Low libido (also called reduced or loss of sex drive) means less or no spontaneous sexual desire, less interest in sexual activity, or less fantasy or erotic thoughts, compared to what someone expects or experiences normally. For trans people, this may be particularly distressing if it conflicts with gender identity, transition goals, sexual satisfaction, or intimacy.
| Factor | How it can affect libido in trans people |
|---|---|
| Hormone therapy | Hormones have a large effect. For transfeminine people (assigned male at birth, AMAB) taking oestrogen and antiandrogens, there is usually a reduction in testosterone, which tends to reduce erections, sexual responsiveness, and libido. For trans men (assigned female at birth, AFAB) taking testosterone, many report increases in sexual desire, but libido may be affected by other factors. |
| Body image, gender dysphoria, and emotional alignment | Discomfort with your body (or certain body parts), or distress about gender incongruence can reduce desire. Feeling affirmed (emotionally, socially, medically) tends to help libido. Surgery can shift some sexual outcomes. |
| Physical sexual function changes | Erection or arousal ability can change (e.g. reduced erections for AMAB people on oestrogen/antiandrogens) which may lead to less desire or pleasure. Also, changes in genital sensitivity are sometimes reported. |
| Hormonal balance | If hormone levels are too low (or imbalanced), libido can drop. Other health issues, medication side effects, or other hormone-related issues (thyroid, etc) also play a role. |
| Psychological and relationship factors | Stress, anxiety, depression, past trauma, body shame, social stigma, lack of intimate partner support can all diminish sexual desire. Tiredness – a busy day-to-day life, fatigue, or unequal burdens in household and caregiving roles can lead to 'choosing sleep over sex.' |
| Time since starting treatments | Libido changes are often greatest in the early months of hormone therapy, then may adjust over time. Some people report libido 'crashing' soon after starting, then partial recovery or shifting in type/character of desire. |
Possible Solutions
Here are approaches and strategies that might help, depending on the individual situation.
Hormone Management
Review hormone regimens: adjust oestrogen, testosterone, antiandrogens to achieve levels that align with goals but minimise unwanted libido suppression.
Consider monitoring hormone levels and evaluating other hormone systems (thyroid, prolactin, etc.).
If you would like to talk to a doctor directly, you can book a session here.
Gender-affirming Surgeries and Body Alignment
Surgeries like vaginoplasty or phalloplasty, or chest/genital surgeries, may influence sexual function and self-image, which in turn can affect libido.
You can learn more about surgeries here, and book a Surgery Referral Session here.
Psychological/Relationship Support
Therapy/counseling to explore body image, gender dysphoria, intimacy, communication with partners.
Address any past trauma, shame, or stigma that might suppress desire.
Practices that support non-sexual intimacy, to maintain closeness without the pressure of sex.
If you would like to speak to a counsellor, you can book a session with one here.
Lifestyle & General Health
Sleep, nutrition, exercise, reducing chronic stress. All of these help with general wellbeing, mood, energy levels, and can indirectly support libido.
Avoiding or managing medications that suppress libido, where possible.
Setting expectations & self-exploration
Recognize that libido may change: how you desire sex might shift, what feels pleasurable might change. This is normal.
Exploring what feels good (types of touch, erogenous zones, fantasies) can help people reconnect with desire in ways that align with their body and identity.