Sexual Dysfunction: Causes, and the Role of Testosterone & Other Medications
Sexual health concerns are some of the most under-discussed in medicine — not because they're rare, but because almost nobody brings them up first. Here's what's actually behind them, and where testosterone and other medications fit in.
Last updated August 2026
The main categories
Low desire (sometimes called HSDD, hypoactive sexual desire disorder), arousal difficulties, trouble reaching orgasm, and pain with sex (dyspareunia) are distinct problems with different causes and different treatments — not one blanket issue with one blanket fix.
Medications that affect desire and function
SSRIs and other antidepressants are the most common medication-related cause of low libido and delayed orgasm — a real, common side effect worth naming directly rather than something to quietly live with. Certain blood pressure medications and, for some people, hormonal contraception can also reduce desire.
The role of testosterone
Testosterone isn't just a male hormone — women produce it too, and it plays a real role in desire. Testosterone therapy for HSDD in postmenopausal women has genuine evidence behind it and is endorsed by The Menopause Society and international consensus guidelines, though it's used off-label in the U.S. — there's no FDA-approved female testosterone product, which means dosing and monitoring depend on finding a prescriber who knows this territory well.
What else can cause it
Menopause-related tissue changes (vaginal dryness and thinning), pelvic floor dysfunction, relationship and mental health factors, and underlying conditions like PMOS or thyroid disease can all show up as sexual dysfunction. It's often a symptom pointing to something else, not always its own standalone diagnosis — which is exactly why it's worth mentioning rather than assuming it's unrelated to everything else going on.
Worth discussing with your provider
Educational information only — general patterns that vary by person. This is not medical advice, a diagnosis, or a substitute for care from your own clinician.
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