What is Male Hypoactive Sexual Desire Disorder?
Male hypoactive sexual desire disorder (MHSDD) is characterized by a lack of interest in sexual activities and the absence of thoughts or fantasies about sex. The condition differs from simple, typical low sex drive in that the symptoms of MHSDD cause distress in the person experiencing it.
Until 2013, hypoactive sexual desire disorder was described by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as gender-nonspecific, meaning it could be diagnosed in women or men. However, the latest edition of the DSM has been changed to include MHSDD as a male-only diagnosis and a separate disorder, female sexual interest/arousal disorder (FSIAD), to describe similar symptoms in women.
Symptoms of MHSDD
Common signs of MHSDD include:
- Little or no desire for sexual activity
- Absence of sexual thoughts or fantasies
- Failure to initiate sexual activity or respond to initiation from a partner
- Failure to orgasm or premature orgasm during sexual activity
- Distress or relationship problems caused by lack of interest in sex
Types of MHSDD
MHSDD is categorized into subtypes depending on the way that symptoms manifest. The subtypes include:
- Lifelong/generalized. In this type, the man has never been interested in sexual activity, either with a partner or alone.
- Acquired/generalized. In this type, the man has had sexual desire for his partner in the past but no longer has an interest in sex with any partner or alone.
- Acquired/situational. In this type, the man has previously had a sexual interest in his partner but no longer does. However, he is interested in sex with a different partner or alone.
What Causes Male Hypoactive Sexual Desire Disorder?
The cause of MHSDD is unknown, but different factors likely trigger it in varying cases. Scientists believe that physical, medical, and psychological factors may all play a role in producing the disorder’s decreased sex drive. Possible risk factors include:
- Low levels of the hormones testosterone or estrogen
- High levels of the hormone prolactin
- Reaction to SSRI antidepressant medications or blood pressure medicines
- Neurological disorders such as multiple sclerosis
- Mental health-related issues such as depression or anxiety
- Inflammatory bowel disease
- Heart disease
- Kidney disease
- Alcohol use
- History of abuse, sexual assault, or other trauma
- Relationship difficulties
- Low self-esteem or body-image issues
Is Male Hypoactive Sexual Desire Disorder Hereditary?
Scientists have not yet discovered any definitive evidence that genes determine the strength of a person’s sex drive. However, some scientists believe that specific genes influence behaviors such as risk-taking and attention and that these genes may also play a role in determining a person’s sexual behavior. However, this research is preliminary, and any genetic component of MHSDD that may be discovered is likely only one of many factors that work together to produce the disorder.
How Is Male Hypoactive Sexual Desire Disorder Detected?
Changes in a man’s sexual desire or behavior may be warning signs of MHSDD. Possible early symptoms of the disorder include:
- Decrease in sex drive from previous levels
- Failure to be aroused by sexual stimulation, including visual stimulation
- Lack of spontaneous desire or the desire to initiate sex
- Loss of interest in masturbation
- Loss of erectile or ejaculatory function
How Is Male Hypoactive Sexual Desire Disorder Diagnosed?
Diagnosis of MHSDD begins by ruling out medical problems that may be causing symptoms. After these exams, if the doctor suspects that MHSDD is the cause of the symptoms, they may recommend a psychological or psychiatric assessment.
Diagnostic steps may include:
- A physical exam. This exam aims at ruling out physical conditions that could be causing the symptoms.
- Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.
After medical causes are ruled out, medical professionals can consider whether the patient meets the diagnostic criteria for MHSDD. These criteria include:
- The patient has little or no desire for sexual activity, sexual thoughts, or sexual fantasies.
- The symptoms have been present 75%-100% of the time for at least six months.
- The symptoms cause significant distress or interpersonal difficulties.
- Symptoms aren’t caused by substance use or a medical condition.
- Other mental conditions do not better explain the symptoms.
It is important to note that low sex drive alone is insufficient to diagnose MHSDD. Doctors will consider the diagnosis only if the symptoms cause distress.
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How Is Male Hypoactive Sexual Desire Disorder Treated?
Treatment of MHSDD varies depending on the underlying condition that seems to be causing it. Potential treatment options include:
- Hormone replacement therapy
- Changes in dosage of antidepressants or other medications that may be causing MHSDD symptoms
- Lifestyle changes (exercise, diet, etc.)
- Cognitive-behavioral therapy (CBT)
- Relationship skills and communication training
- Mindfulness techniques
How Does Male Hypoactive Sexual Desire Disorder Progress?
Untreated MHSDD can cause long-term complications, including:
- Depression or other mental health-related issues
- Loss of healthy interpersonal relationships
- Low self-esteem
How Is Male Hypoactive Sexual Desire Disorder Prevented?
There is no known way to prevent MHSDD. However, prompt treatment may relieve the effects of the disorder and make it less likely that the sufferer will experience severe complications over time.
Male Hypoactive Sexual Desire Disorder Caregiver Tips
Many people with MHSDD also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with MHSDD:
Male Hypoactive Sexual Desire Disorder Brain Science
Scientists don’t yet fully understand what types of brain activity control sexual desire and arousal. But, in general, researchers believe that low sex drive results from lower than usual activity in brain areas that produce excitement, higher than normal activity in the regions that produce inhibition, or a combination of the two.
The chemical mechanisms behind this activity are quite complex. Certain chemicals (neurotransmitters and hormones) trigger the production of other brain chemicals that, in turn, influence behavior. These secondary chemicals include those that cause excitement or arousal (dopamine, oxytocin, norepinephrine, etc.) and those that inhibit excitement (serotonin, opioids, etc.). When the chemical balance leans toward the inhibitory chemicals and away from the excitatory chemicals, a low sex drive may result.
Male Hypoactive Sexual Desire Disorder Research
Title: Hypoactive Sexual Desire Disorder in Males (HSDD)
Principal investigator: Mohit Khera, MD, MBA, MPH
Baylor College of Medicine
The purpose of this study is to determine if the study drug will increase sexual desire in men with HSDD. Half of the participants will take ADDYI, while the other half will receive a placebo (a look-alike pill with no medicine).
This pilot randomized placebo-controlled study will include 60 men (30 treatment and 30 placebo). ARM 1 will take flibanserin 100mg orally every night, and ARM 2 will take a placebo orally every night.
There will be four study visits, and the study duration is approximately four months. Participants will have physicals at each visit. Blood draws for tests will be done at three visits, and up to 4 questionnaires will be completed at each visit. The study drug will be randomized.
Title: Ginkgo Biloba: Antidepressant-Induced Sexual Dysfunction
Principal investigator: Cindy Meston, PhD
University of Texas
Virtually all antidepressant medications are associated with a high incidence of adverse sexual side effects. In women, the side effects most commonly reported include decreased sexual arousal with decreased lubrication, delayed or inhibited orgasm, and decreased sexual desire. To date, there are no effective pharmacological antidotes for treating these sexual side effects. Ginkgo biloba extract (GBE), a naturally occurring substance from the ancient Chinese Ginkgo tree, has properties proven to increase peripheral blood flow and facilitate the relaxation of smooth muscle tissue. Its effectiveness in this regard has been demonstrated in numerous clinical trials that show ginkgo Biloba to be highly efficient in treating peripheral vascular disorders. Female sexual arousal involves a complex interplay of these same actions – the relaxation of smooth muscle tissue and the inflow of blood to the genital region. Hence, pharmacologically, it is feasible that GBE may effectively enhance female sexual arousal.
Moreover, given that the mechanisms hypothesized to facilitate female sexual function are operative at a peripheral rather than a central (i.e., neurotransmitter) level, it is unlikely that GBE would adversely impact the mood-alleviating therapeutic effects of antidepressant medications that are believed to be centrally mediated. Limited, uncontrolled studies lend support to this hypothesis. The purpose of the present study is to provide the first empirical examination of the effects of both acute and chronic GBE on subjective and physiological measures of sexual function in women who are experiencing clinically diagnosable hypoactive sexual desire disorder, female sexual arousal disorder, and/or inhibited female orgasm secondary to either to fluoxetine, sertraline, or paroxetine use. Women (N = 110) stabilized on antidepressant medication and free of a current Axis I disorder will be randomized to 8 weeks of daily treatment with either GBE (200 mg) or placebo. Sexual functioning will be assessed through (a) daily patient diary recordings, (b) patient-rating scales completed each week, and (c) blind independent evaluator ratings. The acute effects of GBE will also be assessed using vaginal photoplethysmograph techniques to assess genital blood flow, both before and following chronic GBE treatment. The findings from the present study will (a) help determine whether chronic and/or acute GBE facilitates sexual function in women with antidepressant-induced sexual dysfunction and (b) examine whether acute GBE influences vaginal measures of sexual arousal. If effective, GBE could play a significant adjunctive role in treating clinical depression and other psychological disorders commonly treated with antidepressant medications.
Title: Testosterone Treatment for Erectile Dysfunction and Multiple Sclerosis
Stage: Not Yet Recruiting
Principal investigator: Omar A. Raheem, MD
LSU Health Multispeciality Clinics
New Orleans, LA
The purpose of the study is to determine the effects of testosterone treatment on erectile function, fatigue, depression, cognitive function, quality of life, urinary incontinence, pain, and damage to neurons in male Multiple Sclerosis patients with low testosterone, using questionnaires, blood samples and a rectal exam in volunteers 55 years and older.
Volunteers will be treated weekly with Xyosted 75 mg (given subcutaneously) for three months, during which they will have 3 study visits, six weeks apart. The Baseline visit will include providing a blood sample, completing questionnaires, receiving training on the Xyosted auto-injector, and undergoing a rectal exam for participants 55 years and older. Visits 2 and 3 will also include collecting a blood sample and completing questionnaires. At Visit 3, the rectal exam for those age 55 years and older will be repeated.