The Potential for Pharmacological Interventions for Low Sex Drive in Men

Despite numerous advancements in the field of sexual medicine, there remain a handful of conditions which are difficult to characterize, have poorly understood pathophysiology, and are challenging to treat. Of this subset of pathologies, a complaint of decreased libido or low sex drive (LSD) is one that is familiar to most sexual medicine providers. The reported prevalence of LSD in the male population ranges from as low as 5% to greater than 17%. 1 Meissner VH Schroeter L Köhn FM et al. Factors associated with low sexual desire in 45-year-old men: findings from the German male sex-study. J Sex Med. Jul 2019; 16: 981-991https://doi.org/10.1016/j.jsxm.2019.04.018 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ,2 Segraves RT. Management of hypoactive sexual desire disorder. Adv Psychosom Med. 2008; 29: 23-32https://doi.org/10.1159/000126622 Crossref PubMed Scopus (18) Google Scholar The variability in these reported rates is likely due to a combination of factors including a lack of universal diagnostic guidelines for identifying LSD and the societal stigma associated with sexual dysfunction leading many men to repress these issues. Moreover, a cultural component also exists as discussion of issues pertaining to sex is considered a private affair and can be taboo in many parts of the world. While various definitions of LSD exist in the literature, in the broadest context, it refers to a recurrent absence of sexual desires or fantasies, which causes personal distress and impacts an individual's quality of life or wellbeing. Furthermore, irrespective of the definition used for LSD, there is a universally strong emphasis that the lack of sexual drive or libido must cause patient distress in order to be considered pathologic and demand intervention. In the Diagnostic and Statistical manual of Mental Disorders (DSM-V), a condition termed male hypoactive sexual desire disorder (HSDD), is used to describe patients with low libido or sex drive that is independent and not a clinical sequelae of other psychiatric or endocrinologic conditions, or due to pharmacologic side effects. 3 Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub, 2013 Crossref Google Scholar Additionally, there is also a distinction that the diagnosis of HSDD cannot be made if a comorbid sexual dysfunction exists. Given the strong prevalence of comorbid sexual dysfunction in men presenting with signs of low libido, Rubio-Aurioles et al. make the case that the term HSDD should then refer only to men without any confounding causes for decreased libido or sex drive as outlined by the DSM-V, and LSD should be a broader term that encompasses men with comorbid conditions, including other sexual dysfunctions, that could contribute to a diminished sexual desire. 4 Rubio-Aurioles E Bivalacqua TJ. Standard operational procedures for low sexual desire in men. J Sex Med. 2013; 10: 94-107https://doi.org/10.1111/j.1743-6109.2012.02778.x Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar For the purposes of this article, this distinction will be used.