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Oh No! Where’d My Libido Go?

Low sex drive in men is fixable. Here's how to get your engine revving again.

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There is an often-cited statistic that men think about sex once every seven seconds. That sounds like a lot, and honestly it is. But while that exact stat might not be backed by science, it's definitely pointing in the right direction. Men do think a lot about sex. Ask almost any guy and they will have a “getting called up to the blackboard in high school at a very inopportune moment” story.

But for a lot of us (one in five, actually) that nonstop stream of sex-consciousness can slow down as we get into our 40s and 50s (and for some as early as 30). Libidos drop, and with that decline, many men are left with feelings of inadequacy and depression. But a decrease in libido is no reason to tear up your man card and crumble into a ball of despair. It is not an uncommon problem for men, and as Dr. Miguel Angel Pineda, director of male sexual dysfunction in the Department of Surgery/Urology at Northwell Health’s Staten Island University Hospital explains, there are several ways to manage this issue. Your first step, which can seem like a doozy, is to go to a doctor and actually talk about it. “There is no need for embarrassment,” says Dr. Pineda. “A sexual medicine specialist has a big arsenal of tools to figure out what the problem might be and once the problem is found, how best to treat it.”

“Libidos drop, and with that decline, many men are left with feelings of inadequacy and depression.”

So, what’s up with low libido?

Short answer: There is no short answer. There are several factors that can lead to reduced libido, which is marked by a decrease in sexual desire and can be associated with a decrease in the quality of a man’s erections. “A common problem is low testosterone, a very strong hormone that controls libido,” explains Dr. Pineda. “Other symptoms of low T levels can include an overall decrease in energy, a loss of muscle mass, a loss of mental acuity, and weakness.”

But while deficient testosterone levels is a common cause, it’s not the only possible culprit. Stress and unbalanced levels of thyroid hormones or dopamine are just a few of the other problems that can cause some sexual dysfunction, among many other possibilities, which leads to the next important point ...

Don’t play doctor

“I see patients come in who have diagnosed themselves with low testosterone,” remarks Dr. Pineda. “So they're taking all these herbal supplements or going to walk-in centers for testosterone shots.” While Dr. Pineda applauds the desire to proactively take control of their situation, he cautions against this approach. “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’s advertised.” And there are a lot of nuances in sexual health diagnosis and treatment, says Dr. Pineda. “Successful and healthy treatment comes with regular follow-ups and monitoring, which might not always be the case with these kinds of walk-in places.”

OK, but is having too much testosterone really going to hurt you? In a word, yes! The risks of having too much T unchecked are no joke. There is the possibility of increased hostility and hypersexuality, and if that doesn’t scare you straight, maybe this will: “When you inject testosterone into yourself, your body says, ‘Oh great. I don't have to make any anymore.’ And your testicles may start to shrink.” (My testicles shrank just hearing that!) “Testosterone is a controlled substance for a reason,” adds Dr. Pineda.

So you have low T. Now what?

If the cause is indeed diagnosed as a hormonal imbalance, doctors will typically suggest a change in diet and exercise regimen. If that doesn’t work, you may be prescribed medications that increase your testosterone via injections, gels, implantable pellets or patches. “There are some other medications that trick the body into making testosterone and these are generally given as pills,” says Dr. Pineda.

Another unexpected factor may be the use of hair loss products. These products work because—you guessed it—it interferes with the production of testosterone. Another potential T blocker? Antifungal treatments for jock itch and athlete’s foot. “In some cases, you find a guy who is trying to fix one problem and ends up causing another,” says Dr. Pineda.

It’s not always Mr. T’s fault

Low testosterone isn’t the only medical cause of low libido. People who suffer from certain conditions like diabetes, high blood pressure, and high cholesterol can also have problems with erections. Why? “A healthy, firm erection is determined by good blood flow. Blood flow to the penis is decreased in men with these diseases,” says Dr. Pineda. There are also chemicals in body fat that take the “male hormone” testosterone and turn it into the “female hormone” estrogen. Pineda explains this frustrating conundrum: “It may be that the less testosterone you make, the more body fat you have. The more body fat you have, the more your testosterone levels are hampered.” If that doesn’t encourage you to drop the Cheetos and pick up a Shake Weight, I don’t know what will. This is where the guidance of a professional comes heavily into play: finding that balance that keeps a patient healthy in all aspects of their life.

You’re not on your own

Dr. Pineda stresses that if you notice a drop in your libido, you should seek the help of a doctor. “As helpless as you may feel, there are a tremendous amount of treatments available. We’ll take things slow and work on it together.”

And he encourages men to come to appointments with their partner, as this is an issue that can have serious effects on a relationship. “Male sexual dysfunction is a problem that affects both partners in a relationship, so it is helpful to have the patient’s partner there to get a complete story and come up with a plan that will help the couple.”

And while there is no miracle cure that’s going to bring you back to your 18-year-old sex drive levels, I think we can all agree that’s probably for the best.

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Published April 16th, 2019
A young woman with dark curly hair is using mobile phone. Female is smiling while holding smart phone. She is lying on sofa at home.

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