Age-Related Hypogonadal Syndrome - Psychotherapy

O'Carroll reviewed the psychological and medical literature from 1970 to 1989, searching for controlled treatment studies of HSDD. He discovered eight such studies, two of which regarded only men. (Of the other six, two included both men and women as the identified patient and four concerned women as the patients together with their partners). His commentary was critical and contemplated essential discouragement in that he found no controlled studies with a homogeneous sample in which psychotherapy was the keystone of treatment and none which involved both drug/hormone treatment and psychotherapy.

Yet, some of what does exist in the literature on the psychotherapy of HSDD in men will be reviewed. Heiman et al. considered studies on the treatment of sexual desire disorders in couples. None of the studies involved only men; most related to the treatment of HSDD in women only, or involved reports that referred to both men and women as the identified patient. Of the three studies that involved men with sexual desire difficultness, only one involved information concerning diagnostic subtyping. The latter investigation reported on a 3-month follow-up of 152 couples in which at least one person had a desire difficulty as part of the delivering complaint. Fifty-eight (58%) of the men had a diagnosis of low sexual desire. Seventeen percent were lifelong and 40% were global. Numbers of patients were not given in the report. In comparing couples in which either the man or the woman showed with a desire difficultness, the authors concluded that initially there was a lower rate of sexual activity when the man was the identified patient, that men tended to initiate sexual activity more often, and that men were more likely to have a situational and produced form of desire difficulty. With a behavioural form of treatment, the authors found at follow-up that significant treatment gains had been made and maintained. In addition, they also claimed that the lifetime/acquired and global/situational differentiation did not predict therapeutic result. This latter statement failed to distinguish between couples in which the man or the woman was the identified patient, unfortunate because it is quite conceivable that the distinction has more meaning for one gender than the other.

The review by Heiman et al. described another study involving a 3-year follow-up of 38 couples treated for sexual dysfunction. The group included six men identified as having HSDD with or without another sexual dysfunction diagnosis. Thirty-three percent of all the men had a notable health problem (it was unclear how many of the six men with HSDD were in this group). In spite of the fact that a diagnostic subtyping system was adopted, it was inexplicably not involved in the report. A behavioural form of treatment was utilized and the outcomes were reported on an individual basis for men and women. The authors concluded that the diagnostically relevant items (that were measured), that is, desire for sexual contact and oftenness of sexual contact, clearly establish a lack of supported success for both men and women.

The Heiman et al. report also included a study by McCarthy of (i) 20 couples in which the outcomes for the men and women were not separately stated and (ii) eight men without partners of whom many reported advance but the original problems were rather unclear (the example of HSDD given in the report was evidently a result of another sexual dysfunction).

O'Donohue et al. surveyed the sex-related literature on the psychological treatment of male sexual dysfunctions. They explicitly omitted studies that relied only on medical treatment. In a clear statement concerning the treatment of sexual desire problems, the authors concluded that no controlled treatment-outcome studies were found for the treatment of . . . sexual aversion disorder and hypoactive sexual desire disorder . . . in men.

Several studies in the O'Donohue review had a mixture of diagnoses and some included men with HSDD. In one such group the outcomes were not reported separately for men and women. Another looked at 40 couples in which the men had erectile dysfunction and/or loss of sexual interest, and compared the potency of three treatments: weekly couple counseling, monthly couple counseling, and T. Subjects were broken into two groups, with high or low levels of sexual interest. Each group was randomly allocated to (i) testosterone or placebo therapy and (ii) weekly or monthly counseling. Results showed no statistically large group deviations in initial clinical ratings and essential relapse between the first and second follow-up in the erections ratings and sexual interest ratings. In addition the oftenness of sexual thoughts at the second follow-up were (statistically) significantly higher in the placebo group.

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Sexual Dysfunction - Partner Issues