Prof. Dr. Volkan İzol Explains – The Most Comprehensive Guide: Scientific, Honest, and Written in a Way Patients Can Understand

Sexual desire (libido) is one of the biological and psychological indicators of men’s health. A decline in sexual desire with age is a very common occurrence, but one that most men are reluctant to discuss. In fact, just like high blood pressure, diabetes, and high cholesterol, it is an entirely medical condition and can be largely treated with the right approach.

In my clinical practice, one of the most common complaints I hear from men—especially those over 40—is, “Doctor, I don’t have the same desire as before; my libido has dropped, and my sex life has declined.” This situation affects not only their sex life but also their self-confidence, their marital relationship, their daily energy, their motivation, and their quality of life.

In this comprehensive article, I will examine the decline in sexual desire in men as they age from medical, hormonal, psychological, and lifestyle perspectives. It will serve as a guide based on scientific research, covering modern treatment options, and written in simple language that patients can easily understand.

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Libido represents a person’s natural interest in, desire for, and motivation toward sexuality.

Male libido is determined by three main mechanisms:

1. Hormones → especially testosterone

2. Brain chemistry → dopamine, serotonin, norepinephrine

3. Psychological state → stress, depression, relationship dynamics

4. Physical health → vascular health, metabolism, sleep

When these four systems are in balance, sexual desire is strong; when any one of them is disrupted, libido decreases.

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Starting at age 35, testosterone levels in men decrease by an average of 1–2% each year.

This process is known as “andropause,” but unlike menopause, it does not occur suddenly. It progresses gradually.

A decrease in sexual desire can result from 10 main causes:

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Testosterone is the “fuel” of libido.

Thoughts on testosterone:

•Sexual desire decreases

•Morning erections become weaker

•Energy drops

•Muscle loss occurs

•Weight gain is observed

•Insomnia and a lack of motivation set in

This condition is called “hypogonadism.”

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The mechanism of penile erection is entirely a vascular process.

Just as aging in the blood vessels of the heart and brain can cause weakness, the blood vessels in the penis are also affected.

As erectile function declines, libido also decreases psychologically.

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•Diabetes

•Thyroid disorders

•Hypertension

•Heart failure

•Kidney diseases

•Fatty liver disease

These conditions reduce libido through both vascular and hormonal mechanisms.

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"Performance anxiety" is the most common cause of low libido in men.

A chain reaction occurs: stress → increased cortisol → decreased testosterone → loss of libido.

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Depression reduces both sexual desire and erections.

In addition, many antidepressants have the side effect of reducing libido.

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Incompatibility with a partner, arguments, and a lack of communication reduce sexual desire.

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Testosterone production peaks during sleep. When sleep is disrupted, testosterone production is also disrupted.

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Adipose tissue converts testosterone into estrogen.

As weight increases, testosterone levels drop → libido decreases.

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It damages the entire vascular system. Chronic smokers experience a significant loss of libido.

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Along with andropause;

•Testosterone levels decrease

•Blood vessel structure weakens

•Nerve conduction velocity decreases

•The muscle-to-fat ratio is disrupted

•Psychological energy decreases

For this reason, a decline in libido is common after age 50.

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My patients often get confused:

•Low libido → decreased sexual desire

•Erectile dysfunction → inability to achieve an erection

These two situations can trigger each other, but they are not the same thing.

It is essential to make this distinction in order to provide the correct treatment.

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❓ “Has my testosterone level dropped?”

Most likely, yes; it is common after age 40.

❓ “Should I start taking medication?”

No decision will be made without reviewing the blood test results.

❓ “Why does libido disappear?”

The most common cause is the "hormone-stress-vascular" triad.

❓ “Could it just be psychological?”

Yes, in many men, it is 100% psychologically based.

❓ “Is there a treatment?”

Absolutely yes. Low libido is one of the most treatable sexual problems.

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The first assessments I conducted at the clinic were as follows:

✔ 1) Blood tests

•Testosterone

•Free testosterone

•LH – FSH

•Prolactin

•TSH

•Estradiol

•Vitamin D

•Fasting blood sugar – HbA1c

•Lipid profile

The erectile mechanism may also be affected.

If you suspect you have sleep apnea.

Are you experiencing stress, anxiety, or depression?

Chronic conditions, medications, and surgical history are reviewed.

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This section is the most important part of the article.

Treatment for low libido is tailored to the individual.

There is no single magic pill or miracle cure.

We can summarize the treatment in 5 main sections:

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If testosterone levels are low, the most effective treatment is testosterone.

Uses:

•Injection

•Gel

•Cream

•Tablet

Benefits:

•Increases sexual desire

•Increases muscle strength

•Reduces fat content

•Increases energy

•Reduces depression

•Restores morning erections

Points to Note:

•PSA monitoring

•Blood density

•Regular checkups are necessary

Testosterone is a highly effective treatment when administered to the right patient at the right dose.

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If prolactin levels are high, libido drops completely.

Once treated, the desire returns.

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Hypothyroidism is a hidden cause of low libido.

It can be treated.

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It supports testosterone.

Patients with low levels tend to have a low libido.

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Cortisol is the enemy of testosterone.

For men, the fear of sexual failure is a major psychological burden.

If you have depression, your libido won't improve.

Even communication therapy can be very effective at times.

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This section is the cornerstone of the treatment.

✔ Sleep Schedule

Testosterone is produced at night.

✔ Regular Exercise

Weightlifting → natural increase in testosterone

A reduction in abdominal fat → lower estrogen levels → increased libido.

✔ Healthy Eating

•Omega-3

•Zinc

•Magnesium

•B12

Supports libido.

✔ Cut Back on Smoking and Alcohol

✔ Track Your Weight

Testosterone levels automatically rise in men who lose weight.

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It has a positive effect on libido by improving the quality of erections.

In some cases, it boosts libido by increasing dopamine levels.

•Maca

•Tribulus

•Zinc

•L-Arginine

•CoQ10

Dosage and quality are important when it comes to herbal supplements.

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Improves vascular health.

It improves the quality of erections → which also boosts libido.

It can increase sexual energy by improving vascular health.

As sexual performance improves, libido returns.

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Yes, it's normal to a certain extent.

However, the following situations are not normal:

•No requests at all

•Complete loss of libido for the past 2–3 months

•The complete cessation of morning erections

•Fatigue, depression, and a decrease in libido along with weight gain

•Complete abstinence from sexual relations with one’s partner

These conditions always require hormone and vascular testing.

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•Going to bed early

•Intense exercise 3 days a week

•Limit alcohol consumption

•Eating a healthy diet

•Engage in stress-reducing activities

•Establishing good communication with your partner

•Cut back on caffeine and sugar

•Daily sunlight

•Mental Detox

These are simple but effective methods.

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•If you haven't had a sex drive for 3 months

•If morning erections have disappeared

•If depression is present

•If you experience weight gain + fatigue + lack of motivation

•If erectile dysfunction is present

•If low testosterone is suspected

•If you have diabetes, thyroid disease, or heart disease

In this case, it is essential to consult a urologist.

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A decline in sexual desire in men as they age is a common occurrence, but it is not inevitable.

With the right diagnosis and personalized treatment combinations, libido often returns completely.

I always tell my patients:

“A decrease in libido may seem like a natural part of aging, but it is actually a largely treatable medical condition.”

The three most important points in treatment:

✔ To maintain hormonal balance

✔ Strengthen blood vessel structure

✔ Establishing a routine for stress, sleep, and nutrition

Once these three issues are resolved, sexual desire in men improves significantly.