Death of the sex drive - and the great debate over whether testosterone can help get it back

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Back in the 1990s, Alan Reeves would regularly perform on stage, stripping off to thousands as a member of The Dreamboys. He was so sought after that he, along with his troupe of male dancers, popped up in the Spice Girls film, Spice World.

The then 24-year-old was, by his own admission, "a bit of a pin up".

But by the time Reeves was in his 30s, he found himself in a very different situation — his mood was low and his libido had virtually disappeared.

"I just didn't feel right," he says.

Reeves, now aged 52, says his lack of a sex drive began to have a detrimental impact on his long term relationship.

"We were going without sex for three, four months at a time. I just wasn't interested," he says.

"This kind of thing can cause couples to break up."

Now a fitness and lifestyle coach based in London, Reeves began testosterone replacement therapy (TRT) and says it has given him his libido back, turning him "from a grumpy old man" to feeling like he's back in his 20s. It just "felt phenomenal" he says.

And women too are turning to testosterone.

Rachel Mason, a 37‑year‑old menopause blogger, says the hormone has been "amazing" for her energy levels, concentration, and libido.

Prescriptions for testosterone have surged. The latest data from the NHS Business Authority, compiled by the Care Quality Commission, shows that prescribing rose by 135% between 2021 and 2024.

This increase comes at a time when sex drive across the UK appears to be waning. According to the National Surveys of Sexual Attitudes and Lifestyles (Natsal), which questions more than 10,000 people roughly each decade with new figures due out later this year, the frequency of sex has steadily declined.

In 1990, people aged 16 to 44 reported having sex an average of five times a month. By 2000, that had dropped to four times, and by 2010, to three. The next set of results are due later this year, and researchers expect the downward trend to continue — though they do not point to a singular reason for the decline.

Against this backdrop, a debate is gathering pace. Can boosting testosterone improve libido, or is much of the attention solely hype, profit, and placebo?

Alan Reeves' experience of declining libido is just one example of a trend researchers say is becoming increasingly common.

"Over the years, we have noticed a drop across every demographic," says Soazig Clifton, Natsal academic director.

"There are fewer cohabiting couples than there were in the 90s, for example, so that could help explain the reduction in sex drive, but even when we looked specifically at that group, there was a decrease."

In fact, some of the steepest declines in sexual frequency were among older, married or cohabiting couples.

Clifton says it is difficult to say conclusively why sex drive seems to be declining.

"No data we have so far can really tell us with any confidence why, as a population, we are no longer having sex as much," she says.

There are several studies which try to understand the reason, highlighting that the digital world could be a major factor, making it harder to switch off, as well as offering more choices of things to do.

Our stress levels are also generally higher than they were 30 years ago, which may be a factor, says Dr Ben Davis, a GP and sex therapist.

"People have so much going on," he explains, "There's tech obviously, but there's also an increase in stress, depression, loneliness […] all of these will add to a reduction in sex drives."

And there is another possibility that has generated lots of interest online and become big business — that low testosterone levels could be having an impact on sex drive.

"Testosterone levels in men are definitely reducing," says Prof Geoffrey Hackett, consultant urologist and member of the British Society for Sexual Medicine (BSSM).

"The rise in obesity, type 2 diabetes, the increasing number of people leading more sedentary lives — all of these reduce testosterone levels. And declining testosterone levels will be a factor in why our sex drive is diminishing."

Several large scale studies over the past 20 years which have measured levels in men, suggest that testosterone levels have dropped, but Hackett stresses that the picture is nuanced — having low testosterone does increase the likelihood of a low libido, but that does not mean that everyone with low testosterone will have a low sex drive.

Despite this complexity, tube stations, bus stops and social media feeds are now festooned with adverts like: Low libido? Brain fog? Tired? Time to get a testosterone check! Has your man lost his spark? It might be his hormones!

So, can testosterone replacement therapy (TRT) really offer a cure‑all for low libido?

Melissa Green has been taking testosterone for nearly a year. She says it not only gave "her zest for life" back – it saved her marriage.

The 43-year-old says her low sex drive was having a huge impact on their relationship.

Being perimenopausal, her GP had already prescribed her oestrogen and progesterone through hormone replacement therapy (HRT) but Green says the GP would not test her testosterone levels, saying she did not need that extra hormone.

The NHS says it follows guidance from the National Institute of Care Excellence which states that testosterone should only be considered for women following a trial of HRT and all other factors which explain low sexual desire have been excluded. Those with concerns should speak to their GP, they add.

Eventually, Green went to a private clinic, had blood tests done, and was told her levels were low. After taking her results back to her GP, she now receives some testosterone on the NHS, and a small top up through a private prescription.

"It's given me my life back. In some ways, I feel like I'm back in my 20s," she says, "I've got more energy, I feel sharper, and my sex drive has come back."

While some are effusive about the impact testosterone has on libido, others say it has had less welcome effects.

Cheryl O'Malley was on testosterone for a year. She says while it may have helped return some of the energy she had lost during the menopause, it also boosted her sex drive too much, and left her with feelings of intense rage.

"I was really horny. I wanted to have sex with my husband, but at the same time I hated him.

"That's when you know this is not a good place to be, this was not me, I felt out of control."

Rachel Mason says when she posts about TRT she finds "many women are so scared to start testosterone, they worry they will become manly, develop facial hair, lose themselves."

Mason says she has a "particularly hairy part" of her wrist where she applies her testosterone gel on a daily basis, but that the benefits she gets from the hormone are worth it.

Along with increased body hair, TRT can come with a range of other side effects. For women, the most common effects are excess hair growth, acne and weight gain, which are usually reversible with reduction in dosage or discontinuation. Alopecia and deepening of the voice are rare with testosterone replacement.

For men, it can cause side effects such as weight gain, painful and prolonged erections, male pattern baldness and mood swings. It can also lead to lower sperm production which can impact fertility. There are treatments that can help, but medical advice is recommended.

Some NHS GPs and secondary care consultants have told the BBC that private clinics are profiteering by selling TRT as a quick fix to a complicated problem.

Dr Paula Briggs, an NHS consultant in sexual and reproductive health, describes it as a "gravy train" where people end up paying a lot of money for something they do not need.

"It's out of control," she says. "The wellbeing industry has created this gap in the market they're using to their advantage.

"It's abusive."

Private clinics, however, say they are improving people's lives by offering a service that the NHS is failing to provide.

Jeff Foster, an NHS GP and medical director at Voy, a multi-million pound clinic specialising in men's health, says the private sector is filling a gap in care.

"Right now, the NHS is not currently set up to diagnose or treat the thousands of men who may have low testosterone."

TRT is offered via the NHS with most clinics functioning under either endocrinology or urology.

Michael Kocsis has been offering TRT through his company, Balance My Hormones, since 2016. He says that he's seen demand grow "exponentially" over the past few years.

Kocsis says some of his patients have gone through the NHS to be tested, and been told they do not have low levels of testosterone, so have decided to go private.

"Just because their level of testosterone might be a bit higher than the threshold set by the NHS, does not mean that TRT can't help them.

"It's not black and white, it's more nuanced than that."

For men, testosterone starts to decrease by around 1% from the age of 30 to 40. NHS advice states that this is a normal part of ageing and is unlikely to affect libido.

Alan Reeves initially received TRT on the NHS. Two tests showed levels of 10nmol/L (nanomoles per litre) and 12nmol/L, and he was given a course of four injections, three weeks apart. But after his fourth treatment, Reeves was told it could no longer continue, "without much of an explanation."

"I was back to square one," he explains. "That's when I decided to go private."

So, what is a healthy testosterone level for men? It differs depending on which organisation you ask and which study you read.

Guidelines from the BSSM, which have been interpreted from major international studies, suggest that men with less than 12nmol/L, should be considered for TRT and will probably be showing symptoms of hypogonadism — a condition where the testes are not producing enough of this vital sex hormone.

NHS guidance differs between trusts, but it states that a man with levels below 6 to 8nmol/L may have testosterone deficiency.

For women, testosterone starts to decrease between the ages of 20 and 40 before it plateaus as they enter menopause. It's normal for levels to go down, but the question is how much that reduction has an impact on sex drive and overall wellbeing.

There are tests available, but it's difficult to take accurate readings because, while testosterone is also vital for women, the amount needed is a lot less. And even if it is prescribed, it has to be given a "off-label" as there is currently no licensed treatments for women available on the NHS.

Briggs is wary of the buzz around TRT. She says she has seen a huge surge in patients telling her they need testosterone because they feel low and not in the mood for sex anymore.

"They tell me they've done their research. Often that means they have seen the life changing impact this hormone has had on someone posting about it on social media.

"Just because it works for a celeb does not mean it works for the general population."

She says GPs in her local area, Cheshire and Merseyside, are inundated with patients asking for testosterone checks. There are many, she says, that will leave with a TRT prescription, only to come back a few months later and say it's had very little impact.

While it does help some people, she says, the proportion of those who say they need testosterone, and who will actually benefit from it, is small. Clinical evidence so far when it comes to women, suggests that TRT is only effective for treating those who are postmenopausal with low libido.

Briggs says advertising by private clinics has "blown everything out of proportion."

"I'm not against TRT when it's needed, what I am against is seeing it so over-promoted."

GP Ben Davis also warns that TRT can have a placebo effect, leaving patients sometimes taking and paying for medication privately, that they do not need.

Cheryl O'Malley has stopped taking testosterone. She says the intense anger and heightened sexual arousal she experienced during treatment have subsided, and her libido has returned to a level that feels comfortable for her.

"I'm so relieved I stopped taking it," she says.

"For some, medication can be really transformative," Davis says, but he adds that it is more than just handing out medication.

"GPs might not have time to discuss with a patient what is behind their low sex drive, could it be their relationship with their partner, could it be how they view themselves, could it be the sex they are currently having is longer turning them on?"

He says that there are so many factors that play into a low libido and testosterone is not the only answer.

Alan Reeves, however, has been on TRT for seven years now and is prescribed testosterone by the private clinic, Balance My Hormones. He says his life has dramatically improved.

"My libido came back, so much so at first, I wanted sex every night for 10 nights.

"But now that's calmed down and I am just in a good place."

Nonetheless, Reeves believes "it is not a silver bullet" and there is no point in taking testosterone without making other changes to your lifestyle.

Otherwise, he says, it's like putting a Ferrari engine in a "clapped out car".

"I walk… taller now, that's partly down to testosterone, partly down to me."

Additional reporting: Nat Wright

Top picture credit: Getty Images

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