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Low desire can be hormonal, emotional, or a side effect of medication. The doctor explores the cause before talking about treatment.

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The neurobiology of sexual desire

Sexual desire is regulated in the brain by a balance between excitatory and inhibitory neurotransmitters, a framework sometimes called the dual-control model (Clayton, Int J Gynaecol Obstet 2010; PMID 20434725). Dopamine, noradrenaline, melanocortin, oxytocin, oestrogen and testosterone act on the excitatory side. On the inhibitory side, serotonin — particularly via 5-HT₂ receptors in the prefrontal cortex and hypothalamus — prolactin and endogenous opioids all dampen desire. When the inhibitory signal dominates, or the excitatory signal weakens, spontaneous and responsive sexual desire drops. Clinically, this model explains several common patterns. Selective serotonin reuptake inhibitors (SSRIs) raise extracellular serotonin in the hypothalamus and can suppress desire as a direct pharmacological effect — not a psychological one. Hyperprolactinaemia, whether from a pituitary adenoma or a medicine (e.g. some antipsychotics), inhibits the hypothalamic-pituitary-gonadal axis, reducing gonadotropin-releasing hormone pulsatility and downstream testosterone production. Low testosterone itself — from ovarian insufficiency, iatrogenic suppression or hypothalamic causes — reduces excitatory tone in the medial preoptic area and nucleus accumbens, brain regions central to sexual motivation (Goldstein et al., Mayo Clin Proc 2017; DOI 10.1016/j.mayocp.2016.09.018).

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How the diagnosis is made

The formal diagnosis of hypoactive sexual desire disorder (HSDD) requires persistently low or absent sexual desire for at least six months, accompanied by marked personal distress, that is not better explained by another medical or psychiatric condition, a substance, or a relationship problem alone. The International Society for the Study of Women’s Sexual Health (ISSWSH) recommends a structured history: establishing whether desire was previously satisfactory, confirming a decrease, verifying the patient is bothered by it, and ruling out secondary causes (medication, endocrine disorder, major relationship conflict, other sexual dysfunction). Prevalence estimates put HSDD at roughly 10% of adult women, making it one of the most common female sexual dysfunctions.

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What a doctor rules out before considering treatment

Several conditions can mimic low desire and must be distinguished from primary HSDD. Depression can reduce libido, but so can the SSRI prescribed to treat it — the history of onset relative to medication changes is often diagnostic. Hypothyroidism slows metabolism and mood; a TSH measurement may be needed. Hyperprolactinaemia requires a serum prolactin level. Oestrogen deficiency from menopause or premature ovarian insufficiency can reduce desire through vaginal dryness and discomfort as much as through central neuroendocrine effects. The reviewing doctor will identify which cause, or combination of causes, applies before discussing any treatment.
This is a broad, honest starting point rather than a single diagnosis: what changes low desire depends on what is actually driving it, which is why the consultation asks about it before any treatment is discussed.

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What causes low sexual desire?

Persistent low sexual desire has several possible causes, and identifying the right one is the first step before any treatment is discussed. The change can be hormonal, emotional, or a side effect of medication. A doctor explores the pattern — when it started, what else was happening at the time, and whether it coincides with a new medicine — to understand what is driving it.

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Common questions

A licensed doctor reviews your questionnaire and decides what, if anything, is appropriate. The consultation is the same medical review used across Hi-Doctor’s sexual health service — it is not a guaranteed prescription. Not every medicine marketed for low desire is available through a consultation; for example, bremelanotide has no EU marketing authorisation.
Some causes of low desire need a different kind of assessment — hormonal, gynaecological, or a review of an existing medication. If that applies, the doctor will say so rather than force a prescription that is not appropriate, and will recommend the right care route.
Yes. The sexual health consultation is handled the same way as any other Hi-Doctor consultation: reviewed by a licensed doctor, kept in your private account chat, and never shared beyond the clinical team treating you.
Yes. The same consultation and doctor-review standard apply wherever you are in the EU; there is no separate process for a particular country.
If the doctor does not approve treatment, the consultation fee is refunded in full within 48 hours. See pricing for the fee details.
1

Start your online visit

Answer a short questionnaire about your health and goal. No in-person appointment, no travel. You’ll know within 24 hours if you’re a candidate.
2

A doctor reviews your case

A licensed doctor reviews your answers personally. If they need clarifications, they message you in the private chat on your account. If treatment is appropriate, they sign an electronic prescription.
3

Review and payment

If the doctor does not approve treatment, the consultation fee is refunded in full.
4

Ongoing support

Private chat with your doctor for questions, a check-in, and renewal where relevant.

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Confidentiality

The sexual health consultation is handled the same way as any other Hi-Doctor consultation: reviewed by a licensed doctor, kept in your private account chat, never shared beyond the clinical team treating you. See safety for how your data and answers are handled.

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What this consultation can and cannot offer

Not every medicine marketed for low desire is available through a Hi-Doctor consultation — for example, bremelanotide has no EU marketing authorisation, so no EU doctor can prescribe it. Where a cause the doctor identifies needs a different kind of assessment — hormonal, gynaecological, or a review of an existing medication — the doctor will say so rather than force a prescription that isn’t appropriate.
A licensed doctor reviews your case and decides what, if anything, is appropriate. The consultation is the same medical review used across Hi-Doctor’s sexual health service — it is not a guaranteed prescription.
A licensed doctor reviews your questionnaire and, if appropriate, issues an electronic prescription valid across the EU. Hi-Doctor does not sell or ship medications — any prescribed medicine is dispensed by the pharmacy you choose.
Yes. The same consultation and doctor-review standard apply wherever you are in the EU; there is no separate process for a particular country.

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How Hi-Doctor handles it

Sexual health is offered as a one-off consultation: one consultation, one doctor, one decision. See pricing for the fee and refund terms, and how it works for the full process from questionnaire to doctor review. Related conditions include erectile dysfunction, premature ejaculation, and performance anxiety. See also safety for the full eligibility checks and the sexual health treatment area.

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Start a consultation

Sexual health consultation

Answer the sexual health questionnaire and a registered doctor reviews it. They decide whether treatment is appropriate, which one, and at what dose — and declining is a normal outcome. See what it costs and how the review works.
This page is reference information, not medical advice and not a prescription. Whether a medicine is appropriate for you is decided by a registered doctor after reviewing your consultation.