Sexual Problems in Men-Is it low libido or impotence

Nearly 30 million men suffer from erectile dysfunction (ED) or impotence and nearly half that number have a decrease in their sex drive or libido.  However, many men believe that erectile dysfunction and diminished libido are the same thing.  It is important that men understand the difference between ED and libido.  ED is the inability to achieve and maintain an erection adequate for sexual intimacy with a partner.  Loss of libido is a decrease in the interest for sexual intimacy.  ED and loss of libido can be separate issues or can occur together as it is common for a man who suffers from ED for a prolonged period of time will also experience a decrease in libido.

What are the symptoms of decrease in libido and what are the causes of this condition?   A decrease in libido is usually a result of a decrease in the level of testosterone which is a hormone produced in a man’s testicles.  A decrease in libido is the most common symptom of testosterone deficiency.  Men with a decrease in testosterone also experience a lack of energy and often complain of lethargy.  Men with decrease in testosterone also experience a decrease in strength or endurance, lose height, fall asleep after dinner, and may even experience depression or a decreased enjoyment in life.

Some causes of testosterone deficiency include:

Testes – medical problems that begin in the testes can prevent sufficient testosterone production. Some of these conditions are present from birth; for example Klinefelter’s syndrome, a genetic disorder that affects the sex chromosomes. Other conditions may occur at various stages of a boy or a man’s life; for example, undescended testicles, loss of testes due to trauma or ‘twisting off’ of the blood supply (torsion), complications following mumps, and the side effects of chemotherapy or radiotherapy.

Pituitary gland – the most common condition that affects the pituitary and leads to low testosterone levels is the presence of a benign tumour. The tumour may interfere with the function of the gland, or it may produce a hormone that stops the production of the gonadotrophins and stops the pituitary gland from signalling the testicles to produce testosterone.

Hypothalamus – particular conditions, such as tumours or congenital abnormalities, can prevent the hypothalamus from prompting the pituitary gland to release hormones. This will inhibit testosterone production by the testicles. This is a rare cause of androgen deficiency.

Drugs can also decrease libido. Many prescription antidepressants can diminish sex drive. Other medications with this side effect include tranquilizers and blood pressure medications. Illicit substances, such as heroin, cocaine, and marijuana, when used heavily and chronically, may lower libido and sexual performance.

Testosterone levels gradually decline after the age of 40. Some estimates suggest that up to one in five men over 70 years have low testosterone levels. A number of factors may contribute to the fall in testosterone, in addition to the ageing process itself. For example, any cause of poor general health, including obesity, will lower testosterone.

The diagnosis of low testosterone is made by a careful history and physical examination followed by a blood test that measures the testosterone level in the blood.

Treatment for proven androgen deficiency is based on hormone (testosterone) replacementtherapy. Testosterone can be administered by tablet, skin patch or gel, injection (short or long acting) or implant.  There is a long acting implant that consists of a pellet that is placed underneath the skin using a local anesthetic in the doctor’s office.  The pellet usually lasts for approximately 6 months and can be easily replaced using the same technique. Men who receive testosterone replacement therapy will require regular visits with their doctor. Prostate examinations are performed according to a man’s age and other risk factors for prostate cancer.

The benefits of testosterone replacement therapy include Increased sexual interest, restoration of erectile function, increased muscle mass, increased strength of bones, and improved mood and sense of well being.

Most sufferers of Low testosterone believe their symptoms are simply a function of growing older. As a consequence, they never seek the medical attention needed. Today, low testosterone treatment options exist that can relieve the symptoms of decreased testosterone and can help men reclaim their lives.

Bottom Line: Testosterone deficiency and the accompanying symptoms of decreased libido, lack of energy, and loss of muscle mass is a common condition that affects millions of American men.  The diagnosis can be easily confirmed with a blood test and the treatment using testosterone replacement therapy can be achieved with several treatment options.

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