It’s Valentine’s Day…But I Don’t Wanna…

Maybe you’re a hopeless romantic and love everything about Valentine’s Day. Maybe it’s just
another day of the week. Or perhaps you’re like me and think Valentine’s Day is a holiday of
commercialism and industry-created pressure. Either way, you probably still deep down feel the need to express some sort of romance to that special someone.

But what happens when – you don’t even want to?

In this edition of Off The Record, we’ll talk about common culprits for lack of sex drive, testosterone, and other potential factors. One more note before we continue:

This article is being published to menMD. Therefore we’re looking at this through the
lens of addressing men’s health here but remember one thing: plenty of women
experience this too, and they too have plenty of treatment options! Sometimes they need
to venture into a Urology office (preferably to a Urologist who specializes in Sexual
Medicine). I LOVE when my women are referred to me by their husbands!

Anyway, tangent over. Let’s dig into our conversation.

What happened to my sex drive?

Today’s topic, as you might have guessed, is NOT sponsored by the makers of Brach’s
Message Hearts. If your sex drive isn’t what it used to be, let’s chat.

The medical word for sex drive is libido. When I have a male patient who comes to me to talk
about low libido, I always start with addressing erectile function.

Many times, a low sex drive is driven by worries of erectile dysfunction.

Most of the time when we fix the erections, the sex drive returns. If you’re stressed about whether or not you can become erect, that is the problem—Not a low sex drive.

Libido is a different topic altogether, and what I’m talking about specifically is a lack of desire. Everything is ready – candles are burning, Barry Manilow is playing, your partner is ready, you are ready (ie you have or can have an erection), but…you just aren’t in the mood. That is low libido, and that is exactly what we’re looking to help you with.

What do we do to fix a low sex drive?

Once we realize that we are working with a low libido diagnosis, and the erections are ok, we
look at the thing you know you should pack in your luggage but forget to: your medication list.

There are many, many common medications that can affect your sex drive. A short list of these

  • Narcotic pain medications
  • Depression/anxiety medications
  • Blood pressure medications
  • Heart failure medications
  • Chemotherapy
  • Prostate cancer treatments

The list goes on. Honestly, we could spend an entire article on how prostate cancer treatments alone affect sex drive, but there’s not enough space to get into that here.

If you are undergoing prostate cancer treatment, it’s important to work with your physician to figure out how to reduce the impact on your sex drive.

I have had some patients where we identify a medication that may be contributing, and then
they discuss it with their PCP or Cardiologist, and with a change in the medication their sex
drive is back to normal. This is a great result, but to be honest it usually isn’t that simple.

What if it’s not a medication issue?

The next step is then to look at your testosterone level. Let me sidebar here again real quick:
PLEASE follow testosterone treatment with a Urologist or an Endocrinologist. I have seen some naughty doctors prescribe testosterone without discussing the potential harms. Leave it to the experts. Please.

Rant over. Again.

Both men and women need hormones for sexual function. Testosterone decreases with age. If
yours is low AND you have symptoms, you should replace it unless you fall into one of the
categories listed below:

Who can have testosterone replacement Who can NOT have testosterone replacement
Men with low testosterone blood levels
(checked 2X) AND symptoms
Men with UNTREATED sleep apnea
Men with a history of prostate cancer Men on active treatment for prostate cancer

I could spend an entire article discussing testosterone replacement but let’s skip to the

Reasons to replace testosterone Reasons to NOT replace testosterone
Low Sex Drive Weight Loss
Low Energy Hair Loss
Depressed Mood Muscle Building
Toxic Masculinity (No, SERIOUSLY.)

As for your treatment options, here is what you should be looking at:

Ways to replace testosterone
(working with a Urologist or Endocrinologist)
Ways to NOT replace testosterone
Muscle Injections So-Called “Men’s Health Clinics”
(Not run by Urologists)
Topical Gels ANYTHING oral or Over the Counter
(Save Your Money!)

Closing thoughts

My rule for testosterone replacement is that if we try it, and if your symptoms are no better, then we stop it.

If you have normal erections, normal testosterone levels, a benign medication list, and your sex drive is still down, it’s time to do a mental health check.

And if that’s where we are? No offense but I’m referring you out. I joke that half of my job is
psychology and honestly, that’s true. I enjoy it, but I know when I’ve met my limits and we need to reach out for extra help. So if you’re asking yourself where your sex drive went, find a
Urologist to talk to.

And remember, you can’t say happiness without saying penis. Go enjoy both.

Still looking for more answers?
Find a doc or schedule a virtual appointment


What’s Off The Record?

Off The Record is a column about life, love, relationships, and sex. Our anonymous urologist will pick questions submitted by menMD patient members and provide some insights, in the most entertaining way. The answers are meant to be thought provoking, engaging, honest, and fun. You can view all Off The Record posts in the Off The Record section of our blog. Better yet, submit your own anonymous question to be answered Off The Record.

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