Low sex drive - or erectile dysfunction?

Q: I don't have the same interest in sex as I used to. Could it be low testosterone? Can you give me testosterone replacement therapy?

A: In general, while a decrease in libido or sexual interest can be a symptom of low testosterone, men with low testosterone levels will also have other symptoms, such as fatigue, less energy, and trouble concentrating.

And, most important, these symptoms will be accompanied by a low blood testosterone level. Not infrequently, I find that men who say they have a low sex drive actually are suffering erectile dysfunction, which is about blood flow and is helped by drugs like Viagra or Cialis.

In these men, their low sex drive is due to an acquired lack of interest in sexual activity caused by their expectation that they will not be able to perform.

Having said that, men who have the above symptoms with a low blood testosterone level can benefit from replacement therapy and improve their quality of life.

My sense is that men seek treatment because they think testosterone replacement is a cure-all, and of course, it isn't. Not to mention that it has side effects, which can include enlarged prostate, low sperm count, swelling of ankles and feet, enlarged or painful breasts, blood clots in the legs, mood swings, elevated blood pressure, increased red blood cell count, and skin irritation at the administration site.

The range of what is considered "low T" is wide, so it's hard to be dogmatic about numbers.

But usually if the blood level is normal, I'll do further investigation and determine whether the patient needs treatment for erectile dysfunction or needs to adjust his expectations.