Patient: ‘m a healthy 27 year old guy, but my libido has plummeted just in the past 7 months. No other relevant changes that could explain why, and I feel totally fine otherwise. Any explanations? And how do I fix this? The timeline corresponded roughly with my breaking up with my girlfriend and also moving to a new city to begin law school. I might attribute the drop in sex drive to stress from my first year of law school, but I’m actually having a great time. I’m working hard, but I feel no more stressed or anxious than usual (I’m generally a pretty relaxed person). Other than this one change, everything else is totally normal. I’m in great shape, I’ve been able to work out and add some muscle, my moods and happiness are not noticeably different than they’ve ever been before, and I have no other complicating health factors that could explain things. No medications or drugs of any sort. I still have a very strong desire to meet women, date them, etc. Hell, now more than ever, since I’m finally single. But my desire has morphed into an almost abstract, Platonic one, without any strong urge for the physical act of sex, at least when I’m there with a woman. My masturbation frequency has gone for 4-6 times a week down to once or twice a week at most, and it often seems like a bit of a chore. My last four sexual encounters during this time period have ended somewhat embarrassingly, as I’ve either been unable to achieve and sustain an erection when I needed to (strangely, it would often occur spontaneously after the initial flurry of activity had died down), or been unable to orgasm. Each time was preceded by pretty major alcohol intake, which is certainly a confounding and possibly aggravating factor. Although these women were all very beautiful, I didn’t know any of them very well, or have any strong connection to them. I felt somewhat detached and removed during each encounter, mostly marveling at my lack of responsiveness and visceral enthusiasm while tangled up with a young, pretty girl. It makes me wonder if my sex drive has just become more psychological and less physical in nature, since I never had this problem with my last steady girlfriend. Anyway, psychological probing aside, I’d mostly just like to fix this so that the next time I’m with a new girl, I’ll be able to perform as usual. I’ve already decided that I need to 1). not masturbate at least a few days before going on a date, and 2). not drink as much alcohol. Any other suggestions? Any diagnoses?
Doctor: There are different causes for low libido. In young males, it is true that stress can significantly lower sex drive. Yo ou may be having a great time and you are probably getting used to stress but still, stress is part of your daily life. I do agree with your plans. For now, avoid those that can possibly lower your libido like alcohol. Having regular exercise may also improve your libido. You can observe this for now but if it will persist for several months, try seeing a doctor so hormonal disturbances (thyroid dysfunction, low testosterone) can also be ruled out. I do hope this helps and take care.