Age-Related Hypogonadal Syndrome - Treatment

General Considerations

The DSM-IV-TR diagnosis of any sexual dysfunction has four requirements: first, diagnostic subtyping must occur (see Classification section in this chapter); second, another Axis I diagnosis be excluded (except another sexual dysfunction); third, an existing medical circumstance could not explain the dysfunction; and fourth, substance abuse also not be present. In the absence of a thorough assessment (history, physical and laboratory exams when appropriate), the clinician is actually regarding a presenting symptom rather than a diagnosis. The two should not be confused. The distinction is crucial.

Treatment follows diagnostic subtyping. (A) If HSDD is acquired and generalized, the clinician must make significant efforts towards finding the explanation(s) for the change. HSDD is sometimes (the frequence appears to be unknown) accompanied by another sexual dysfunction, especially erectile dysfunction, and when both occur together, it may be revealing and useful to find out which came first and to act accordingly. One might understand how a lack of sexual desire can cause erectile problems. Nevertheless, the opposite is not so clear. The extent to which the presence of erectile dysfunction can outcome in a generalized lack of sexual desire appears to be entirely unknown. (B) If HSDD is lifelong but situational, a biogenic explanation is unlikely and individual psychotherapy undertaken by a mental health professional seems favored. (C) If HSDD is produced but situational, a biogenic explanation is, again, unlikely (with the possibly exception of hyperprolactinemia). In this circumstance, psychotherapy seems suggested but depending on the apparent aetiology, could be rendered individually or together with a partner. (D) If the history reveals that HSDD has been lifelong and generalised, change is unlikely and the clinician should direct therapeutic energy towards helping the person (or, more likely, the couple) to adjust. Kinsey's admonition looks relevant: . . . there is a certain incredulity in the profession of the existence of people who are basically low in capacity to respond. This amounts to asserting that all people are more or less equal in their sexual endowments, and neglects the existence of individual variation. No one who knows how remarkably different individuals may be in morphology, in physiological reactions, and in other psychologic capacities, could conceptualise of erotic contents (of all things) that were basically uniform throughout a population.

About The Author

David Crawford is the CEO and owner of a Male Enhancement Reviews company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2009 David Crawford of Male Enhancement Facts This article may be freely distributed if this resource box stays attached.

Treatment of Sexual Disorders - Evolution of Current Treatment Approaches

Age-Related Hypogonadal Syndrome - Diagnosis

Low sexual desire is usually interpreted as a symptom of andropause/ADAM/ PADAM. To explain the desire shift, a great deal of emphasis has been given to laboratory values, especially adjustments in T. Nevertheless, the typical history has incurred much less attention. Only one study of aging men seems to have analysed various manifestations of sexual desire. Schiavi et al. reported on 77 volunteer couples who responded to an announcement concerning a examination of elements contributing to health, well-being, and marital satisfaction in older men. Three groups of men were compared: 45 54, 55 64, and 65 74. The following were determinations corresponding to the issue of sexual desire: (i) sexual interest, responsiveness, and activity was noted even among the oldest men; (ii) increasing age was associated with erectile dysfunction, but not with HSDD or PE (premature ejaculation); (iii) the following frequencies consistently reduced with age: desire for sex, sexual thoughts, maximum time uncomfortable without sex, coitus, and masturbation; and (iv) . . . the degree of satisfaction with the men's own sexual functioning or enjoyment of marital sexuality did not change with age .

As far as the laboratory is concerned, evaluating BAT is the desired parameter for determining hypogonadism, although it is not always available. Abnormality is evaluated by comparing the T level with young adult men. If the testosterone level is below or at the lower limit, it is prudent to affirm the results with a second determination with assessment of LH and . . . FSH.

Etiology

In addition to hormones, many other alterations take place in male physiology which lead to the aging process. One nonsexual example that is referred for the intention of offering perspective, is the multiple elements which are connected with diminished bone mass and which include: low estradiol (E2), vitamin D deficiency, low GH, low T, poor nutrition, smoking, certain medications, excess alcohol, inactivity, lack of exercise, poor calcium intake, genetic predisposition, and certain illnesses.

About The Author

David Crawford is the CEO and owner of a Male Enhancement Pills company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2009 David Crawford of Male Enhancement Reviews This article may be freely distributed if this resource box stays attached.

Treatment of Sexual Disorders - Evolution of Current Treatment Approaches

Male Sexual Desire Disorder - Age-Related Hypogonadal Syndrome

Terminology and Definitions

Hypogonadism refers to the results of decreased function of the gonads; happens at any age and for a variety of causes; and is classified into two forms on the basis of the source of the problem, that is, either of testicular origin, or as a effect of disorder in the hypothalamic-pituitary axis. Sex-related phenomena linked with hypogonadism are described in the Hormones section of this chapter.

The term andropause points a special type of hypogonadism that is linked to aging in men and is said to consist of the following: diminished sexual desire and erectile function, fall in intellectual activity, fatigue, depression, decrease in lean body mass, skin alterations, decrease in body hair, decrease in bone mineral density resulting in osteoporosis, and increase in visceral fat and obesity. The word andropause is an attempt to draw a parallel in men to the experience of menopause in women. Whereas menopause occurs abruptly, andropause is said to occur quite slowly. As well, menopause is related with the irreversible end of reproductive life, whereas in men spermatogenesis and fertility continue into old age. In the opinion of some observers, trying to equate the two is rather questionable.

The existence of andropause is a subject of argument partly because of great difficulty distinguishing this syndrome from age-related confounding variables such as nonendocrine sicknesses (both acute and chronic diseases), poor nutrition (inadequate or excessive food intake), smoking, alcohol use, and medications. Some observers have less doubt about the existence of a disorder but prefer to use a different name: ADAM (androgen decline in the aging male), or PADAM (partial ADAM which refers to androgen decline that is still within the normal range).

To underline the fact that many hormones decline with age, the word adrenopause has also been used to describe the diminution of the adrenal androgens DHEA and DHEAS, and somatopause to describe the same in the somatotrophic hormone, growth hormone (GH).

About The Author

David Crawford is the CEO and owner of a Male Enhancement Facts company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2009 David Crawford of Male Enhancement Reviews This article may be freely distributed if this resource box stays attached.

Presence of Another Sexual or Gender Disorder in a Patient or Partner

Sexual Dysfunctions

Three studies evidence that it is common for HSDD to be associated (or comorbid or correlated) with another sexual dysfunction. Nevertheless, correlativity is not the same as causation. The same factor(s) may result in both disorders. Nevertheless, the observation is at least profound, and beyond that, may be etiologically meaningful.

1. Segraves and Segraves reported on 906 subjects (including 374 men) who had been recruited for a pharmaceutical company study of sexual disorders. Only the men will be discussed in this article. They were described as age 51 (SD = 10.1), and 30% (n = 113) had a primary diagnosis of HSDD. Almost half (47%) had a secondary diagnosis of erectile impairment and a few (n = 3) had retarded ejaculation (patients with premature ejaculation were excluded from the study).

2. Schiavi reviewed 2500 charts of individuals and couples referred between 1974 and 1991. This survey included 1775 men, of which 13.3% (n = 236) were 60 years old or older (range 60 84). Most of the men (66%) were diagnosed with erectile disorder but 28% had HSDD either alone [3% (n = 8)] or affiliated with another sexrelated diagnosis [ED 14% (n = 34); PE 11% (n = 27)]. In some, erectile dysfunction was the cause while in others it was the result. In most it was not possible to determine the primary dysfunction .

3. Together with colleagues, Schiavi also analyzed the psychobiology of a group of sexually healthy men aged 45 74 living in stable sexual relationships. Seventy-seven couples were studied. One of the issues considered was a comparison of men with and without a sexual dysfunction. Seventeen men met their criteria for erectile dysfunction and five for HSDD (22% and 6.5%, respectively, of the total group). They found a significant difference in the age of the HSDD men who did and did not have accompanying erectile dysfunction (70.8 and 58.6 years, respectively). They added that the number of men with HSDD was too small to do any statistical comparisons with men who were not experiencing this disorder. Sexual difficulties in a partner, for example, intercourse-related pain experienced by a woman, may result in profound change in the level of sexual desire in the other person.

About The Author

David Crawford is the CEO and owner of a Male Enhancement Facts company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2009 David Crawford of Male Enhancement Pills This article may be freely distributed if this resource box stays attached.

Sexual Disorder - Biological, Psychological, and Social

Not only are there multiple origins for HSDD in men, but the theoretical view of the observer regarding sexual issues as a whole make understanding sexual problems like HSDD even more difficult.

One might look first at differing points of view about sexuality in general. Some view sexual difficultness from primarily a biomedical position and regard sex as natural. Kolodny et al. wrote: to determine sex as natural means just as an individual cannot be taught to sweat or how to digest food, a man cannot be taught to have an erection, nor can a woman be taught to lubricate vaginally. Because the reflex pathways of sexual functioning are inborn does not mean that they are immune from disruption due to impaired health, cultural conditioning, or interpersonal stress. Some have reworded naturally to mean automatically, without purpose or without effort .

Others look at sexuality and see the absence of intimacy as being crucial to understanding the psychological origins of many sexual difficulties. One can in particular value (and learn from) the implications of the absence of intimacy for sexual relationships generally, and sexual desire in particular, when regarding the plight of those with a serious mental illness who, by the very nature of the disorder, also have significant intimacy difficulties. The roots of intimacy difficulties are in the patient's past . . . this . . . needs to be thoroughly explored because it may well have included turmoil in his or her family-of-origin, as well as a shortage of love and nurturing connections which are so often a rehearsal for love relationships later in life. As well, the patient's past may not have involved the experimental love and sexual relationships of adolescence in which so much learning takes place about oneself and others.

Yet others look at sexual matters from a social constructionist point of veiw. Tiefer wrote that the primary influences on women's sexuality are the norms of the culture, those interiorized by women themselves and those imposed by institutions and enacted by significant others in women's lives.

It may well be that these viewpoints do not apply equally to men and women, and that sexuality in men is, for example, more natural. However, even as the word natural is implemented to men, it does not explain the contribution to sexual problems of either intimacy issues or cultural variations in sexual behavior.

During development and growth, there is interaction with the environment that builds up experience and potentiation of sexual stimuli. The social and cultural environment sets sexual expression and the meaning of sexual experience .

About The Author

David Crawford is the CEO and owner of a Male Enhancement Products company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2009 David Crawford of Male Enhancement Reviews This article may be freely distributed if this resource box stays attached.

Male Hypoactive Sexual Desire Disorder - History

Maurice outlined a brief set of matters that a clinician might cover with the procedure of history-taking to define the pattern of any sexual dysfunction:

Table 1.1 Pattern of a Sexual Dysfunction: What to Ask

1. Duration of difficulty: lifelong or acquired
2. Circumstances in which difficulty appears: generalized or situational
3. Description of difficulty
4. Patient's sex response cycle (desire, erection, ejaculation/orgasm if male; desire, vaginal lubrication, orgasm, absence of coital pain if female)
5. Partner's sex response cycle (see #4)
6. Patient and partner's reaction to presence of difficulty
7. Motivation for treatment (when difficulty not chief complaint)

Sexual desire in men evidences in three ways: (i) psychologically through thoughts, fantasies, and dreams; (ii) behaviorally in sexual activity with a partner; and (iii) behaviorally in sexual activity with oneself through masturbation or self-stimulation. Topics in Table 1.1 form the basis of the following proposed questions that one might ask when faced with a man who says that he is not sexually interested.

1. Has a feeling of low sexual desire always been a part of your life or was there a time when you were more interested?

Comment: This question will facilitate to settle if the desire problem is one that is lifelong or acquired. Talking about the length and the past might also allow the man to reflect on times when, for example, he encountered a similar pattern of initial desire followed by disinterest.

2. What kinds of things are you thinking about when the two of you are sexual with each other? and/or What sort of sexual thoughts or fantasies do you have at other times? and/or About how often are you and she/he sexually involved with each other?

Comment: These questions aid to determine if the problem is situational or generalized. Understandably, many clinicians object to the idea of asking people about fantasies, or what is going on in a patient's mind. Our society treasures privacy and for most people, nothing is more private than their sexual fantasies. This attitude of psychological intrusion challenges a health professional to separate his/her social self from his/her work function. For example, there is simply no doubt that finding out if a man is thinking about other men or about women in an erotic situation is necessary, not elective, in determining his sexual orientation, which may, in turn, facilitate to clarify the cause for his apparent sexual disinterest.

Sexual desire is a feeling which usually (but not always) evidences in sexual behavior. Generalizing from sexual behavior to determine someone's sexual desire (the third question in #2) can be difficult since there are many reasons for someone engaging in sexual activity apart from being sexually interested (the most common being the idea of wanting to please one's partner).

Other questions that are worth asking in this context include: When was the last time that any sexual activity took place? and/or How often has any sexual activity taken place in, say, the last 6 months?

3. Have you had sexual experiences with other women since you have been in this relationship? and Have you ever had sexual experiences with other men? and How frequently do you have sexual thoughts about other women? and other men?

Comment: All four questions might help to clarify whether the desire problem is situational or generalized. For reasons mentioned previously, thoughts can be more informative than actions.

4. Tell me about your masturbation experiences? How often do you masturbate? Do you look at pictures in magazines at the same time (or videos, or on the internet)? What do the pictures show? Women? Men? Couples? What are the people doing?

Comment: Again, these question will aid to define if the desire difficultness is situational or generalized. If, for example, the man is masturbating and thinking about sexual subjects but at the same time not sexually interested in his partner, then the desire difficulty is clearly situational. Questions about the content of pictures tell the clinician about the man's erotic focus, be it individuals belonging to the opposite or same sex, or sexual activities that are not mainstream.

5. Some men have sexual thoughts about women in the summertime when their bodies are not so covered. What's your own experience?

Comment: This question can be yet another way of finding out if the man finds others to be erotically attractive and who the people might be.

About The Author

David Crawford is the CEO and owner of a premature ejaculation supplements company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of causes of male impotence This article may be freely distributed if this resource box stays attached.

Patient Preference, Sexual Scripts, and Pharmaceutical Choice

Male Hypoactive Sexual Desire Disorder - Epidemiology

The best information on the epidemiology of sexual disinterest in men comes from surveys of the average population and convenience samples. In the literature on this subject, little undertake is made to distinguish between the different diagnostic subtypes.

An excellent source of population-based information on sexual disinterest in men arrives from the National Health and Social Life Survey (NHSLS; 15). 78 Maurice Laumann and his colleagues interviewed a probability sample of 3432 adults (including 1410 men) in the US between the ages of 18 and 59. Because the study is so oftentimes cited, it is worth examining the results in some detail.

In a 90 min interview on many sex-related subjects, one of the questions asked was during the last 12 months has there ever been a period of several months or more when you lacked interest in having sex? (No obvious attempt was made to subtype the responses.) Overall, 16% of the men said they were indeed not interested in sex (vs. 33% of the women). When the responses were assembled into 5-year groupings, the highest numbers of those who answered yes were from men who were in two groups: those who were 40 44 and 50 59 years old. These numbers do not quite fit with the standard perception of waning sexual desire with increasing age. The figures seem to suggest a greater degree of complexness. Contrary to expectations, the fewest men who answered yes were in the group of men who were 44 49 years. Looking at the opposite end of the sexually active age spectrum, and again not quite fitting with average beliefs, 14% of the youngest group of men (18 24 years old) also answered positively.

Some social constituents examined in the Laumann et al. study correlated with lack of sexual desire in men. Those who answered affirmatively included 20% of the never married men (vs. 12% of the married); 22% of the men whose education was less than high school (vs. most of the other levels of education where the range was 13 16%); and 20% of black men (vs. 15% of whites). The impact of religion was unclear with no one religious group outstanding. The relationship to poverty was large in that 25% of poor men responded positively (vs. 13 15% of men at other income levels).

In the same survey, health and happiness were also separately connected with sexual disinterest. The greater the impairment of health and the magnitude of unhappiness, the greater the extent of sexual disinterest.

Further analysis of the sexual dysfunction data from the NHSLS survey used multivariate techniques to estimate the relative risk (RR) for each demographic characteristic as well as for essential risk factors. In comparing the oldest group of men to the youngest, the former were three times as potential to have low sexual desire. Similarly, never married men were almost three times as likely to experience lack of sexual desire compared to those who were currently married.

The statistical method of latent class analysis (LCA) was also applied for analyzing risk constituents and quality-of-life concomitants in relation to categories of sexual dysfunction rather than individual symptoms. Risk factors that were found to be predictors of low sexual desire in men involved daily alcohol consumption, poor to fair health, and emotional problems or stress. The same was true of thinking about sex less than once weekly (more than three times as likely vs. those who thought about sex more than once weekly), ever had any same-sex activity (more than twice as likely vs. those that never did), and sexually touched before puberty (about twice as likely vs. those that were not touched).

When looking at quality-of-life concomitants, men with low sexual desire experienced a low level of physical satisfaction and a low level of general happiness, with their primary partner.

Another survey using a stratified probability sample was conducted in Britain and concerned the prevalence of sexual function problems in people who had at least one heterosexual partner in the past year. The study took place from 1999 to 2000 and involved 11,461 men and women aged 16 44. The response rate was 65.4%. Problems were reported according to two duration periods: those which lasted at least 1 month in the past year, and those which lasted at least six months in the past year. Thirty-five percent of men described at least one sexual problem in the past year, and lack of interest in sex was the most common such concern (17%) in the shorter time period. The prevalence dropped to 2% when considering the at least 6-months time frame.

In yet another study involving 100 normal volunteer couples who were well-educated and who considered their marriages as ones that were working, Frank et al. found that a similar (to the US and UK studies) percentage of men (16%) were sexually disinterested. Similarly, when a sample of gay men were asked about sexual concerns, including lack of desire in or desire for sex, 16% said it was a current problem and 49% pointed that it was a problem at some time in their lives.

About The Author

David Crawford is the CEO and owner of a treating impotence company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of how to avoid premature ejaculation This article may be freely distributed if this resource box stays attached.

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Normal Sexual Desire for Men

If one accepts the notion that sexuality generally and sexual desire in particular may be different in men and women, another question quickly follows: when considering sexual desire, what is normal for men? A corollary to this question is: since there is a general understanding that sexual activity changes with age, what represents normal sexual desire for men as they get older?

An exceptional source of information on men and sexuality (including sexual desire) is the Massachusetts Male Aging Study (MMAS), a survey that compound a random sample of men in the general population aged 40 70, and one in which questions were asked about sexual issues from the viewpoint of both behavior and subjective thinking. A total of 1709 men taken part in the study. A self-administered questionnaire included 23 items on such sex-related subjects as: satisfaction; oftenness of activity; frequency of desire; oftenness of thoughts, fantasies, or erotic dreams; frequence of erections and erectile difficultness; orgasm difficultness; genital pain; frequence of ejaculation; and attitudes to sexual changes with age. Studies were divided into two categories: behavioural and subjective phenomena. Only the latter will receive comment here, as sexual desire is a personal phenomenon (which, indeed, might have behavioral consequences but far from always).

Outcomes of the survey pointed a consistent and profound fall with age in feeling desire, in sexual thoughts and dreams, and in the desired level of sexual activity. The fall in sexual interest neither preceded nor followed a similar decline in sexual behavior or events. They appeared to occur together. Since the data were cross-sectional, it was not possible to answer the question about which came first . . . there was no evidence here of a disjunction between the level of sexual activity desired and the level of activity actually reported; it is not the case that as men age they desire at a level that is various from that which they report. Yet, the authors also found that satisfaction did not follow the same path in that . . . men in their sixties reported levels of satisfaction with their sex life and partners at about the same level as younger men in their forties.

The authors of the MMAS considered many factors that might be associated with the decline in sexual interest and found that aging and its social correlates . . . were strongly predictive of minimized involvement with sexual activity . . . (and that) . . . good health was associated with more involvement . . . The authors concluded that the MMAS study, by looking at men in their middle years, goes part way towards filling the gap of up-to-date normative data available to inform clinicians as to the regular levels of activity and interest of normally aging men.

About The Author

David Crawford is the CEO and owner of a organic impotence company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of vigrx plus This article may be freely distributed if this resource box stays attached.

Epidemiology of Sexual Dysfunction

Female Hypoactive Sexual Desire Disorder - Hormonal Treatment

Testosterone

Long-term data for safety and benefit of testosterone therapy in women are lacking, but such data are essential before long-term practice of testosterone can be urged. Likewise, safety data for the utilisation of testosterone in nonestrogen substituted postmenopausal women are lacking and no recommendation for its apply can be made presently. Nor can the supplementation of T to premenopausal women be urged until such time there exist safety and efficaciousness data. Unfortunately, any enduring benefit after short-term treatment, although theoretically potential, is unproven. In addition, supplementing T on a temporary basis only, could have unfavorable results on the couple if an improvement affiliated with T therapy is no longer apparent when it is withdrawn.

If despite the above, T supplementation is contemplated, careful assessment must establish absence of ongoing psychological (interpersonal, intrapersonal, contextual, and societal) and physical factors negatively affecting sexual desire and arousability. On the basis of available data, no specific testosterone regime or dose can yet be recommended. The chosen formulation of testosterone must have pharmacokinetic data pointing that it produces blood levels within the normal premenopausal range. Accomplishing physiological free testosterone levels by transdermal delivery appears to be the best approach.

Contraindications to testosterone therapy include androgenic alopecia, seborrhea, or acne, hirsutism as well as a history of polycystic ovary syndrome, and estrogen depletion. Oral methyl testosterone therapy is contraindicated in women with hyperlipidemia or liver dysfunction. Regular follow up is both clinical inspection of skin and hair for seborrhea, acne, hirsutism, and alopecia and biochemical through monitoring of free/bioavailable testosterone and SHBG, keeping these values within the normal range for premenopausal women. Of note, methyl-T is not included in the regular assays for T. Possibly, the target level for older women should be even lower but this remains obscure. Lipid profile and glucose tolerance are also monitored. The current recommendation is to prescribe only for 12 months owing to lack of extended safety data.

Tibolone

Tibolone is a synthetic steroid with tissue selective estrogenic, progestogenic, and androgenic actions. In practice in Europe for more than 10 years, tibolone offers some relief from vasomotor symptoms, estrogen agonist activity on the vagina and bone, but not on the endometrium. Tibilone was thought not to have estrogen agonist activity on breast tissue; but a recent, albeit nonrandomized but very large study of postmenopausal hormonal therapy showed a similar increase in breast cancer in women receiving tibolone and those receiving various combinations of estrogen and progestins. The typical (presumed beneficial) estrogenic outcomes on lipids are not seen, but it is of note that tibolone does not promote (unwanted) coagulation. Prospective randomized trials comparing tibolone to placebo or to various formulations of estrogen and progestin therapy have been done. Although in most but not all, there was significant improvement in sexual desire in the women receiving tibolone; no study focused on sexually dysfunctional women. Recruitment centered on vasomotor symptoms or bone density. Studies in postmenopausal women with loss of arousability and therefore of sexual interest are needed.


About The Author

David Crawford is the CEO and owner of a orgasm disorders company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of penis pills that work This article may be freely distributed if this resource box stays attached.

Increasing The Insulin Output