What is loss of libido?

Libido is a person's overall sex drive or desire for sexual activity. Loss of libido refers to a reduced interest in sexual activity. Although it is common to lose interest in sex from time to time, loss of libido for a prolonged period may be a cause for concern for some people.

How do I know if I have a loss of libido?

• Little or no interest in sexual activity
• Few or no sexual thoughts or fantasies
• Little or no interest in initiating sex
• Difficulty getting pleasure from sex
• Lack of pleasure when genitals are simulated
• Being concerned about your lack of sexual activity or fantasies

What decreases a man's libido?

A. Physical

• Low testosterone levels
  • Testosterone is responsible for strengthening muscles, stimulating sperm production and sex drive
  • Low testosterone levels is one of the main causes of a loss of libido, and doctors often conduct blood tests to check the testosterone level before diagnosing a patient with low libido
  • Adult men are said to have low testosterone levels if their levels fall below 300ng/dL. The decrease in testosterone also leads to a loss of libido
  • Hypogonadism is an autoimmune disorder where the gonads (sex glands) produce little to no sex hormones
    • This illness results in extremely low testosterone levels and thus leads to a loss of libido
• Age
  • About 40% of people over the age of 45 have low testosterone levels
• Too little or too much exercise
  • Too little exercise may lead various health problems (e.g. obesity, high blood pressure, type 2 diabetes) which can decrease sexual desire and arousal
  • Too much exercise are also associated with decreased libido in men, as proven by this study.
• Alcohol
  • Heavy alcohol drinking (drinking more than 14 mixed drinks a week) has been linked to low testosterone levels
  • Over time, excessive amounts of alcohol can also lower sex drive
  • Do note: An average adult male should consume 2 or fewer alcoholic drinks daily to avoid long-term health deterioration
• Drug use
  • Medications for blood pressure (e.g. ACE inhibitors, beta blockers) may prevent ejaculation and/or erections
  • Other medications may also lower testosterone levels (e.g. chemotherapy, pain relievers, some antidepressants)
  • Tobacco, marijuana and other illegal drugs also relate to a decrease in testosterone level
  • Smoking also has a negative impact on sperm production and sperm movements
• Chronic illnesses
  • Cancer may reduce sperm production count
  • Chronic illnesses that result in chronic pain may also take a toll on your body, and thus your body will not prioritise sexual intercourse as an important activity
    • Type 2 diabetes, hypertension, high cholesterol, high blood pressure, chronic lung/ kidney/ heart/ liver failure
• Issues with sleep
  • Non-obese men with obstructive sleep apnea (OSA) often experience low testosterone levels
    • Research also showed that 1/3 of men with severe sleep apnea had reduced levels of testosterone
  • In a study surveying young, healthy men, testosterone levels decreased by 10% - 15% after sleeping for less than 5 hours each night for a week
    • The testosterone levels are especially low between 2pm and 10pm the following day

B. Psychological

• Depression
  • People with depression often experience a reduced or complete lack of interest in activities they once found enjoyable (e.g. sexual activities)
  • Loss of libido is also a side effect of certain antidepressants:
    • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
    • Selective serotonin reuptake inhibitors (SSRIs)
• Stress
  • Stress may disrupt hormone levels, resulting in low testosterone levels
  • Arteries also narrow in times of stress, resulting in less blood flow to the erectile tissue. The restricted blood flow may result in an erectile dysfunction (ED)
  • Another study of veterans with post-traumatic-stress-disorder (PTSD) found that PTSD increased their risk of sexual dysfunction by more than 3 times
• Low self-esteem
  • Thinking that you are unattractive and undesirable may make you want to avoid sexual activities altogether
  • Low self-esteem may also manifest in performance anxiety during sexual intercourse, which can lead to reduced sexual desire
  • Low self-esteem may also lead to larger mental problems (e.g. depression, anxiety, drug or alcohol abuse) which all have been linked to low libido
• Problems in relationship
• Sexual intercourse is unfulfilling
  • If a man or his partner has sexual dysfunction, they may find sexual activities unfulfilling and thus lose their sex drive

How to restore my libido?

A. Lifestyle changes

• Diet
  • One study found zinc to be important in regulating testosterone levels in men. As such, consuming foods that are high in zinc, such as eggs and oysters, can help to increase testosterone levels and treat the loss of libido
  • Eating potassium-rich foods can also treat the loss of libido, as potassium helps with testosterone production. Some potassium-rich foods include: bananas, beets and spinach
• Exercise
  • It is important to get regular exercise that is not too high in intensity
• Sleep
  • Lack of sleep causes the body to release a stress hormone called cortisol, which decreases testosterone production. As such, getting enough sleep (at least 7 hours of sleep) can reduce the amount of cortisol released and increase testosterone levels, effectively treating the loss of libido
• Alcohol
  • Cutting down on alcohol can treat the loss of libido, as excessive drinking can lead to reduced testosterone levels.

B. Testosterone replacement therapy (TRT)

Testosterone replacement therapy is carried out to increase testosterone levels. It is available in several forms:

Testosterone Transdermal Patches

• Used in adult men who have hypogonadism
• Applied once a day
• Should not be used to treat low levels of testosterone due to aging (age-related hypogonadism)
• Some side effects include:
  • Redness, irritation, burning or blisters at the application site
  • Back pain

Testosterone Gel

• Used in adult men who have hypogonadism
• Testosterone is absorbed directly into the skin when the gel is applied
• Applied once a day
• Some side effects include:
  • Headaches
  • Dry skin
  • Acne

Injections and Implants

• Testosterone can be directly injected into the muscles, or implanted into tissues
• After which, your body will slowly absorb the testosterone into your bloodstream

C. Oral Medication

• A 2015 study by the US FDA found that taking testosterone supplements do not necessarily affect your testosterone levels. In fact, it was found that the zinc in these products was the cause of increased testosterone levels
• However, other drugs have proven to be effective in increasing testosterone levels:
  • Oestrogen Blockers
  • Aromatase Inhibitors

Oestrogen Blockers

• Oestrogen is a female sex hormone that occurs naturally in men, inhibiting testosterone production
• Oestrogen blockers prevent this from happening, resulting in higher testosterone production
• Typically used for people who are not suitable for TRT

Side effects:

• Acne
• Mood changes
• Abdominal pain
• Nausea/ vomiting
• Possible risk of prostate cancer

Aromatase Inhibitors

• Overweight people typically can produce normal levels of testosterone, but an enzyme in body fat (aromatase) converts testosterone to oestrogen
• High levels of oestrogen inhibit testosterone production
• Aromatase inhibitors prevent the conversion of testosterone to oestrogen, and thus can dramatically increase testosterone levels for obesity-related low testosterone

Side effects:

• High blood pressure
• Joint pain
• Nausea
• Greater bone density

D. Psychotherapy (Counselling)

A sex therapist will listen to your problems, and deduce whether the main cause of your loss of libido is psychological, physical or both.

• If a medical condition is the main cause for the loss of libido, a therapist can prescribe medication to help with the psychological effects of the patient's symptoms
  • This prevents relationship tensions and improves the patient's mood
• If there is no medical condition, therapists can identify the emotional reasons for low sex drive

Sex therapy emphasises on communication with your partner. Through therapy, one can learn more about their partner's turn-ons and turn-offs, helping to maintain their sexual attraction to one another. By exploring different ways of having sexual intercourse, couples can make their sex life more enjoyable.

For more information or if you require a medical consultation, please contact My Healthcare Collective here.