Page 88 - Remedial Andrology

Figure 10: Flow-diagram of psychological evaluation of patients with low sexual desire

Evaluate psychosexual history and
development

Evaluate dysfunctional thinking style and Consider role of partner
expectations regarding sexuality and men’s
sexual performance Consider whether lack of
desire is dyadic (desire
to engage in sexual
behaviour with the partner)
or solitary (desire to

Collect evidence for specific anxiety triggers engage in sexual behaviour
with one’s self)

Decide on referral to (sexual)psychotherapy
or psychological intervention

7.4.2 Pharmacotherapy
Low sexual desire secondary to low testosterone levels can be treated with different formulations of
testosterone. The favourable effect of testosterone therapy on sexual motivation and the presence of sexual
thoughts was shown in a meta-analysis [941]. The aim of treatment should be to reach the physiological range
of testosterone (see Section 3.5).

Hyperprolactinaemia can also cause LSD and one of the most relevant aetiological factors is prolactin-
secreting pituitary adenomas. These adenomas can be easily diagnosed with MRI of the pituitary gland and
can be treated with dopamine agonist agents [945]. The other accompanying endocrine disorders, such as
hypothyroidism, hyperthyroidism and diabetes, should be treated accordingly.

Pharmacotherapy can also be used to treat major depression; however, it should be remembered that
antidepressants may negatively affect sexual functioning; therefore, antidepressant compounds with less effect
on sexual function should be chosen. Psychotherapy can increase the efficacy of pharmacotherapy, especially
for patients whose LSD is due to depression [946].

7.5 Recommendations for the treatment of low sexual desire

Recommendations Strength rating
Perform the diagnosis and classification of low sexual desire (LSD) based on medical and Weak
sexual history, which could include validated questionnaires.
Include physical examination in the initial assessment of LSD to identify anatomical Weak
abnormalities that may be associated with LSD or other sexual dysfunctions, particularly
erectile dysfunction.
Perform laboratory tests to rule out endocrine disorders. Strong
Modulate chronic therapies which can negatively impact toward sexual desire. Weak
Provide testosterone therapy if LSD is associated with signs and symptoms of testosterone Strong
deficiency.

SEXUAL AND REPRODUCTIVE HEALTH - MARCH 2021 87