Management of low libido in males
Offer an opportunity to discuss the management of low libido. Initial management may include the provision of information (verbal or written) regarding normal sexual function and factors that can contribute to difficulties. Patient information sheets can be found at the Healthy Male website. Specific suggestions (eg altering medications, suggesting referrals) and more in-depth therapy (eg some forms of counselling) may be offered by the clinician. Alternatively, consider referral to an accredited therapist with a specialist interest in sexual health practice, such as a sexual medicine specialist, sexologist, general practitioner, nurse, psychologist, other sexual health counsellor or sexual health physician. The Society of Australian Sexologists and the Australian Psychological Society set national accreditation standards for quality and safety of practice and list accredited members.
Review medications that may affect sexual function, such as selective serotonin reuptake inhibitors and some opioids.
Address underlying conditions (see Assessment of males with low libido for a list of contributing conditions), in particular erectile dysfunction and premature ejaculation. Weight loss of 10% can improve libido in people with obesity.
If issues such as financial pressures or family concerns are contributing, signposting to sources of financial advice or social work services may be useful. Psychological therapies (eg counselling, including relationship counselling, cognitive behavioural therapy, psychotherapy and mindfulness) may be offered by the clinician. Alternatively, consider referral, depending on level of expertise.
Testosterone treatment is only indicated if specific criteria for androgen deficiency are met. Testosterone improves sexual desire in males, regardless of age, who have low serum testosterone and low libido. In the T-Trials Sexual Function Trial1 a small-to-moderate treatment effect on sexual desire score was found (a mean increase of 2.93 points [range 0 to 33] from a mean baseline of 12 points, where reduced sexual desire is indicated by a score less than 20).