Hi and welcome to NT.

I'll give my thoughts and my experience as a male that has experienced sexual dysfunction with a TBI. Keep in mind your partner’s injury and mine are different, he had a series of concussions while mine was a one-time TBI that was classified moderate to severe.

My issue with resuming sex after my injury included the inability to have an erection. In addition to a skull fracture I also sustained an open book pelvic fracture. Either in conjunction with the pelvic trauma or the repair surgery there was some collateral damage to the “boys”. There was loss of libido in addition to the ED. Tests showed low testosterone; now I use a testosterone supplement which helps with libido, and Levitra is helpful on the performance side.

So regarding your question, "can it return", my experience suggests that it can. One area to consider is his medications. Wellbutrin can cause loss of libido. You mentioned his testosterone "balance"; consider that the testosterone range for men is pretty wide, if he is on the low end of the "normal" range that could contribute to lowered libido also. Is he physically able to have an erection? If not, or if it’s difficult to maintain or weak, this could translate in to lowered interest in sex. ED medications can be helpful here.

I’m guessing this is part of the couple’s therapy? Since the romantic love part seems to be there I’d suggest as next steps a visit to a urologist for a full testosterone test, prostate check, and a discussion about ED medication. The urologist will likely have free samples of Levitra, Cialis, and probably Viagra.

Best to you both.