Since you have fairly well ruled out low testosterone as a possible
cause of low libido, I will address other possible causes. However, I
have included some information on testosterone levels, at the end of
A low testosterone level is actually the least common cause of a
decreased male libido! The causes of decreased libido are both
physical and psychological, listed here (In no particular order):
hyperprolactininemia, diabetes, overweight, anemia, Parkinson?s
Disease, arthritis, alcohol and/or drug abuse, lack of self esteem,
past sexual abuse, sexual anxieties including latent gayness, stress,
depression, certain medications particularly antidepressants,
diuretics, tranquilizers and Proscar (for prostate problems), working
long hours, lack of sleep, infidelity, and to exert power over a
partner, and rarely, a low testosterone level.
?The slightest sniffle can leave some people switched off sex, and
everyone knows what bad patients men often make. Everyone copes with
illness differently, of course, just be aware that in some cases a
loss of libido can be symptomatic of a more serious condition, from
thyroid disease to pituitary gland problems.?
?ISD (Inhibited Sexual Desire) is a very common sexual disorder. The
most common cause of ISD seems to be relationship problems wherein one
partner does not feel emotionally intimate or close to their mate.
Communication problems, lack of affection that is not associated with
continuing into sexual intercourse, power struggles and conflicts, and
a lack of time alone together are common factors. ISD may also be
associated with a very restrictive upbringing concerning sex, negative
attitudes toward sex, or negative or traumatic sexual experiences
(such as rape, incest, or sexual abuse).
Physical illnesses and some medications may also contribute to ISD,
particularly when they produce fatigue, pain, or general feelings of
malaise. Hormone deficiencies may occasionally be implicated.
Psychological conditions such as depression and excessive stress may
inhibit sexual interest.?
?A lack of sexual appetite or Inhibited Sexual Desire (ISD) for men
and women can severely disrupt the sexual relationship of a couple.
ISD is present if there is both a low rate of sexual activity and a
subjective lack of desire for sexual activity; desire here includes
awareness of wishes for sexual activity, and feelings of frustration
if deprived of sex. Both physical and psychological factors contribute
to ISD. Physical causes include: hormone deficiencies; depression;
stress; alcoholism; kidney failure; and chronic illness. Psychological
causes include: relationship problems (power struggles, conflict,
hostility), sexual trauma such as rape, major life changes (death of a
family member, childbirth, geographic relocation), and pairing
negative memories with sexual interaction. People who are angry,
fearful, or distracted are usually not desirous of sexual intimacy.?
?Libido is an appetite, Dr. Zussman says. And it often can be
difficult to help someone acquire a taste for something?or to
acknowledge to themselves that they really do have a craving for
something delightful. "You can present tempting foods like a luscious
dessert," she says, "but that won't necessarily help someone who
doesn't feel like eating or who denies the pleasure of eating sweets."
And ?Low libido becomes a problem that should be addressed only when
it is perceived as a problem, sex therapists say. "It's usually only
in the framework of a relationship that it becomes an issue," Dr.
Zussman says. "It's when there is a discrepancy in desire between the
person and the partner, or when people feel there's something wrong
with them because they have a low level of desire."
?Inhibited sexual desire (ISD) refers to a low level of sexual
interest. The person with ISD fails to initiate or respond to their
partner's desire for sexual activity.
ISD may be primary (where the person has never felt much sexual desire
or interest), or secondary (where the person used to possess sexual
desire, but no longer does).
ISD may also be either situational to the partner (the person with ISD
is interested in other people, but not his or her partner), or it may
be general (where the person with ISD has a lack of sexual interest in
anyone). In the extreme form of sexual aversion, the person not only
lacks sexual desire, but may find sex repulsive, revolting, and
Sometimes, rather than being inhibited, there may simply be a
discrepancy in sexual interest levels between two partners, both of
whom have interest levels within the normal range.
?It is NOT normal for a person to have no sexual desire. When a
husband refuses to get professional help or refuses to work on this
dilemma with his wife, he is being irresponsible. Bottom line, he is
saying that he is not interested in saving the marriage.?
?52% said they spend less time having sex than they did 5 years ago,
and 38% say they have sex less than once a week. The survey linked
daytime sleepiness with marital problems?
?If the patient complains of low or poor sex drive or a lack of
desire, then a serum testosterone is drawn. Inasmuch as depression may
coincide with a low serum testosterone, the depression scales are
completed by the patient to rule out depressive symptoms.?
Hyperprolactinaemia - an uncommon disorder in which too much prolactin
is produced by the pituitary gland. ?Hyperprolactinemia depresses
libido and causes infertility in both sexes and amenorrhea in women.
Medication changes can usually correct psychotropic-induced
hyperprolactinemia. Elevated prolactin levels from other causes (such
as a pituitary prolactinoma) usually respond to dopamine agonists such
as bromocriptine or cabergoline?
?When the total testosterone level is low and/or the patient complains
of reduced libido, a serum prolactin level should also be measured. A
high serum prolactin level may indicate pituitary dysfunction and may
require consultation with an endocrinologist. Serum LH levels are
measured when serum prolactin levels are normal or low to help
differentiate intrinsic testicular failure from a pituitary or
hypothalamic abnormality. LH is usually high in patients with primary
?Prolactin measurements are used for the investigation of
gynecomastia, hypospermia and oligospermia, impotence or lowered
libido and hypothalamic-pituitary disorders?
?A survey done by the Chartered Institute of Personnel and
Development of managers who worked more than 48 hours per week, shows
that "Nearly a third admit that work-related tiredness is causing
their sex life to suffer and 14 percent report a loss of, or reduced,
?Sexual abuse robs survivors of their ability to feel safe in the
world and with themselves. Internal safety is the extent to which you
feel safe when the situation you are in is safe. Many survivors feel
unsafe even when the person they are with or the situation they are in
is safe. There is a difference between feeling safe and being safe.
The first is a feeling and is affected by your past experiences with
safety or lack of safety. The second is an actual fact about whether
or not the people you are with or the situation you are in is safe.
It's so important for survivors to develop a sense of safety (internal
safety) as well as to have ways to identify whether or not people and
situations are safe (external safety). Both internal and external
safety are needed for enjoyable consensual sex. Without internal
safety, sex can feel very scary and triggering. Without external
safety, the sex will not be safe, consensual, or pleasurable.?
Male Menopause (Andropause)
?Irritability, moodiness, lethargy, decreased libido, thinning bones,
loss of muscle tone, forgetfulness--women going through menopause are
all too familiar with this set of symptoms. But men may also
experience this "change of life" and have similar symptoms, along with
sexual problems. Could aging men be experiencing "male menopause" and
more importantly, could they benefit from hormone replacement? This
issue is creating a growing debate among medical experts?
?In Boston, a recent study surveyed 1700 middle-aged men. The report
states 51% of normal, healthy males age 40 to 70 suffered from the
above male menopause symptoms. The aging process alone, can not be
responsible for this problem as well over 40% of males remain sexually
active at 70 years of age and beyond.?
It would be helpful for you to know that one can have a normal
testosterone level, and still have low ?free testosterone? levels.
Having a low Free Testosterone can cause a loss of libido as well! It
may also be possible that your testosterone elevels were even higher
before, and have been, without your knowledge, gradually dropping. You
will find the many physicians prescribe testosterone orally,
injection, or topically in a patch, regardless of a normal
?He does, however, see a clear role for testosterone therapy in
certain men with symptoms, such as decreased sexual desire, ED,
irritability, lack of sleep, while acknowledging that it is hard to
differentiate these symptoms from those associated with normal aging.
"We tend to focus on sexual dysfunction, but anemia, loss of muscle
mass, osteoporosis, fatigue, and depression are also symptoms of
hypogonadism," said Dr. Morales. "We urologists castrate men to treat
[advanced] prostate cancer, and we see all those symptoms in men after
the testicles are removed, but this is artificial [whereas,] the
natural version [of testosterone deprivation] is more subtle."
Not all the symptoms must be present, according to Dr. Morales. "When
a man comes to me, I get a clinical picture of the signs and symptoms
and send him for a blood test. If the blood test documents his levels
as below normal, then the patient should have a three-month trial of
testosterone supplementation. As for the choice of testosterone
therapy, that depends on patient preference, cost, and efficacy--it
doesn't matter which type--skin patch, rub-on gel, injectable--of
testosterone." Each has advantages and drawbacks, he said. "In the
USA, you don't have a safe oral version that other countries do."
?Low levels of the male hormone aren't a common cause of sapping your
sexuality, but it always must be suspected, Dr. Reznichek says.
Depending on the cause, a physician could prescribe either
testosterone injections or a medication that counteracts other
hormones that are suppressing naturally occurring testosterone, he
?Taking testosterone is dangerous only if you have certain medical
conditions. For starters, it's important to check your liver function
before, and at regular intervals during, a
testosterone-supplementation program. If there is a negative impact to
the liver, it can be reversed by discontinuing the testosterone, says
?Therapeutic replacement to measured levels of total testosterone in
the 800 ? 1200 ng/dl range is clinically beneficial, especially in
treating sexual dysfunctions in the older male. Sex hormone binding
globulin (SHBG) increases with aging in men so that the availability
of free testosterone, the functionally active form, diminishes with
age resulting in male low testosterone. I obtain total and free
testosterone levels in patients. I occasionally encounter adequate
total testosterone with inadequate free testosterone levels, which is
a treatable situation.?
?If you do get your testosterone levels measured, make sure to ask for
a reading of both total and free testosterone. If you do have a blood
test, remember that testosterone levels are generally higher in the
morning and lower in the evening. However, the degree to which
testosterone levels vary during the day is reduced as you age. There
are also peaks and troughs during the year. Testosterone levels reach
a high during June and July, and drop during winter and early spring?
?Testosterone production and plasma levels fall in most men as they
age, and there appears to be a threshold at which lower levels may
result in sexual dysfunction. However, there appears to be a wide
variation among men at what level they may experience problems with
falling testosterone levels.
Studies show that plasma concentration testosterone levels begin
falling in early middle age, and bioavailable testosterone is nearly
halved between the ages of 25 and 75. Total testosterone levels fall
about 1 percent per year from mid-life but it is not clear whether
this is medically significant.?
?Different labs measure free testosterone differently. But ranges they
consider "normal" generally fall between 260 nanograms/deciliter to
1,000 ng/dL. (2.6 nanograms/milliliter to 10 ng/mL). Since physicians
and laboratories are only recently beginning to recognize the
importance of testing free testosterone, you may have to lobby to get
the test. If you are unable to get that reading and are forced to
stick with total testosterone, learn the range of normal for your lab.
Normal ranges for men usually are between 250 ng/dL to 1,200 ng/dL of
blood (2.5 ng/mL to 12 ng/mL).?
?Measuring serum testosterone: Testosterone levels increase throughout
puberty from < 20 ng/dL (< 0.7 nmol/L) to between 300 and 1200 ng/dL
(10.5 and 41.5 nmol/L) in adulthood. Serum testosterone secretion is
pulsatile as well as circadian. In the second half of puberty, levels
are higher at night than during the day. A single sample is sufficient
to establish that circulating testosterone levels are normal. Because
98% of testosterone is bound to carrier proteins in serum
(testosterone-binding globulin), alterations in these protein levels
will alter total testosterone levels.?
More about testosterone
Good advice from Calgary Health
Dr. Andrew Weil has some interesting tips to increase male libido:
I do not put a lot of stock in ?special Diets?, but this Male Libido
diet appears to be an overall healthy diet, and best of all, the site
is not asking you to purchase any supplements!
I urge you to get a complete physical to rule out conditions such as
diabetes, hypothyroidism (a sluggish thyroid can trigger depression),
hyperprolactinemia, and stress and/or depression. A laggard libido can
be treated, and a frank discussion with your physician, along with a
complete physical, blood and urine tests may be all you need. If
nothing medical can be found as the origin of your problem, you may
benefit from talking to a good therapist or marriage counseling.
Finally, be aware that drugs for erectile dysfunction such as Viagra
or Cialis will not affect libido!
I hope this answers your question! If any part of my answer is
unclear, or if I have duplicated information you already had, please
request an Answer Clarification, before rating. This will enable me to
assist you further, if possible.
Low male libido
Decreased sex drive
Clarification of Answer by
04 Jun 2004 23:36 PDT
Hi again kcip,
If your doctor is amenable to ordering the tests you request, having
the ?complete? testosterone panel would seem to give you the whole
picture, along with some thyroid, cortisol and overall general health
About 60% of circulating testosterone is bound to a protein called sex
hormone binding globulin (SHBG), about 38% of testosterone is bound to
albumin, and the rest is ?free? testosterone. SHGB binds to
testosterone, making it virtually inactive. Free testosterone is the
functionally active portion of circulating testosterone. Generally
speaking, if your SHBG is low, the testosterone level will be higher.
Some labs will calculate a ratio of testosterone to SHGB, expressed as
T/SHGB and is sometimes called the testosterone free index (TFI).
According to this AndroGel site, ?As individual testosterone levels
tend to vary, determination of low testosterone may require more than
one blood test. The best initial test is a morning plasma total
testosterone level which measures free plus bound testosterone. Low
level diagnoses should be confirmed with a second test. Men who are
symptomatic, yet register at the low end of the normal scale (200-350
ng/L) should have a free or non-SHGB-bound testosterone measurement.?
To save money, your doctor will probably want to repeat just your
testosterone level to verify. If it comes back as high as the first,
she/he may not feel the need to test for the other analytes. Some
physicians like to order the ?whole shebang? ordering *all* the tests,
and get the labs over with one needlestick, and one follow-up. Wheter
your doctor orders a complete workup or orders just one or two tests
at a time, will have to be worked out between you and your doctor.
Good tests to start with:
Total and Free testosterone (and SHBG if considered necessary)
CBC w/manual diff
Comprehensive Metabolic Panel
You probably will not need an LH test, unless you are having fertility problems.
Check your stress level! (This is not, of course a blood test!)
?It might come as shock to some but men can suffer from a form of
menopause similar to what women endure. In fact this malady, sometimes
called male menopause, shares a number of Chronic Fatigue Syndrome
(CFS) symptoms. Could it be then that some men thought to have CFS are
actually suffering from this treatable hormone deficiency instead?
While the answer is not so straightforward, often those treated for
male menopause find relief from at least some of their "CFS"
symptoms.? And ?Similarly, studies have shown the hormone DHEA, which
promotes the production of testosterone and other sex hormones, to be
low in CFS patients. Dr. David Brownstein has written several books on
natural hormone therapy. He has 'observed consistently low DHEA levels
in most individuals with fibromyalgia and chronic fatigue syndrome.'
Likewise studies have shown that growth hormone which is reduced in
male menopause is also diminished in those with CFS.
That CFS and male menopause may be related seems logical based upon
the research establishing abnormally low levels of the hormone
cortisol in CFS patients. The hormone chain reactions that lead to
proper levels of cortisol are intertwined with the hormone chain
reactions that balances the testes production of hormones. Alterations
in one chain can easily effect the other chain. So perhaps in some
patients with CFS while the original cause of their problems may be
alterations in the cortisol hormone chain, abnormally low levels of
sex hormones result that actually bring on the symptoms.?
?One study found that stressful life events can predispose an
individual to develop depression by sensitizing the HPA axis in early
life. These stressful experiences actually "sculpt" specific neural
circuits in the brain, and can result in habitualized oversecretion of
the adrenal hormone cortisol. Chronically high cortisol levels are
linked with a variety of mood disorders, including anxiety,
depression, and panic disorder; in fact, as many as 7 of every 10
patients with depression show an enlargement of the adrenal gland
approximately 1.7 times that of healthy controls.?
When you get your lab results back, kcip, do two things. First, ask
your doctor to go over everything. Ask the doctor what the results
mean, and what they mean to your condition. Then ask for a copy of the
actual report from the performing lab. You have a right to a copy. On
the lab report will be *that* lab?s normal ranges. You will then be
able to see how your results fall among the normal ranges. Each
performing lab has its own reference range, depending on their
methods, and these results really should not be compared to results
from another lab. Your physician knows your medical history best, and
with a proper explanation of the results, you should know where you
stand! I don't wish to overemphsize the non-physical aspect of
decreased libido, but, understand that emotional factors are more
often the cause than abnormal lab results!
Normal lab values will be somewhere near these values, again depending
on the performing lab?s methods:
20-39 yrs: 400-1080 ng/dL
40-59 yrs: 350-890 ng/dL
60 yrs & over: 350-720 ng/dL
Male, 19 years and older: 47.0-244.0 pg/mL
Males 2mo-150 yr: 3-18ng/mL
See a chart of more lab values here:
I hope this has made my answer more understandable, kcip, and I wish
you the very best!