Andrew Siegel, MD 3/21/2020
“Social distancing.” “Shelter-in-place.” “Stay at home.” “Self-isolation.” “Flatten the curve.” “Lockdown.”…Surreal, scary, pre-apocalyptic, dystopian. Homebound America and most of the world– No congregating, no sports to spectate, cinema and Broadway dark, concerts canceled, weddings, bas mitzvahs and other affairs deferred, gyms closed, traffic ceased, businesses shuttered. No restaurant dining, haircuts, salons, massages, limited brick and mortar shopping. Pandemonium. Hospitals stormed. Our urology practice remains open–we must deal with urological emergencies–kidney stones, urinary retention, urinary tract bleeding, infections, testes torsion, etc.,–so that ER beds are reserved for those with COVID-19.
What to do? Read, stream, home exercise, catch up with family, online social gatherings and “virtual” happy hours.
Paralleling the baby boom aftermath of many “disasters,” e.g., blizzard babies, blackout babies, hurricane babies, it would be no surprise if December 2020 witnesses an escalation of the birth rate induced by COVID-19 home confinement. We will welcome a new generation of coronial babies (“coronials”) spawned in the mayhem. Cut to this week’s entry on the male libido.
li·bi·do: /ləˈbēdō/ noun sexual desire and drive
Stereotypes often portray men as single-minded, sex-obsessed Lotharios. Although true for some–perhaps many– members of the male constituency, there is no lack of men—whether single or married—who have a subdued or absent interest in sex. Men with diminished libidos often seek urology consultation to have the issue evaluated and treated.
Image by BedexpStock, from Pixabay’s.
Although biochemistry (testosterone) plays a key role, sex drive is multifaceted and much more complicated than simply level of testosterone. Sexual desire is complex and multifactorial, with other determinants including physical, psychological, emotional, social, and relationship factors. It is entirely possible to have a normal testosterone and a poor libido and equally plausible to have a low testosterone and a normal libido, so although biochemistry is important, other factors that are equally, if not more, salient.
Libido Facts:
- Anatomically, the male libido resides in the cerebral cortex and limbic system.
- Libido levels fluctuate throughout life, from day to day, and moment to moment; clearly an 18-year-old’s libido is different from that of an 80-year-old’s.
- All aspects of sexuality decline with aging, although sexual interest and drive usually depreciate the least.
- One’s libido may not match that of their partner and that can spell trouble.
- Boredom from the monotony of a long-term relationship may contribute.
- Relationship issues may affect libido, and libido may affect relationships.
- Erectile dysfunction may lead to loss of libido, since many men lose interest in activities in which their performance is sub-optimal.
- Testosterone is the chemical “governor” of libido.
- Low testosterone can be caused by undescended testes, bilateral twisted testes, testes infections, testes removal, Klinefelter’s syndrome, chemotherapy, and toxic damage from alcohol or heavy metals. It can also be caused by pituitary-hypothalamic issues including injury from tumor, trauma or radiation.
- Medications that may affect libido include those that decrease testosterone levels (often used to treat prostate cancer), ketoconazole, opioid pain relievers, many anti-depressants including SSRIs and SNRIs and excessive alcohol.
- Low libido can be caused by underlying health conditions (physical or mental) and/or the treatment of medical conditions.
- Low libido is commonly caused by anxiety, stress, fatigue, relationship issues, exhaustion, preoccupation with problems of daily living, etc.
- Obstructive sleep apnea, endocrine (hormonal) issues, diabetes, obesity, chronic heart, kidney and liver issues, depression, and post traumatic stress disorder are common underlying causes.
- A healthy libido involves “all systems go”—being well rested, unstressed, not preoccupied, etc.
- Male enhancement, libido booster supplements that are on sale on the Internet and in vitamin stores are no more effective than placebo and are costly, unregulated and potentially dangerous.
What to Do If Your Libido Has Gone South?
- Undergo a thorough medical evaluation including lab and hormonal testing to seek out possible underlying physical and psychological factors and/or medications that may be contributing to the problem. Treatment can then be directed at the specific factor(s) identified with referral to the appropriate specialist (e.g., pulmonologist for sleep apnea; endocrinologist for hormone problems, etc.).
- In the event of low levels of testosterone, medication to normalize testosterone levels will often substantially help.
- If erectile dysfunction is the key underlying issue, it can be addressed by a variety of means, after which libido will often improve significantly.
- If psychological/emotional/relationship issues are responsible, appropriate referral to a counselor, social worker, psychologist, psychiatrist, etc.
- Lifestyle modification can be beneficial: stress reduction and management, obtaining sufficient sleep, maintaining a healthy weight, healthy eating, exercise, tobacco cessation, moderation of alcohol intake.
Wishing you the best of health in these troubled times,
A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”: www.HealthDoc13.WordPress.com
Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
Prostate Cancer 20/20 on Apple iBooks
PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Our Greatest Wealth Is Health 