Low Libido in Men

Evaluation and Assessment

Morning serum testosterone level is crucial in evaluating men with low libido, with low defined as <300 ng/dL, according to the American Diabetes Association and the American College of Physicians 1, 2
The prevalence of low testosterone in men with sexual dysfunction varies from 12.5% to 35%, making hormonal testing an important diagnostic step, according to the American College of Physicians 3
Evaluate prolactin levels if libido issues persist, and consider luteinizing hormone if there's clinical suspicion of pituitary dysfunction, as recommended by the American College of Physicians 4

Testosterone replacement therapy (TRT) is the first-line treatment for men with low libido and documented low testosterone levels, as recommended by the American College of Physicians 1, 2, 3
Testosterone replacement therapy may not significantly improve erectile function, but it improves sexual desire, according to the American College of Physicians 2
Intramuscular formulations are preferred over transdermal due to lower cost and similar efficacy, as recommended by the American College of Physicians 2, 3
PDE5 inhibitors, such as sildenafil, vardenafil, or tadalafil, may improve sexual function even in men with normal testosterone levels, with success rates of 69-88% compared to 26-35% with placebo, according to the National Comprehensive Cancer Network and the American College of Physicians 5, 6, 3
The choice between sildenafil, vardenafil, or tadalafil should be based on patient preference, cost considerations, and side effect profile, according to the American College of Physicians 3
Gonadotropin therapy is an alternative treatment for men wishing to preserve fertility 4

Cancer survivors with low testosterone levels may benefit from testosterone therapy, but other contributing factors should also be evaluated, as suggested by the National Comprehensive Cancer Network 5
Men with diabetes have higher rates of sexual dysfunction and may benefit from both testosterone therapy (if levels are low) and PDE5 inhibitors, according to the American Diabetes Association 1
Erectile dysfunction and low libido may be markers for cardiovascular disease, and appropriate referrals should be made, as recommended by the American Urological Association 6
Testosterone replacement therapy is not recommended for men with normal testosterone levels seeking to improve energy, vitality, physical function, or cognition, as stated by the American College of Physicians 2
Testosterone replacement therapy is not recommended for men with age-related low testosterone without sexual dysfunction, according to the American College of Physicians 2

Lifestyle modifications, such as adequate sleep (7-8 hours), regular exercise, weight loss if overweight/obese, reduction in alcohol consumption, and smoking cessation, can improve sexual function and overall health, as recommended by the British Medical Association 4
Medication review and consideration of alternative medications with lower risk of sexual dysfunction can also be effective 4
Psychosexual therapy and cognitive behavioral therapy can address relationship issues, performance anxiety, and other psychological barriers, with success rates of 50-80% in patients with psychogenic sexual dysfunction 4
Partner involvement, including addressing partner's concerns and expectations, and evaluating relationship dynamics that may contribute to sexual dysfunction, is also important 4

Monitor for potential adverse effects, including polycythemia, cardiovascular events, and prostate-related issues, as reported by the American Academy of Family Physicians 7
Reevaluation of symptoms within 12 months of initiating any treatment is recommended, and discontinuation of treatments that don't show improvement in sexual function 2
Referral to a sexual health specialist may be considered for complex cases that don't respond to initial management 4