthright with your medical practitioners to enable them to help you as comprehensively as possible.