Physiological causes, objective factors, and related medications for low libido

**II. Abnormal Sexual Desire**

[Physiological causes of low libido] Male sexual dysfunction includes both low libido and high libido.

Besides the decline in libido due to aging, any decrease in libido that is incompatible with or disharmonious with age in normal young adults or the elderly is considered abnormal and can be termed low libido.

Of all sexual dysfunctions, low libido is the least understood. Primary low libido is relatively rare and is often accompanied by hypogonadism.

In men, secondary hypoactive sexual desire disorder is more common. It refers to a condition where the libido was originally normal, but later changed significantly and became much lower than before. It may be caused by or result of other sexual dysfunctions.

When low libido coexists with other sexual dysfunctions, the situation becomes more complex. It is important to determine whether low libido is an adaptive response to other sexual dysfunctions. For example, is premature ejaculation particularly detrimental to a man, to the point that he prefers to avoid sexual contact and eventually develop low libido?

The number of men with low libido is significantly less than that of women. The causes include socio-psychological factors, as well as the influence of organic diseases and drug interference.

Some men, influenced by their childhood education and environment or psychological trauma, develop deep-seated prejudices against sex, which hinder normal sexual psychological development. If these prejudices are not corrected after marriage, they may suppress their sexual desire.

The occurrence of functional hyposexuality is closely related to central inhibition, spinal cord dysfunction, and age-related changes in sexual function.

The brain is the center of human mental activity. When the inhibition of the brain and limbic system is enhanced, sexual inhibition occurs.

Spinal cord dysfunction mainly refers to factors such as excessive sexual intercourse, masturbation, and indulgence in pornography, which over time lead to central nervous system disorders.

Hyperthyroidism can also manifest in various forms of sexual dysfunction and sexual behavior disorders. Approximately 10% to 20% of patients experience increased libido in the early stages, especially those with mild hyperthyroidism. Most hyperthyroidism patients experience decreased libido, and may even have decreased blood testosterone levels and reduced testosterone reserves.

[Objective reasons for low libido] Sexual function is not only affected by the functions of various systems in the body, but also by psychological, mental, physical and other factors.

(1) Physical factors: Sexual activity itself requires the participation of multiple systems of the body. Extreme physical fatigue or weakness will affect emotions and the state of the higher nervous system of the cerebral cortex.

Therefore, low libido or lack of libido is easily caused by excessive physical exertion, serious illness, or extreme physical weakness due to long-term chronic diseases.

(2) Energy factors: Excessive mental exertion, mental stress, or constant thinking about work problems can cause the excitation point of the central nervous system to be focused on work, which can inhibit the sexual center and thus lead to low libido.

(3) Psychological factors: These are very important and common factors. Excessive sadness, worry, anger, or fear can affect one's mental and psychological state.

A lack of sexual stimulation or attraction to the opposite sex requires a certain level of sexual stimulation to trigger sexual desire.

Low libido can also occur when a husband has an affair and dislikes his wife, or when the relationship between husband and wife breaks down for other reasons.

(4) Endocrine factors: Normal levels of male hormones in the blood can maintain a certain level of responsiveness in the sexual center and induce sexual response under appropriate stimulation.

Male hormones can increase the excitability of the sexual center, making certain stimuli more effective and thus arousing sexual desire.

Conversely, when testicular function declines and insufficient male hormone production occurs, libido declines.

Therefore, due to the decline in testicular function compared to young adults, it takes a longer time for older adults to achieve an erection, unlike younger adults who can achieve an erection quickly after sexual stimulation. Sometimes, older adults need direct stimulation of the sensory nerve endings of the genitals, i.e. the glans penis, to achieve an erection, and the firmness of the erection is also weaker than that of younger adults.

(5) Other factors: Any factors that can cause erectile dysfunction or premature ejaculation, such as chronic inflammation of the reproductive tract, can further affect libido and lead to a lack of sexual desire if the condition is not cured and recovered within a long period of time after causing premature ejaculation or erectile dysfunction.

[Diseases that cause low libido] The causes of low libido in men are complex. All serious systemic diseases, chronic diseases, and excessive fatigue can reduce sexual arousal and lead to low libido.

However, in reality, decreased libido in these patients is only an early manifestation of the disease, and most of them will experience other sexual dysfunctions.

Many endocrine disorders, such as chronic adrenocortical insufficiency, Cushing's syndrome, hyperprolactinemia, hypopituitarism, and hypothyroidism, can cause low libido in men.

Hereditary diseases, such as Klinefelter syndrome; liver diseases, such as chronic active hepatitis and cirrhosis; nutritional and metabolic diseases, such as hypoglycemia, hypokalemia, diabetes, and malnutrition; and many other diseases, such as chronic renal failure, congestive heart failure, brain tumors, cerebrovascular diseases, chronic obstructive pulmonary disease, collagen diseases, parasitic infections, prostatitis, and malignant tumors, can cause low libido in men.

In addition to the aforementioned organic diseases that can lead to low libido in men, a lack of sexual knowledge and poor mental and emotional state are also important causes of low libido in men.

[Medications that cause low libido] It has been confirmed that many medications can also cause low libido in men.

Drugs such as alpha-methyldopa, antihistamines, barbiturates, monoamine oxidase inhibitors, phenothiazines, propranolol, reserpine, clonidine, coronary heart disease medication, phenytoin sodium, cannabis, spironolactone, oral anti-androgens, estrogens, and alcohol can all reduce libido and lead to low libido in men.

Therefore, it is necessary to strictly control the dosage when using these drugs to prevent adverse reactions.

[Overcoming the Fear of Low Libido] Decreased libido is a normal phenomenon for middle-aged men, but a decrease does not mean complete disappearance, and a temporary disappearance does not mean permanent disappearance. As long as this physiological change is correctly understood and psychologically adjusted, it is entirely possible to restore and maintain sufficient sexual interest through counseling and treatment, and restore sexual relationships to their former state.

Being able to freely express your fears, anger, grief, anxiety, and other uncomfortable emotions in front of a doctor helps clear the confusion and distractions in your mind, and is a key step in reducing negative effects.

For those psychological confusions that cannot be resolved and cause disturbance, it is necessary to repeat them again and again.

Repeatedly raising this question can gradually reduce or even eliminate its impact on oneself.

Men not only need to get rid of their own negative emotions, but also help their partners overcome this psychological barrier.

Help your partner understand the nature and possible causes of the problem, so she can avoid putting pressure on herself and promote communication between the two of you.

Regularly reading or watching books and films with explicit sexual descriptions to stimulate and awaken romantic feelings or fantasies can be an effective adjunctive treatment method that can help alleviate decreased libido.

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