What are the treatment options for low libido?

Treatment Options for Low Libido

Treatment for low libido should be gender-specific, with testosterone therapy recommended for men with low testosterone levels and a combination of hormonal and non-hormonal approaches for women, including consideration of flibanserin for premenopausal women with hypoactive sexual desire disorder. 1, 2, 3

Gender-Specific Approaches

For Men:

1. Hormonal Treatment

   • Measure morning serum total testosterone levels (preferably free or bioavailable testosterone)
   • Consider testosterone replacement therapy if:
     • Total morning testosterone <300 ng/dL on at least two separate measurements
     • Patient has symptoms of hypogonadism
     • No contraindications exist (e.g., prostate cancer, breast cancer) 1, 2
   • Target testosterone levels in mid-normal range (350-600 ng/dL)
   • Options include testosterone gel (1.62%), patches, injections, or pellets 2

2. Non-Hormonal Approaches

   • PDE5 inhibitors may improve both erectile function and libido 1, 2
   • Lifestyle modifications: increased physical activity, smoking cessation, weight loss if obese, reduction of alcohol consumption 1, 2
   • Pelvic physical therapy 1
   • Psychological evaluation and therapy for underlying issues 1, 4

For Women:

1. Pharmacological Options

   • Flibanserin (FDA-approved for premenopausal women with hypoactive sexual desire disorder)
     • Dosage: One tablet at bedtime only
     • Important precautions: Avoid alcohol (risk of severe hypotension and syncope)
     • Side effects include dizziness, somnolence, nausea, and fatigue 1, 3
   • Androgens may be considered in selected cases, though evidence is limited 1, 5

2. Non-Pharmacological Approaches

   • Psychosexual therapy (50-80% success rate) 2
   • Lifestyle modifications: exercise, mindfulness, yoga 6
   • For women with vaginal dryness/discomfort: vaginal moisturizers, lubricants, topical vitamin D or E 1
   • Vibrator or clitoral stimulatory device with referral to appropriate specialist 1

Addressing Underlying Factors

Medical Conditions

• Evaluate and treat depression and anxiety (often co-occurring with low libido) 7
• Manage chronic diseases that may affect sexual function (diabetes, cardiovascular disease) 2
• Review medications that may reduce libido (e.g., certain antidepressants, antihypertensives)

Relationship Factors

• Partner-specific problems should be addressed 5
• Communication issues and relationship conflicts may require couples therapy 2, 5

Special Considerations

Cancer Survivors

• Treatment approaches must be tailored for cancer survivors, particularly those with hormone-sensitive cancers
• Testosterone therapy is contraindicated in men with known or suspected prostate cancer 1, 2
• Flibanserin is not contraindicated in breast cancer patients, though data in this population are limited 1

Monitoring

• Regular follow-up to assess treatment efficacy and side effects
• For testosterone therapy: monitor testosterone levels, lipid panel, blood pressure, and glucose/HbA1c 2
• For flibanserin: monitor for hypotension, syncope, and CNS depression 3

Common Pitfalls to Avoid

• Failing to screen for underlying medical conditions or medication side effects
• Not addressing psychological and relationship factors
• Using testosterone in men with prostate cancer or attempting to conceive
• Prescribing flibanserin without proper counseling about alcohol restrictions
• Neglecting to follow up on treatment efficacy and side effects

The management of low libido requires a comprehensive approach that addresses biological, psychological, and relationship factors, with treatment tailored to the individual's specific needs and circumstances.