When a Man’s Sex Drive Is Too Low

The male libido is always in overdrive, right? Wrong — one out of five men actually have a low sex drive.

Men. High sex drive. Panting sexual animals. We know what they want. And we know when they want it: right now.

Even doctors tend to see men as “sexual automatons,” hardwired always to want sex, says pioneering sex researcher Irwin Goldstein, MD, director of sexual medicine at San Diego’s Alvarado Hospital and editor in chief of The Journal of Sexual Medicine. “But that is not the case at all,” Goldstein tells WebMD Magazine. “Many, many men — about one in five –have such low sexual desire they’d rather do almost anything else than have sex.”

One in five men doesn’t want sex? How can that be true? And why haven’t we heard about it? Actually, many women have — the ones hearing the phrase “Not tonight, dear.” Goldstein says most people think that is a rare occurrence. “But in fact, almost 30% of women say they have more interest in sex than their partner has.”

The causes of low sex drive

So what’s behind low sexual desire? Aging plays a role, though many older men have a robust interest in sex, Goldstein points out. Like most other human traits, the sex drive varies. Most men are in the normal range; some are extraordinarily driven toward addiction-like sexual behavior. At the other end of the scale are men with very low sexual interest. These are men who suffer from hypoactive sexual desire disorder (HSDD).

“There are always men on both sides of the normal curve,” Goldstein says. “And a certain percentage — perhaps up to a quarter — will be considered to have HSDD for a whole host of reasons.” These include:

Psychological issues. Stress and anxiety from the strain of daily life, relationship or family problems, depression, and mental disorders are among the many factors that can affect sexual desire.

Medical problems. Diseases such as diabetes; conditions such as obesity, high blood pressure, and high cholesterol; and HIV drugs, some hair-loss remedies, and other medications can negatively affect sexual desire.

Hormonal causes. “Testosterone is the hormone of desire, arguably for women as well as for men,” Goldstein says. Low testosterone levels usually mean low sexual desire. Levels dip as men age; other causes include chronic disease, medications, and other drug use. Other hormones can play a role, too, such as low levels of thyroid hormone or, rarely, high levels of prolactin, a hormone produced in a gland at the base of the brain.

Low dopamine levels. Sexual desire obviously involves the brain — and the brain’s chemical messaging system is intimately linked to sexual desire. One of those messengers is dopamine. Doctors have noted that Parkinson’s disease patients treated with dopamine-stimulating drugs had increased sexual desire. Goldstein says these drugs help some men with HSDD.

Each cause of low sexual desire has its own treatment. When the root cause is psychological, sex therapy can offer men specific techniques and strategies for regaining their enjoyment of sex. “It is not psychotherapy; it is psychology counseling focused on sexual issues,” Goldstein explains.

In cases where the problem is low testosterone, men can take testosterone supplements if they have measurably low levels. About 25% of men go for weekly testosterone shots, Goldstein says, but most opt for skin patches or gel formulations applied directly to the skin of the chest, shoulders, or abdomen.

When Goldstein suspects low dopamine levels are at the heart of a man’s low sexual desire, he might prescribe dopamine-increasing drugs, though this treatment is not currently approved by the FDA and has risks.

However, a new drug now in clinical trials — for women — does increase dopamine levels while decreasing a specific kind of serotonin in the brain. Early clinical studies suggest the drug could help women with low sexual desire. Goldstein thinks this new treatment has promise. And if it’s approved for women, he says, it will likely be tested in men.

In the end, the choice for men who’ve lost their desire for sex is not between being a panting sexual animal and being a eunuch. Instead, the real choice is whether these men are ready to regain a vital source of intimacy with their partners — and a key part of a healthy life for themselves.

Safe Sex – Topic Overview

Sexually transmitted diseases (STDs) are spread by sexual contact involving the genitals, mouth, or rectum, and can also be spread from a pregnant woman to her fetus before or during delivery. STDs, which affect both men and women, are a worldwide public health concern.

Although most STDs can be cured, some cannot, including HIV (which causes AIDS), genital herpes, and human papillomavirus (HPV), which can cause genital warts.

STDs can be spread by people who don’t know they are infected. Always use protection every time you have sex, including oral sex, until you are sure you and your partner are not infected with an STD.

If you are in a relationship, delay having sex until you are physically and emotionally prepared, have agreed to only have sex with each other, and have both been tested for STDs.

Abstinence as prevention

Completely avoiding sexual contact (abstinence), including intercourse or oral sex, is the only certain way to prevent an infection.

Discuss safe sex with your partner

Discuss STDs before you have sex with someone. Even though a sex partner doesn’t have symptoms of an STD, he or she may still be infected.

Questions to ask someone before having sex include:

• How many people have you had sex with?
• Have you had sex without a condom?
• Have you ever had unprotected oral sex?
• Have you had more than one sex partner at a time?
• Do you inject illegal drugs or have you had sex with someone who injects drugs?
• Have you ever had unprotected sex with a prostitute?
• Have you had a test for HIV? What were the results?
• Have you ever had an STD, including hepatitis B or hepatitis C? Was it treated and cured?

Safe sex practices

Some STDs, such as HIV, can take up to 6 months before they can be detected in the blood. Genital herpes and the human papillomavirus (HPV) can be spread when symptoms are not present. Even if you and your partner have been tested, use condoms for all sex until you and your partner haven’t had sex with another person for 6 months. Then get tested again.

• Watch for symptoms of STDs, such as unusual discharge, sores, redness, or growths in your and your partner’s genital area, or pain while urinating.
• Don’t have more than one sex partner at a time. The safest sex is with one partner who has sex only with you. Every time you add a new sex partner, you are being exposed to all of the diseases that all of their partners may have. Your risk for an STD increases if you have several sex partners at the same time.
• Use a condom every time you have sex. A condom is the best way to protect yourself from STDs. Latex and polyurethane condoms do not let STD viruses pass through, so they offer good protection from STDs. Condoms made from sheep intestines do not protect against STDs.
• Use a water-based lubricant such as K-Y Jelly or Astroglide to help prevent tearing of the skin if there is a lack of lubrication during sexual intercourse. Small tears in the vagina during vaginal sex or in the rectum during anal sex allow STDs to get into your blood.
• Avoid douching if you are a woman, because it can change the normal balance of organisms in the vagina and increases the risk of getting an STD.
• Be responsible. Avoid sexual contact if you have symptoms of an infection or if you are being treated for an STD or HIV. If you or your partner has herpes, avoid sexual contact when a blister is present and use condoms at all other times.