A lot of men assume that low testosterone is to blame for most libido issues, but the truth is often more complicated than that.
“There are many factors that can influence sex drive apart from a hormone deficiency,” says T. Mike Hsieh, M.D., an associate professor of urology at the University of California, San Diego who specializes in sexual dysfunction. These reasons can range from mental health disorders to medication side effects, he says.
Even if you’re completely healthy, it’s natural for your libido or erectile function to dip now and then, Hsieh says.
Companies that make ED drugs or libido supplements, however, like to promote the idea that every guy should be walking around with the sex drive (and pipe-hard boner) of a 16-year-old, but that’s unrealistic. In a lot of ways, it’s helpful to think of your sex drive the same way you think about your mood. Sometimes it’s up and sometimes it’s down, and these sorts of fluctuations are normal.
“If it’s only been a few days or a week and you’re also burned out or stressed, you might want to give it a little more time before seeing someone about your [libido] concerns,” says Ian Kerner, PhD, a licensed psychotherapist and author of Sex Recharge.
So when should you see a doctor about your sex drive concerns? These guidelines could help you decide.
If You’re Experiencing These Symptoms
While many libido issues have nothing to do with a man’s testosterone levels, there are clusters of symptoms that doctors look for if they suspect hormone issues or imbalances, Hsieh says. “We have a validated questionnaire—the ADAM questionnaire—that we use if we suspect hormone deficiencies,” he says.
ADAM stands for “androgen deficiency in the aging male.” And if you answer yes to two or more of the questionnaire’s criteria, Hsieh says, that may be an indication that a hormone deficiency is to blame.
Here are those criteria:
It’s important to note that many of these symptoms are “non-specific,” meaning they’re caused by a range of health conditions—including mental health disorders like depression, Hsieh says. Some researchers have also argued that the yes/no nature of the ADAM questionnaire lacks nuance and precision.
Still, if you answer yes to two or more of these questions, it may be time to talk with a doctor or therapist, Hsieh says.
If Your Sex Drive Drops Suddenly
There is no such thing as a “normal” sex drive, Hsieh says. “Some men seem to need sex or sexual release every day, while others aren’t bothered by a lot less,” he explains. But whatever your baseline, if your libido falls abruptly and doesn’t recover within a couple weeks, let your doctor know, Hsieh says. “If you have an acute drop-off in how you normally feel, that’s not normal,” he adds.
If You’re Considering Popping Pills
A lot of men are quick to throw OTC pills or supplements at their libido issues. “They assume that, because it’s over-the-counter, these things are safe,” Hsieh says. The U.S. consumer supplement market, however, is largely unregulated, he explains. If you’re shopping for testosterone supplements online, you could end up in a world of trouble.
“We see patients coming into the hospital, including young men, with liver failure as a result of taking these supplements,” Hsieh says. A testosterone supplement could also cause your body to stop making that hormone naturally, which can lower your sperm production, Hsieh says. Another common side-effect of OTC hormone supplements is elevated red blood cell counts, which can lead to clots and bleeding problems, he says.
“If you don’t feel normal, talk to a health care professional rather than turning to Dr. Google or over-the-counter supplements,” he adds.
If Your Issue Is Messing with Your Life
In many cases, there are no strict criteria that separate a run-of-the-mill libido lull from a more serious problem. Also, many libido issues are very specific or dependent on context.
“I see patients who say they have no problems when they watch porn, but they can’t do it with their partner,” Hsieh says. “I also have guys who say things like, I can only have sex for an hour, but I want to have sex for two hours like I see in porn.”
While these concerns can be distressing, they have little to do with your physical health or hormone levels. A safe rule of thumb: If you find yourself becoming preoccupied with your struggles, or if your issue is messing with your relationship or ability to date, it’s time to see someone, Kerner says.
“If it feels like you’re in an extended period of low libido or it’s distressing you, I would recommend seeing a psychotherapist—preferably one who specializes in sexuality, like a sex therapist,” he says.
Many M.D.s don’t have the specialized training—let alone the time—to talk through all the different psychological and lifestyle variables that may be affecting your sex drive, he says. A therapist may be better equipped to work through all that with you, he adds.
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