What’s up with my Low Libido?

I'm in my late 40s and I'm losing my hair and getting a gut (which I kind of expected) but lately, my sex drive has gone off a cliff. This sudden lack of libido is pretty depressing and even though my wife doesn't say anything, I can tell it is bothering her, too. What's going on? I feel like I turned into a mush of a man overnight!

Sincerely,
“Lost Libido”

First off, don’t panic—one in five men will experience issues with low sex drive, so you’re not alone. We usually see this problem with men in their 50s and 60s, so the fact that you are on the younger side suggests there might be a larger issue, perhaps with your hormone levels. So I encourage you to see your doctor, or a urologist.

Your physician will conduct a physical exam, take your medical history, and do blood work to test several things, including testosterone levels. Testosterone is a very strong chemical that affects libido, and low levels can cause a decreased interest in sex, decreased firmness in erections, and an overall decrease in energy and muscle mass, among other things. There are many things that can affect testosterone, such as obesity, diabetes, steroid use, some genetic conditions, and even certain medications such as antifungal treatments and hair loss remedies. So we’d need to dig into your history and lifestyle a bit to find out what’s going on. In some cases, we find a guy who is trying to fix one problem ends up inadvertently causing another.

That brings me back to the importance of seeing a doctor to get the proper diagnosis and treatment plan. I’ve had patients who, prior to seeing me, diagnosed themselves with low testosterone and started taking herbal supplements. These supplements are not evaluated by the FDA, so there’s no way to know what is actually in them and if they do what is advertised. I have heard of men going into walk-in clinic-type places that offer testosterone shots, but if you don’t actually have low testosterone levels and proper follow-up care, this can be a dangerous option. Too much testosterone can cause problems with blood clots, sleep apnea, breast enlargement, and acne. And when you inject testosterone into yourself, your body is tricked and says, “Oh great, my testosterone levels are fine, I don't have to make any anymore.” And so your testicles may start to shrink, which can affect fertility.

If your doctor does find that you have low testosterone, you may be prescribed medication that increases your testosterone via injections, gels, patches, or pills. 

If you go through a medical workup and everything comes back normal, your low libido may be an emotional issue, in which case you would benefit from the guidance of a sex therapist.

Low libido can have a number of causes. But rest assured that sexual medicine specialists have many tools to figure out what the problem is and how to treat it. As I tell all of my patients, we’ll take things slowly and work on it together.

• Meet Dr. Miguel Angel Pineda, director of male sexual dysfunction and urologic prosthetics.
• Learn more about what you can do about a low sex drive.