Differential Diagnosis for Loss of Libido
- Single Most Likely Diagnosis
- Chronic Marijuana Use: The patient's daily use of marijuana is a significant contributor to his loss of libido. Marijuana's active ingredient, THC, can affect hormone levels and neurotransmitters that regulate sexual function, leading to decreased libido.
- Other Likely Diagnoses
- Alcohol Use: Although the patient only drinks wine 2 times a week, chronic alcohol use can still impact libido by affecting hormone levels, particularly testosterone, and altering brain chemistry.
- Smoking: Occasional smoking can also contribute to decreased libido due to its negative effects on cardiovascular health and hormone regulation.
- Psychological Factors: Stress, anxiety, or depression, which are not mentioned but could be underlying issues, often contribute to loss of libido.
- Do Not Miss Diagnoses
- Hypogonadism: Despite the patient's normal testosterone levels, it's essential to consider hypogonadism, as it can cause loss of libido. Further evaluation might be necessary to rule out this condition.
- Pituitary or Testicular Disorders: Disorders affecting the pituitary gland or testes can lead to hormonal imbalances that cause loss of libido.
- Medication Side Effects: Certain medications, not mentioned in the scenario, can significantly impact libido. It's crucial to inquire about any prescription or over-the-counter medications the patient might be taking.
- Rare Diagnoses
- Hyperprolactinemia: A condition characterized by elevated prolactin levels, which can suppress testosterone production and lead to loss of libido.
- Chronic Illness: Certain chronic illnesses, such as diabetes, can cause loss of libido due to their effects on blood flow, nerve damage, and hormonal changes.
- Sleep Apnea: Untreated sleep apnea can lead to decreased libido due to the lack of quality sleep and potential hormonal imbalances.