So, Dr. Scholz, today we want to talk about libido.
I think a lot of times people get this confused with potency and obviously in
the prostate world there's a lot of talk about function and everything but there is
a psychological standpoint when it comes to libido that isn't talked about often, and I think it's
very much confused. So, can you describe the difference between libido and potency?
Yeah, this comes up a lot because in the prostate world we give medicines that block testosterone
which causes libido to to fly out the window. The—It is confused because the
absence of potency when men can't get an erection obviously that puts a real kibosh on their libido
and and so oftentimes they're thought of sort of as the same thing, but I think
it's important to have precision about the difference between libido and potency because
they're treated differently and they're both important.
Libido, we're talking about the desire for sexual activity or the interest in sexual activity
and and with modern medicines men can get erections with relatively little interest.
In other words, if their testosterone is very low from from treatment, for example, they take
a shot or sometimes even a pill—they can get an erection but they're not really motivated to
participate in sexual activity. So, there's been a lot of talk about how to correct
erectile dysfunction with Viagra and shots and whatnot and it seems that the idea of
restoring libido is talked about less; perhaps because I know some of my patients when their
libido is low don't really miss it that much. I mean that's just life without a libido, and
I remember my old partner in crime Ralph Blum who wrote a book with me
was actually relieved when his libido was low. He had had a I guess a very strong libido and gotten
him into trouble at certain occasions So, anyway I think it's good that we're talking about that
and we're making a clear distinction between the ability to get an erection which we term potency
and the interest in sexual activity which we call libido.
So, you had mentioned a couple things that could cause a loss of libido,
can you discuss maybe the medications or the different things that could cause that?
Yeah so the reason that I got thrown into this field is because the most powerful treatment for
prostate cancer in a medical point of view is to block testosterone;
we call them androgen blockade, testosterone inactivating pharmaceuticals, hormone blockade,
and the testosterone levels in the blood correlate very closely with libido.
Prior to men going through puberty in, you know, the early teens
there's very little interest in the opposite sex. I remember myself when
I was 10 or 11 years old and I had yet to get testosterone being mystified by the older boys
chasing madly after women. Of course, the light bulb went on when I got testosterone myself.
So it's a—the things that block testosterone that we use for prostate cancer are big offenders
and that's no doubt why we're talking about this today, but there are other things too
that can cause low libido, medicines that are used as antidepressants like Paxil or Prozac
Celexa, these sorts of things. There are blood pressure pills, beta blockers they're called,
a category blood pressure pills and and then sedatives like Valium and Xanax, those sort of
things can suppress libido. All those things can be an issue; I think other things to consider is
an uninterested partner. If someone has a libido but their partner's not interest, I think that
tends to quell interest in sexual activity. Another thing, of course,
is when people are under stress, financial stress, or maybe they have health issues that are
problematic. Sexual activity is sort of like the icing on the cake of life and the ability to
desire and pursue that means that usually we're free of terrible overriding concerns. I always
get a laugh in the James Bond movies—which I enjoy very much—where they're dodging the bullets
and then they grab a quick kiss as they're racing down the hallway. I just, it's too implausible for
me that people would have any kind of libido or romantic attraction when their life is endangered,
but those are all things that can get in the way of libido
and the big one of course in my field is low testosterone from hormone blockade.
So how many men who are on hormone therapy do experience this loss?
I mean some people who aren't experienced in this would say a hundred percent. The.
frequency is pervasive and the loss of libido, especially as men get up close to 60 and above, is
almost 100. In other words, there's not even a little libido left. For some of these men,
the sexual activity, getting intimate and all this sort of thing without the sex drive
is they're almost repulsed by it. It's really a struggle; I don't know if it's
their fear of closeness or their or what, but the absence of libido is profound. Saying that,
there are occasional exceptions and people, rare people, especially younger men some of them
are wired differently and lo and behold some men with zero testosterone do still have a libido, and
one mechanism that we use when we know we have to give hormone blockade is sometimes we use a mild
agent called Casodex or bicalutamide and some men, particularly those that are younger, will retain
an interest in sexual activity when they're on just Casodex instead of using things like
Lupron and Zytiga and Xtandi, but the general rule of thumb is if people are embarking upon
hormone blockade, count on the fact they're gonna lose their libido.
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