Does my libido decline after 40, and is there anything I can do about it?
A decline in libido after 40 is normal but not inevitable. For men with a confirmed low testosterone level and associated symptoms a well-supported treatment exists, and for women around the menopause hormone therapy offers concrete help, particularly for vaginal complaints.
A decline in libido after 40 is very common for both men and women, but it is by no means an inevitable fate. In women, the ovaries gradually produce less oestrogen and testosterone around the menopause. Up to half of sexually active older women are affected by this, with reduced desire topping the list. Falling oestrogen levels can also cause vaginal dryness, which makes sex painful. Even so, the majority of older women continue to consider sex important.
In men, testosterone declines gradually with age. Approximately 30% of men between the ages of 40 and 79 have a measurable deficiency, with possible consequences including reduced interest in sex, erectile problems, muscle loss and increased abdominal fat. Being overweight, having diabetes and having high blood pressure all raise that risk. This therefore affects a substantial minority, not everyone.
For men who have both symptoms and a demonstrably low testosterone level, testosterone therapy is a serious option. The large TRAVERSE trial (more than 1,100 participants) showed that the therapy clearly improved sexual activity and desire, an effect that lasted two years1. Erectile problems were not resolved by the therapy in that same study. Men with normal testosterone levels gain nothing from it; it does not work as a general anti-ageing remedy.
For women around the menopause, hormone therapy and lifestyle adjustments are the best-known options. Hormone therapy demonstrably helps with sexual complaints caused by the loss of hormones, and the evidence is strongest for vaginal dryness and pain during sex. Non-hormonal approaches also exist, but concrete effect sizes have not been well established in the available research.
DHEA is a substance the body converts into oestrogen and testosterone, and its levels fall sharply with age. In women over 70 there are indications of a limited positive effect on libido, but the results are contradictory. The long-term risks for cardiovascular disease and hormone-dependent cancers have not been sufficiently studied, and researchers therefore explicitly advise against DHEA supplementation in older adults. Are you using dutasteride or finasteride for hair loss? These medications can also reduce libido as a side effect. Discuss this with your doctor.
The claims are based on epidemiological studies, a large randomised trial (TRAVERSE, PMID 37589949) and review articles on the menopause and low testosterone in men. The evidence for testosterone therapy in men is the strongest. For hormone therapy in women the evidence is moderate but consistent. For DHEA the evidence is thin and contradictory.