Libido has stayed low for months — what is the first oMeds step?
Low libido is routed by sex and biomarker context. Men: TRT when low T is confirmed; sexual-wellness pathway (PDE5) when libido is intact but performance is not. Women: BHRT (often with low-dose testosterone) when biomarkers match.
Full answer
Libido is multifactorial — hormonal, vascular, psychological, and relational inputs all matter. The Assessment separates desire from performance. Men with confirmed low total/free testosterone are routed to Testosterone Optimization; men with intact libido but erectile concerns are routed to the Sexual Wellness pathway (tadalafil/sildenafil). Women with peri/menopausal hormone shifts are routed to BHRT, which in select candidates includes low-dose testosterone for desire. Thyroid, prolactin, SSRIs, and sleep debt are screened first because their correction can resolve libido without pathway initiation. Every route is provider-reviewed against the biomarker panel.
Educational. Not a substitute for individualized provider review.
- Testosterone Optimization pathway — Primary source · oMeds
- Reviewed by Dr. Laura Purdy, MD, MBA · Clinical Director, oMeds · Last reviewed 2026-05-29