Testosterone, Libido, and Midlife Sexual Changes

Many men in midlife notice changes in energy, mood, desire, or sexual confidence and begin exploring whether hormones may be part of the picture. Testosterone levels naturally decline with age, and for some men this shift can meaningfully affect how they feel — both physically and sexually.

At the same time, sexual concerns in midlife are rarely only hormonal. Stress, relationship patterns, mental health, performance anxiety, and life transitions often play an equally important role.

My approach is to help you understand what hormones can explain — and what they can’t.

What Low Testosterone Can Affect

When testosterone levels are genuinely low, men may notice:

  • Reduced sexual desire or interest in sex

  • Fewer spontaneous erections

  • Lower energy or motivation

  • Changes in mood, confidence, or drive

Hormone therapy can be helpful for some men, particularly when low levels are confirmed through appropriate medical testing. Many of my clients work with primary care providers, endocrinologists, or urologists to evaluate this option.

What Testosterone Therapy Doesn’t Usually Solve on Its Own

Even when hormone levels improve, many men find that:

  • Erectile difficulties persist in certain situations

  • Desire feels inconsistent or “mental” rather than physical

  • Sexual anxiety or pressure remains

  • Long-standing relationship patterns continue to affect intimacy

This is because sexual function is influenced by both the body and the mind. Hormones may restore baseline capacity, but confidence, arousal, and satisfaction are shaped by psychological and relational factors.

How Sex Therapy Fits In

Sex therapy provides a space to:

  • Understand how stress, anxiety, and expectations affect sexual response

  • Address performance pressure or fear of “not working”

  • Rebuild confidence and trust in your body

  • Explore desire changes in long-term relationships

  • Integrate medical treatment with psychological support

For many men, therapy becomes especially useful after starting hormone treatment — when the question shifts from “Is something wrong with my body?” to “Why doesn’t this feel the way I expected?”

A Collaborative, Balanced Approach

I do not prescribe medication, but I regularly work with men who are:

  • Considering testosterone testing

  • Starting hormone therapy

  • Adjusting expectations after treatment begins

Rather than viewing hormone therapy as a shortcut or a failure, I help clients approach it as one tool among many in improving sexual health and overall wellbeing.