Dr. Roach

Dr. Keith Roach

DEAR DR. ROACH: For two years now, I have totally lost all of my libido. Please help provide an explanation and a pathway to a cure. I am 76 years old now and in very good health. I’m 5 feet, 11 inches tall and weigh 182 pounds. I am married and have a good relationship with my wife, with the exception of us not being able to have intimate relations. I exercise five to six days a week for a little over an hour with cardio and strength exercises at a local gym.
I don’t get any erections at any time, even at night or during sleep. I have zero libido and total erectile dysfunction (ED), which has also gone on for approximately three years or more. ED medications do not help at all. I once had a penile injection, and a suction device I tried gave me results that were somewhat painful and unsuitable for intercourse.
Is my only option an operation to restore blood flow to my penis? Getting surgical penile implants seems like an unlikely option. — Anon.
ANSWER: Loss of libido is common in both men and women, especially as we age. There are many causes, and trying to find the underlying cause is the key to treatment.
Psychological issues (such as depression) and issues with a partner are the most common causes in my experience. Although you said you have a good relationship with your wife, you haven’t commented on any mental health issues. Sometimes libido loss is the first clue to this. Many physicians overlook these important considerations.
There is a complex relationship between erectile dysfunction and libido, where loss of one can spur loss of the other. The brain is our most important sexual organ. I suspect, in your case, your ED is related to the loss of libido.
Medications are important causes behind loss of libido. The SSRI class of antidepressants and antianxiety medicines most commonly produce this side effect. Opiate pain medicines also commonly have this effect. The prostate medicines dutasteride and finasteride occasionally do this. Men who use alcohol, cannabis and other recreational drugs excessively may have low libido. Hormone issues are critical as well. Low testosterone is the most important, but prolactin, estrogen and thyroid hormone abnormalities need to be evaluated.
Lack of adequate blood flow to the penis is a common cause of ED. Complete loss of erections suggests a physical cause of ED. In addition to blood flow and hormones, nerve supply to the area is another cause that can be evaluated, but it is seldom the cause in people without a known neurological disease.
In absence of a known cause, there aren’t any approved treatments for men with low libido. One drug (flibanserin) has been approved for women, but even though I found an ongoing trial, there wasn’t any published data on its effectiveness in men. Some drugs have been tried off-label, such as bupropion, which has been useful in treatment of loss of libido associated with SSRI medications.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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