Understanding estrogen, stress, medications, and relationships, plus real solutions that go beyond testosterone
What's Really Happening With Your Sex Drive
You're not alone if you're thinking, "Why don't I feel like having sex anymore?"
Between 30-45% of women experience low libido at some point. It's one of the most common concerns I hear about, and one of the most misunderstood.
Here's what matters first: Low libido isn't your fault. It's not because you're broken or defective. And it's almost never a simple fix like "just take testosterone."
But here's what's also important: If you never feel in the mood..like, ever, that's worth paying attention to. Not because something is wrong with you as a person, but because your body is trying to tell you something.
This guide walks you through what's actually happening with your libido, why it might have changed, and what genuinely works to bring desire back.
The Normal Pattern: How Female Libido Actually Works
Before we talk about what goes wrong, let's clarify what's actually normal.
Your Desire Changes Throughout Your Cycle (And That's Healthy)
Here's something most women never learn: Your sex drive isn't supposed to stay the same all month.
Unlike men, whose sexual desire tends to be pretty consistent, women's libido naturally rises and falls through the menstrual cycle. This isn't a problem. It's biology.
What happens each month:
In the first 2 weeks (follicular phase), estrogen gradually increases. As it rises, you naturally feel more interested in sex. By the time you're a few days away from ovulation, desire peaks, usually at its highest point of the entire month.
Right before ovulation, estrogen spikes. This is when most women want sex the most. Biologically, this makes sense: your body knows ovulation is the fertile window.
After ovulation (second half of the cycle), estrogen drops and progesterone takes over. As progesterone rises, desire naturally decreases. Many women feel less interested in sex, more tired, a bit bloated, and less "sexy."
When your period starts, both hormones drop, and libido is typically at its lowest.
This cycle is completely normal. You're not supposed to want sex equally on day 5 of your cycle and day 20. The variation is the healthy pattern.
When Should You Worry?
The key distinction: It's normal to not want sex during certain phases. It's not normal to never want sex during any phase of your cycle.
If you're experiencing:
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No sexual thoughts or desires at any point in your cycle
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Never responding to your partner's advances
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Zero interest even during your naturally high-desire phase (right before ovulation)
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Months or years of feeling this way
That's worth investigating.
What's Actually Affecting Your Libido: The Real Causes
When women come to me frustrated about their libido, we look for what's actually causing it. Usually, it's not one thing. It's several things working together.
#1 Stress and Cortisol (Often the Biggest Factor)
This is the number-one libido killer, and it's usually the first place to look.
When you're stressed, whether it's work pressure, family demands, money worries, or just life being overwhelming, your cortisol (stress hormone) is elevated. Your nervous system is in "I need to survive this" mode.
And here's how your body works: Sex isn't necessary for survival. So when you're in survival mode, your body shuts down sexual function. It's not personal. It's just your nervous system saying, "We'll deal with that later."
What this looks like:
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You're stressed and suddenly realize you haven't thought about sex in weeks
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You have no energy for physical intimacy
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You're too in your head to be present during sex
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You feel touched-out and don't want anyone on you
The practical fix: This sounds simple but it's not always easy, you need to reduce stress. Not just "be less stressed," but actually take steps:
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Regular exercise (150+ minutes weekly genuinely lowers stress hormones)
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Sleep (7-9 hours is non-negotiable, this is where hormones regulate)
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Saying "no" to things that drain you
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Having an actual conversation with your partner about what you're dealing with
One conversation can shift this: Sometimes just telling your partner, "I'm so stressed about X, Y, and Z, can you help me with some of these things?" opens space for intimacy again.
#2 Your Relationship
Here's something doctors don't always address: You might not have low libido. You might just not want sex with your current partner.
Research shows women's sexual desire is deeply tied to emotional connection and relationship satisfaction. If there are unresolved conflicts, lack of trust, poor communication, or if you just don't really like your partner much anymore, that kills desire.
What this looks like:
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You feel fine when your partner isn't around
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You have no desire with your partner specifically
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Sexual thoughts exist, but not about your partner
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You feel disconnected or resentful
The actual solution isn't a pill. It's communication. Either with your partner directly or with a couples therapist. Sometimes this is enough to restore desire, just feeling heard and reconnected.
#3 Hormonal Changes
Yes, hormones matter. But probably not the way you think.
Estrogen is the #1 hormone for female desire. When estrogen is low (especially during perimenopause or menopause), desire drops significantly.
Research is really clear: Higher estrogen = higher sexual desire, better lubrication, better orgasms.
Progesterone is the opposite. Higher progesterone actually suppresses sexual desire. This is why many women feel less interested in sex during the second half of their cycle.
Testosterone gets all the attention, but here's the reality: Studies show testosterone only improves female libido at very high doses, much higher than the body naturally produces. At normal doses, testosterone's benefit is minimal.
Many women take testosterone and feel slightly better overall (more energy, better mood) but their libido doesn't really improve. This is because testosterone isn't the primary driver of female sexual desire, estrogen is.
#4 Birth Control Pills
Hormonal birth control directly suppresses libido for many women.
The pill:
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Suppresses testosterone (which, while not the main driver, does play a supporting role)
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Can affect how your body responds to estrogen and progesterone
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Creates synthetic hormone levels that don't match your natural cycle
The data: Studies consistently show women on hormonal birth control report lower sexual desire compared to when they're not on it.
If you started birth control and noticed your libido disappeared, that's probably not coincidental.
Options:
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Try a different formulation (some have less impact than others)
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Consider non-hormonal contraception
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Discuss with your OB about alternatives
#5 Antidepressants (SSRIs)
This is important to know: One of the most common side effects of antidepressants (particularly SSRIs like sertraline, paroxetine, fluoxetine) is sexual dysfunction, including loss of desire and inability to orgasm.
This affects 40-65% of people taking these medications. It's incredibly common, and it's one of the main reasons people stop taking them.
The irony: These medications treat depression, but the sexual side effects sometimes create emotional numbness around sex.
If this is you:
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Talk with your psychiatrist, switching to a different antidepressant sometimes helps
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Some have fewer sexual side effects (bupropion, mirtazapine, vilazodone)
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Adjusting the dose or timing sometimes helps
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Adding another medication to counteract the effect is sometimes done
Don't just stop the medication, talk with your doctor about options.
#6 Vaginal Dryness and Pain
If sex hurts, you're going to avoid it. This isn't low libido, this is self-protection.
Vaginal dryness and atrophy happen especially as women approach menopause:
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Estrogen decline makes vaginal tissue thinner and drier
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Natural lubrication decreases
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Pain during intercourse happens
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You naturally start avoiding sex
This creates a vicious cycle: Pain → avoiding sex → more atrophy → worse dryness → more pain
The fix:
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Vaginal moisturizers (hyaluronic acid products used daily)
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Lubricants during sex
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Vaginal estrogen (cream, tablets, or ring)
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DHEA suppositories
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Consulting a gynecologist
Once you address the physical problem, desire often comes back naturally.
#7 Medication Side Effects Beyond SSRIs
Other medications affect libido:
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Proton pump inhibitors (for acid reflux) interfere with zinc absorptio, zinc is needed for testosterone production
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Antipsychotics affect hormones and sexual function
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Some blood pressure medications reduce blood flow
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Other hormone-altering drugs have sexual side effects
If you started a medication and noticed libido changes, this is worth discussing with your doctor.
#8 Lifestyle Factors
Small habits add up:
Alcohol: Regular drinking suppresses sexual desire and function. One or two drinks might lower inhibitions temporarily, but chronic alcohol use kills libido.
Smoking: Cigarettes damage blood vessels. Good blood flow is essential for arousal and orgasm. Smokers consistently report lower sexual desire and satisfaction.
Sleep deprivation: Without adequate sleep, your hormones are dysregulated, cortisol is elevated, and sexual function suffers.
No exercise: Physical activity improves blood flow, hormone production, confidence, and energy, all important for sex drive.
The Three Components of Female Sexual Function
When discussing "low libido," it's helpful to understand there are actually three separate pieces:
#1 Desire (The Mental Piece)
Do you think about sex? Does it cross your mind? Do you feel attracted to your partner? Do you initiate?
This is purely psychological and highly influenced by stress, relationship satisfaction, and hormones (especially estrogen and cortisol).
#2 Arousal and Lubrication (The Physical Response)
Even if you want to have sex mentally, does your body cooperate?
This includes:
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Natural vaginal lubrication
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Blood flow to genital tissue
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Vaginal expansion and elasticity
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Clitoral response
This is very dependent on estrogen, blood flow, and your nervous system being in a relaxed state.
#3 Ability to Orgasm
You can want sex and be physically aroused but still struggle to reach orgasm. This can be from hormonal changes, medication side effects, stress, or just not having the right stimulation.
Important: Sometimes "low libido" is actually one of these other components being affected. A thorough evaluation looks at all three.
The Hormone Reality: What Actually Affects Female Sexual Desire
Let's talk straight about the hormones involved.
Estrogen: The Primary Female Sex Hormone
Estrogen is the most important hormone for female sexual desire. Full stop.
Research shows:
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Higher estrogen = higher sexual desire
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Estrogen peak (right before ovulation) = your highest desire point of the month
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Estrogen decline (approaching menopause) = often significant drop in desire
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Estrogen therapy often restores desire in postmenopausal women
Estrogen affects desire by:
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Creating vaginal lubrication
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Improving blood flow to genital tissue
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Enhancing orgasm quality
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Creating psychological arousal (you actually think about sex)
Progesterone: The Desire Suppressant
Progesterone is the natural counterbalance to estrogen.
Research shows:
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Higher progesterone = lower sexual desire
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You feel this during your cycle, in the second half when progesterone is highest, desire naturally drops
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This is why many women say, "I'm just not feeling it" the week before their period
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It's not weakness or dysfunction, it's progesterone doing its job
Some women taking progesterone supplementation report that even moderate doses kill their libido entirely. This makes complete sense given what we know about progesterone's effect on desire.
Testosterone: Overrated as a Fix
Testosterone gets a lot of attention, but the reality is more nuanced.
What research actually shows:
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Testosterone helps female libido only at supraphysiologic doses (much higher than the body naturally produces)
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At therapeutic doses that match normal levels, testosterone's benefit for libido is minimal
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Testosterone works best in combination with adequate estrogen, not alone
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High-dose testosterone has side effects: acne, facial hair, mood changes, clitoral enlargement
Why many women take testosterone and don't see libido improvements: Because testosterone alone doesn't address the primary driver, which is estrogen.
The misconception comes from cases of women using extreme high-dose testosterone pellets (which is not standard medical practice) and reporting dramatic effects. But those aren't physiologic doses.
Cortisol: The Stress Killer
Elevated cortisol directly suppresses sexual desire.
When cortisol is high:
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Your nervous system is in "threat" mode
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Non-essential functions (like sexual arousal) get deprioritized
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Your body wants to survive, not procreate
This is often the first thing to address if libido is low.
Solutions That Actually Work
Solution #1: Manage Your Stress Seriously
If elevated stress is the cause (and it often is), you need to actually address it.
Exercise: 150+ minutes of moderate cardio weekly directly lowers cortisol. This is one of the most effective stress-reduction tools available.
Sleep: 7-9 hours nightly is non-negotiable. This is when your body regulates hormones, lowers cortisol, and repairs itself.
Meditation or mindfulness: Even 10 minutes daily can shift your nervous system.
Saying no: Set boundaries with energy-draining people and commitments.
Honest communication with your partner: "I'm really stressed about X, Y, Z, can you help me?" can open space for intimacy again.
Solution #2: Address Medication Side Effects
If you're on SSRIs: Talk with your psychiatrist. Options include:
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Switching to a different antidepressant (some have fewer sexual side effects)
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Adjusting the dose or timing
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Adding another medication to counteract the effect
If you're on hormonal birth control: Discuss with your OB:
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Trying a different formulation
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Considering non-hormonal alternatives
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Timing of when you take it
Don't suffer silently—your doctor can help find solutions.
Solution #3: Address Vaginal Dryness and Pain
Vaginal moisturizers: Hyaluronic acid products used daily (not just during sex)
Lubricants: Water-based or silicone-based during sexual activity
Vaginal estrogen: If estrogen is low, vaginal creams, tablets, or rings can directly address dryness and atrophy
DHEA suppositories: Intravaginal DHEA can improve vaginal health and sexual function
See a gynecologist: If dryness is severe, you need professional help.
Solution #4: Restore Estrogen If Low
If estrogen is genuinely low (particularly perimenopause or menopause):
Systemic estrogen therapy: Patches, pills, or creams that enter the bloodstream
Vaginal estrogen: Cream, tablets, or ring for local effect on vaginal tissue
Combination therapy: If you have a uterus, progesterone accompanies estrogen
Estrogen therapy often dramatically improves sexual desire, arousal, and orgasm quality in perimenopausal and postmenopausal women.
Solution #5: Improve Your Relationship
Sexual desire in women is tied to emotional connection.
If relationship issues exist:
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Have honest conversations with your partner
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Consider couples therapy
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Work on emotional intimacy and connection
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Discuss sexual desires and preferences openly
A therapist can help with communication if it's difficult.
Solution #6: Optimize Your Lifestyle
Quit smoking: Improves blood flow within weeks
Reduce alcohol: Especially if you drink regularly
Regular exercise: Improves confidence, blood flow, and hormone production
Better diet: Focus on nutrients supporting hormone production
Prioritize sleep: 7-9 hours is absolutely necessary
What Your Doctor Should Actually Check
If you're seeing a healthcare provider about low libido, a thorough evaluation includes:
Hormonal tests:
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Estrogen (estradiol)
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Progesterone
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Testosterone
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Thyroid function (TSH, Free T4, Free T3)
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Cortisol levels
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Prolactin
Medical history:
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Current medications and sexual side effects
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Birth control history
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Relationship satisfaction
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Stress levels
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Sleep quality
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Sexual history
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Pain during sex
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Ability to orgasm
Sexual function evaluation:
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Do you want to have sex?
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Does your body respond physically?
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Can you reach orgasm?
A good doctor takes time to understand which components are affected.
FAQ: Questions Women Actually Ask About Libido
Q: Is it normal for my sex drive to change throughout my cycle?
A: Yes, absolutely. Your desire is supposed to be higher before ovulation and lower in the luteal phase. This is healthy biology, not dysfunction.
Q: Should I take testosterone for low libido?
A: Probably not as a first step. Estrogen is the primary hormone affecting female desire. Testosterone only helps at very high doses. Address estrogen, stress, and other factors first.
Q: Can birth control kill my libido?
A: For many women, yes. Hormonal birth control suppresses desire for 30-40% of users. If you notice this correlation, talk with your OB about alternatives.
Q: Will SSRIs kill my sex drive?
A: They affect 40-65% of people who take them. If this is happening, talk with your psychiatrist about different options, several antidepressants have fewer sexual side effects.
Q: How long until I see improvement?
A: It depends on the cause and treatment. Stress reduction can show benefits within weeks. Hormone therapy typically takes 4-8 weeks to notice. Be patient.
Q: What if my doctor says "it's all in your head"?
A: Find a different doctor. Low libido has real physiologic causes. A good doctor investigates thoroughly.
Q: Do I need medication, or can lifestyle changes help?
A: Sometimes lifestyle changes alone work. But if hormonal causes exist, medication may be necessary. A good evaluation determines what you actually need.
The Real Bottom Line
Here's what matters:
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It's normal for female libido to fluctuate. You're not supposed to want sex equally all month.
-
It's not normal to never want sex. If you have zero desire any time, something needs attention.
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Testosterone isn't the answer. Estrogen matters more. But multiple factors usually contribute.
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Stress is often the biggest culprit. Managing stress is foundational.
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Medications matter. Birth control and antidepressants can genuinely suppress libido.
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Your relationship matters. Sexual desire is tied to emotional connection and safety.
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It's treatable. Whether the cause is hormonal, medication, stress, or relationship-based..solutions exist.
Your sexual health is part of your overall health. You deserve to feel confident, connected, and genuinely interested in intimacy. Low libido isn't something you just live with.
Take the first step: Get a thorough evaluation. Understand what's actually causing your low libido. Then address it, whether that's managing stress, changing medications, improving communication with your partner, or optimizing your hormones.
Your most fulfilling sexual life is possible. You just need the right information and the right support to get there.