Posts Tagged ‘low libido’

Libido Letting You Down? Solutions to That Problem

September 1, 2012

For men, Libido is your sex drive and it is different from ability to get an erection or be able to achieve a successful pregnancy. Women’s libido is also different from orgasm or her ability to have an egg unite with a man’s sperm. In women, gynecologic conditions may make engaging in sexual intimacy difficult or painful and ultimately impact her libido.

Libido is the name Freud gave to our sex drive. Libido is a multifactorial situation which is influenced by hormones, psychological and physical factors, romance, and the opportunity for fulfillment. It is normal for libido to decline with age going much faster for women after menopause than for men in middle age, which has about a 1% decline each year. But nearly all couples in their 60s and 80% of couples in their 70s continue to find enjoyment with engaging in sexual intimacy.

Hormonal deficiency is a common cause of deteriorating sex drive in both men and women. The solution is very simple and consists of replenishing the deficiency with testosterone in men and estrogens in women. However, hormones won’t solve the problem if there is some other underlying reason for the sex drive going into the tank.
So what is a man and a women with a loss of severe decrease in their sex drive to do? If you are suffering from fatigue, your sex drive deficiency may be a result of anemia, thyroid deficiency, or kidney disease. A few blood tests will make the diagnosis and help your doctor put your libido back on track.

Next talk to your doctor about all of your medications including, over the counter medicines, herbal medications and supplements. If the problem is related to medications, you can usually note the onset of libido problems that occurred shortly after staring a medication that can plummet your sex drive.

If you have heart disease or have suffered a heart attack and you or your partner is fearful that sex will worsen your cardiac problem or cause another heart attack, speak to your physician. A good rule of thumb is that if you can climb two flights of stairs without chest pain or severe shortness of breadth, then it is probably safe for you to engage in sexual intimacy with your regular partner.

If you are a woman and are going through the menopause, that doesn’t mean that you have bury your sex life forever. As a matter of fact, menopause for many women enhances their sex life as they are no longer worried about conception and fear of pregnancy. Some women do lose their sex drive after menopause and this may be a result of estrogen deficiency. Talk to your doctor about hormone replacement therapy.

I suggest that if you are a woman, try estrogen first. That works for most women as it reduces their hot flashes and pumps up their libido. However, testosterone may also be effective for women in small doses as it is for men who require larger amounts of testosterone in order to restore their libido. Testosterone is available for men and women in a topical gel or a small rice-sized pellet inserted under the skin and replaced every four to six months.

Women may lose interest in sex after menopause because of vaginal dryness (VD). This VD isn’t treated with antibiotics but with topical estrogen creams or vaginal rings impregnated with estrogen or vaginal pellets of estrogen. If a woman can’t take estrogens, then there is always lubricating creams and jellies such as the old standby, K-Y Jelly that alleviates VD and the discomfort associated with the loss of lubrication.

If you are a man and are suffering from erectile dysfunction (ED), this may also impact your sex drive as well. Certainly check your hormones because if low testosterone is the problem, then replacement therapy with gels, injections, or pellets will restore your sex drive 85% of the time.

For both men and women: get lots of exercise. Regular exercise promotes good health. It not only makes you feel good all over, but restores the blood supply to the pelvic area in both men and women.

How about aphrodisiacs?
You will probably receive unsolicited E mails and mail from companies offering an improvement in sex drive and creams and lotions to make a man’s penis bigger. Absolutely none of these studies have withstood scrutiny by medical professionals and probably are a waste of your time and hard earned money. I am an amateur magician and what they have to offer would be real magic if they worked the way the marketing materials described. A loss of sex drive has a problem since the beginning of recorded history and every society and culture have been looking for the magic elixir or potion that can restore the fountain of youth. The ancients have ground up dried beetles (Spanish fly) and rhinoceros horns but to no avail, except that Spanish fly can make you sick. Included in the myths of aphrodisiacs include oysters. They, too, will not restore a man’s libido or potency. According to the FDS, there is no scientific proof that any over the counter aphrodisiacs work to treat decreased libido problems. According to Dr. Ruth Westheimer, “The largest sex organ is not between our legs but between our ears.”

A few words about Viagra, Levitra, and Cialis. These are prescribed medications for the treatment of ED and will not resolve problems with libido or sex drive. The drugs are very effective for ED but will not cure loss of sex desire.

Bottom Line: Problems with a man or woman’s libido is common to many middle aged men or women. Many of the problems are related to hormone deficiency and can be effectively treated.

Don’t Let Anti-Depressants Put Your Sex Life To Bed

May 24, 2010

Today depression can be successfully treated with medication.  Unfortunately, sexual dysfunction is a common side effect of nearly all classes of anti-depressant medications. The side effects include decreased libido, inability to orgasm, decreased sensation in the genitals, vaginal dryness (in women), and erectile dysfunction (in men).

There are other causes of loss of libido, which includes hormone deficiency in both men and women and can easily be diagnosed with a blood test for testosterone and if the level is diminished, replacement therapy can easily be accomplished with injections and gels in men and with medication and gels in women.

If anti-depressants are the likely cause, there are several possible options. There are some anti-depressants that are less likely to cause loss of libido.  Wellbutrin is one of those medications that is associated with less sexual side effects than other anti-depressants.

The drugs used to treat erectile dysfunction, Viagra, Levitra, and Cialis have been effective in resolving the side effects of anti-depressant medication in both men and women.

For those who are on anti-depressant medication, consult with your doctor and tell him\her about the sexual side effects and the doctor may be able to decrease the dosage of the anti-depressant medication that causes the sexual side effect yet provide adequate medication to control the depression.

Another option is to ask your doctor about changing the time of day that you take your medication.  For example, if you plan to have sexual intimacy in the evening, then take your anti-depressant medication before you go sleep.  Thus the blood level of the anti-depressant will be lowest the next evening at the time you engage in sexual intimacy.

You can also ask your doctor if you can divide your anti-depressant medication and take it twice a day rather than one large dose which will elevate the blood level of the anti-depressant more than using smaller doses several times a day.

Finally, consider a drug holiday.   This involves taking a short break from your anti-depressant medication. There are reports that a two-day break from antidepressant therapy can lower the rate of sexual side effects during the break without increasing the risk of a recurrence of depressive symptoms. This approach, the weekend holiday, works with quick-clearing drugs, such as Zoloft and Paxil. One potential risk with taking a drug break from antidepressants that have very short half-lives, such as Zoloft and Paxil, is the recurrence of symptoms of depression.

Bottom Line:  Sexual side effects are commonly associated with the use of anti-depressant medications.  However, if you speak to your physician, alternatives may be found that will put your sex life back on track.

Dr. Neil Baum is a physician in New Orleans.  He can be reached at (504) 891-8454 or on his website, http://www.neilbaum.com

Hypoactive Sexual Desire- or I’ve Got a Headache!

April 25, 2010

He: “Are you in the mood?”

She: “Naw, I’ve got a headache!”

If you are a female and you experience these feelings about loss of desire for sexual intimacy, you may have hypoactive sexual desire (HSD).  In other words, you’re rarely in the mood; you neither initiate sex nor seek stimulation. Hypoactive sexual desire is the most common form of female sexual dissatisfaction and occurs when there is a persistent lack of desire or absence of sexual fantasies.

Lack of desire often occurs as a result of problems with your partner.  Communications problems, anger, a lack of trust, a lack of connection and a lack of intimacy can all adversely affect a woman’s sexual response and interest.  If this sounds like you, counseling and therapy with your partner is probably your No. 1 treatment option to overcome HSD.

In addition to psychological causes there are medical causes of HSD.
Many commonly prescribed drugs, such as antihypertensives, antidepressants and birth control pills, interfere with sex drive, arousal and orgasm by affecting the balance of sexual hormones and the transmission of chemical messengers. Antidepressants, known as selective serotonin reuptake inhibitors (SSRIs), combat depression by increasing the production of serotonin in the brain. Although serotonin may decrease depression, it also dampens sexual desire.

The onset of menopause, either surgically produced by removing the ovaries or naturally as a consequence of aging, is characterized by a gradual decline of the hormones estrogen, progesterone and testosterone. Reduced testosterone levels can lead to a decline in libido. Ironically, the conventional hormone replacement regime of estrogen given to relieve menopausal symptoms can make matters worse, because estrogen increases a protein (called steroid hormone-binding globulin) in the blood that binds to testosterone, causing testosterone to become less available to the body.

Depression is also associated with HSD. A common symptom of depression is diminished sex drive, which, in turn, can exacerbate depression. Studies indicate that 12 percent of all women will experience clinical depression at some point in their lives. One of the side effects of the popular antidepressants Prozac, Paxil and Zoloft is loss of libido. Even with a lower-grade form of depression that is not easily recognized because you can function with it. A woman with depression may feel isolated and overwhelmed and withdraw from sex and social activities.

Overcoming HSD
If you’re suffering from loss of libido and think there is a medical basis for your problem, here are some solutions to consider:

Talk to your doctor about testosterone, especially if you have had your ovaries removed, are taking estrogen or under severe stress. Get your testosterone level evaluated and if it is below 20 nanograms per deciliter, consider starting testosterone therapy. Testosterone is central to a woman’s sexual function that no amount of sexual stimulation can make up for its absence.  Using testosterone to treat FSD has not been approved by the FDA, so you’ll need to find a physician open to prescribing it to treat lack of sexual desire. If you are already on hormone replacement therapy for menopausal symptoms, ask your doctor to add testosterone to your regimen.

Switch to medications known to have less effect on sexual function or lower dosages. The antidepressants Prozac, Zoloft and Paxil, of which women are major consumers, cause loss of libido in as many as 60 percent of patients. I suggest asking your doctor to change to an antidepressant that has less sexual side effects like Celexa, Wellbutrin, BuSpar, Serzone or Effexor.

Viagra, the little blue pill used to treat erectile dysfunction in men, may help jump-start your sex life as long as you have the desire to engage in sex and have been stimulated enough for it to take effect,. It’s especially helpful if your lack of desire is related to hysterectomy or menopause. Doctors aren’t exactly sure how Viagra helps rekindle lust but it helps women achieve arousal, which is the phase that comes after desire, by increasing blood flow to the vagina, clitoris and labia.

For more information contact your physician or find a physician who has experience treating HSD.  I also recommend the best-selling book For Women Only by Jennifer and Laura Berman.

Testosterone Treatment in Men With Prostate Cancer-The Controversy

April 25, 2010

I have been a proponent of testosterone replacement therapy in men

with documented low levels of testosterone.  Men with low testosterone

present with lethargy, malaise, decrease in libido, erectile

dysfunction, falling asleep after meals and loss of muscle mass.  The

diagnosis is easily made with a blood test, the serum testosterone

level, and is easily treated with injections of testosterone or the

application of testosterone gels to the skin.  The medical textbooks in the 1990’s state that the treatment is

contraindicated in men with difficulty with urination, untreated

obstructive sleep apnea, high blood counts, and in men with prostate

cancer.

But now there are a few doctors who question the advice of avoiding

testosterone in men who have been successfully treated for prostate

cancer.  For decades the prevailing treatment for men with prostate

cancer that spread beyond the prostate gland was to decrease the

testosterone produced by the testicles.  This was accomplished by

removing the testicles or orchiectomy, or medically castrating the men

with drugs that produced castrate levels of testosterone in the blood.

Dr. Abraham Morgentaller, a urologist a Beth Israel Deaconess

Hospital in Boston, began treating men with prostate cancer, who had

symptoms of low testosterone and confirmed by the blood testosterone

test, with supplemental testosterone.  This was certainly against the

previous advice of other urologists.

What is the evidence to support this new approach to testosterone

deficiency in men with prostate cancer?  Dr. Morgantaler published a

report that men who developed prostate cancer had a statistically

lower testosterone level than men who were free of prostate cancer.

He also started treatment of a select group of men with prostate

cancer with testosterone and followed them closely with PSA tests and

found that there was no increase in the PSA test but marked

improvement in the men’s libido, energy level, and over all quality of

life.

So what is a man to do?  Talk to your doctor.  If your doctor agrees

that there may be a roll for testosterone in men with prostate cancer,

you can receive therapy with testosterone replacement.  In my practice

I select men who have zero, or near zero, PSA tests for at least one

year after treatment for prostate cancer.  They receive testosterone

replacement under close scrutiny and must agree to getting a PSA test

every month.  If the PSA rises, then they must agree to discontinue

the testosterone replacement therapy.  For more information go to my

website, www.neilbaum.com