Testosterone Deficiency Syndrome and Hypoactive sexual desire disorder
Testosterone deficiency syndrome
Testosterone deficiency syndrome (TDS) is a clinical and biochemical syndrome associated with age characterized by suggestive symptoms of testosterone deficiency and a decrease in serum testosterone levels.
In most cases the reason for urology/andrology consultation is erectile dysfunction or loss of libido. But beyond these symptoms, the testosterone deficit is associated with series of conditions that negatively affect men’s health.
Plasma levels of testosterone and those of their transporting proteins present important changes which occur with aging. Thus, while levels of total testosterone and albumin have a tendency to decrease, the levels of SHBG (sex hormone-binding globulin) increases; therefore, there will be more plasma testosterone that will bind to SHBG, with the consequent decrease in the fraction of free and bioavailable testosterone. For all this, the levels of free and bioavailable testosterone decrease with age to a much greater extent than those of total testosterone. It has been observed in population studies that at 80, men present only 50% of testosterone levels observed in healthy men in their twenties.
The decline in serum testosterone levels will produce a decreased sexual activity and mood disturbances, as well as a decrease in bone mineral density and changes in body composition.
The goal of testosterone replacement therapy is to restore physiological concentrations of testosterone. The method of testosterone replacement therapy depends on availability, safety, effectiveness, potential side effects and preference (patient and physician). Currently, we have several treatment options available as injections or transdermal gels.
Hypoactive sexual desire disorder
Hypoactive sexual desire disorder (HSDD) or low sexual desire is the persistent absence of thoughts, erotic fantasies and a lack or absence of sexual fantasies or desire for sexual activity.
Often the person with HSDD avoids any kind of sexual contact.
The person does not start (spontaneous desire) or does not respond to the partner (receptive desire).
Lack of desire leads to alterations in sex as a couple, although sometimes it is the cause and in other cases the consequence.
This lack of interest can occur in any area of sexuality in general (generalized HSDD) or towards the partner in a specific way (situational HSDD).
The decrease in desire may be secondary to erectile dysfunction or other sexual disorders.
Low libido is multifactorial (organic, psychological and/or external factors).
Psychological treatment
The objective is to regain the motivation to have sex and the erotic fantasies.
- Psychoeducation and realistic thoughts: “men are not always in the mood for sex”
- Discovering and favoring the inducers of desire.
- Performing techniques of physical-emotional reconnection with the partner (sensory focus).
- Incorporating ideas to enhance desire such as sex games and/or erotic toys to diversify, innovate and enrich eroticism.
- Trying other erotic activities without penetration; the couple is trained to diversify in sexual practices.
It is advisable to establish a more or less stable sexual rhythm to create a habit, make time for intimacy, scheduling intimate (sex) meetings. The tomorrow-sex rarely comes.
