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Urology/libido problem


QUESTION: How does a mans libido vary from one person to another in terms of frequency and fluctuation? Mine is low or non existent much of the time and only gets high say once a week. Is this considered within the normal variation? and is there a way to make it high instead of low most of the time?

What could explain this low libido? If its so low most of the time, why does it eventually become high even if infrequently?

Does this mean it takes a long time for the testosterone to build up? and so could it indicate that the hormones are not being produced quickly enough, or is that not the way it works?

some have suggested that decreasing the prolactin through the use of cabergoline can in fact increase ones libido. This is not the usual purpose of the drug but is it a possibility?


While most people have a more or less stable libido, there are obviously times when emotions run high.  There is no set limit or definition related to frequency or fluctuations.  To have a low libido most of the time would not be considered normal in a younger man but might be perfectly acceptable in an elderly one.

Changes in libido such as you describe are not likely to be from testosterone fluctuations or build up.  That's now how it works.  It's more of an average rather than instantaneous response.

Decreasing prolactin can increase testosterone and often libido, but only in patients where the prolactin level is abnormally high which suppresses testosterone.  If your testosterone and prolactin levels are normal, this medication would not be likely to help libido.

Most common cause for intermittent but significant changes in libido would be psychological.

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QUESTION: you said to me before that it is impossible to prove that there are psychological causes. That was what you said in relation to my testicular pain. Why is it different for libido? where is the evidence which links the two?

you also say that there are times when emotions run high. Yet you say it is an average rather than instantaneous response. I dont see how these two statements can be consistent?

Testosterone is often thought to be involved in libido, yet how does that explain why women have just as much libido as men given their bodys much lower levels of the hormone?
How does that explain how a man can have low libido even with normal T levels?

Previously you were sceptical about the effectiveness of maca for libido because there are no proper studies on it.
But this is not really the issue. The issue is that urologists do not know the physiology of libido. There is no objective definition. This for example, leads to some urologists mistakenly prescribing viagra to a person with low libido. How can there be any studies on the effectiveness of any substance for libido when there is no way to measure it? the study would be highly subjective anyway.

Is the subject of libido within the scope of a urologists knowledge and training? Is it considered an important topic? I get the impression that since it is not life threatening, loss of libido is not considered very much.


Depression is a well known and established mental health disorder which is known to cause loss of libido as one of the symptoms.

Having a high or low testosterone level does not have instantaneous or immediate effect.  If your level is suddenly increased from low to normal due to additional testosterone supplementation, it can take months to see any change.  That's what I meant by an average response.  Regarding emotional response, such immediate changes to drive or libido are due to other psychological and emotional factors other than testosterone level.

There are many differences between men and women, but it has been shown that although women have much lower levels of testosterone than men, changes in these low levels can affect libido in women as well.  

There are plenty of definitions of libido and explanations.  Check out the following website for more info:

Urologists are primarily surgeons so we only get involved peripherally in the evaluation and treatment of decreased libido.  Typically, we can evaluate decreased testosterone, but we then usually refer patients to endocrinology, primary care, sex therapists or mental health professionals for further treatment.

You are correct that there is no way to measure libido and this certainly interferes with diagnosis and treatment.  Viagra can be effective if the decreased sexual desire is a result of ED which is effectively treated with the drug.


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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