Libido

Organic molecules thus far identified, such as those fisted above, appear either to have irreversible antifertifity effects, to be inherently toxic, or to affect libido. It has been demonstrated that sperm count could be depressed in men injected with large doses of androgens. However, questions about the potential utility of androgens as male antifertifity agents are stiU debated. 

CRH (Corticotropin releasing hormone) is expressed in the nucleus paraventricularis of the hypothalamus and drives the stress hormone system by activating synthesis and release of corticotropin at the pituitary and in turn corticosteroid from the adrenal cortex. CRH is also expressed at many other brain locations not involved in neuroendocrine regulation, e.g. the prefrontal cortex and the amygdala. Preclinical studies have shown that CRH also coordinates the behavioral adaptation to stress (e.g. anxiety, loss of appetite, decreased sleepiness, autonomic changes, loss of libido). 

Adverse reactions with finasteride usually are mild and do not require discontinuing use of the drug. Adverse reactions, when they occur, are related to the sexual drive and include impotence, decreased libido, and a decreased volume of ejaculate... 

Miscellaneous—edema changes in libido breast pain, enlargement, and tenderness reduced carbohydrate tolerance venous thromboembolism ... 

Hot flashes, loss of libido, impotence, diarrhea, nausea, vomiting, gynecomastia... 

Changes in steroidal hormone production, conversion, and handling are also prominent features of cirrhosis. These changes can result in decreased libido, gynecomastia (development of breast tissue in men), testicular atrophy, and features of... 

Nonspecific symptoms include anorexia, fatigue, easy bruising and bleeding from minor injuries, decreased libido, and pruritus (particularly with biliary involvement). 

Absence of regular menstrual periods (amenorrhea), impotence, and decreased libido caused by disruption of the gonadotropin secretion. 

Decreased libido, decreased energy, erectile dysfunction, impotence, decreased sperm production, infertility, gynecomastia, and rarely, galactorrhea. 

Lower abdominal pain Back and leg pain Migraine headaches Other headaches Nauses Dizziness Diarrhea Libido Tor f Infection Nosebleeds Seizures Arthritis Yeast infection Changed insulin requirements... 

Possible complaints of infertility, vaginal dryness, decreased libido... 

SSRIs Citalopram 10-30 mg fluoxetine 10-20 mg fluvoxamine 50 mg paroxetine 10-30 sertraline 25-150 mg all agents are given by mouth daily and can be dosed continuously or during the luteal phase only26 Sexual dysfunction (reduced libido, anorgasmia), insomnia sedation, hypersomnia, nausea, diarrhea... 

Androgens are important for general sexual function and libido, but testosterone supplementation is only effective in patients with documented low serum testosterone levels. 

Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for sexual intercourse. The definition is very subjective due to differences in desired or needed rigidity in patients of different ages and in different types of relationships. Patients may refer to their dysfunction as impotence, but the National Institutes of Health Consensus Development Conference recommends that the term erectile dysfunction replace the term impotence due to confusion with other forms of sexual dysfunction and the negative connotation associated with the term impotence.1 Patients may also develop libido or ejaculatory disorders, but these are not considered erectile dysfunction. 

Testosterone also plays a significant albeit complex role in erectile function. Testosterone is responsible for much of a man s libido. With low serum concentrations, libido declines. Additionally, testosterone helps with stabilization of intracavernosal levels of nitric oxide synthase, the enzyme responsible for triggering the nitric oxide cascade. Interestingly, some patients with low or borderline low serum concentrations of testosterone will have normal erectile function, while some with normal levels will have dysfunction. 

The International Index of Erectile Dysfunction (IIED) is the most widely used questionnaire to assess the severity of ED.10 It consists of 15 questions with 5 domains erectile function, libido, orgasmic function, sexual satisfaction, and overall satisfaction. The erectile function domain has a maximum score of 30 with a score of less than 26 indicating some degree of ED. 

Yohimbine is an indole alkaloid produced in the bark of yohimbe trees. It selectively inhibits a2-adrenergic receptors in the brain that are associated with libido and penile erection. Since there is only limited data supporting its efficacy, yohimbine is not a recommended treatment for any form of ED.22 Adverse effects of the drug include nausea, irritability, headaches, anxiety, tachycardia, and hypertension. 

Androgens are important for general sexual function and libido, but testosterone supplementation is only effective in patients with documented low serum testosterone levels. In patients with hypogonadism, testosterone replacement is the initial treatment of choice, as it corrects decreased libido, fatigue, muscle loss, sleep disturbances, and depressed mood. Improvements in ED may occur, but they should not be expected to occur in all patients.23 The initial trial should be for 3 months. At that time, re-evaluation and the addition of another ED therapy is warranted. Routes of administration include oral, intramuscular, topical patches or gel, and a buccal tablet. 

Assess the patient s specific symptoms to determine the type of dysfunction. Does the patient have ED or an ejaculatory or libido disorder ... 

Drug-induced sexual dysfunction Ejaculation disorders Decreased libido, erectile dysfunction, ejaculation disorders... 

Decreased libido If the patient is sexually active, sexual counseling may be helpful... 

If the patient is started on a 5a-reductase inhibitor, monitor the patient for drug-induced decreased libido, erectile dysfunction, or ejaculation disorders. If severe, discontinue the drug. 

Flutamide is an androgen receptor antagonist that achieves peak concentrations approximately 2 to 4 hours after an oral dose. Flutamide is metabolized extensively, with a terminal half-life of about 8 hours. Bicalutamide achieves peak concentrations approximately 6 hours after the dose, with a terminal half-life of 6 to 10 days. Bicalutamide undergoes stereospecihc metabolism, where the S-enantiomer is cleared more rapidly by the liver than the -enantiomer. Nilutamide achieves peak serum concentrations between 1 to 4 hours after an oral dose and has a terminal half-life of 38 to 60 hours. Nilutamide is metabolized extensively, with less than 2% excreted as unchanged drug by the kidney. Side effects common to these agents are hot flashes, gynecomastia, and decreased libido. Flutamide tends to be associated with more diarrhea and requires three-times-daily administration, whereas bicalutamide is dosed once daily. Nilutamide may cause interstitial pneumonia and is associated with the visual disturbance of delayed adaptation to darkness. 

The most common adverse effects reported with LHRH agonist therapy include a disease flare-up during the first week of therapy, hot flashes, erectile impotence, decreased libido, and injection-site reactions.19 The disease flare-up is thought to be caused by initial induction of LH and FSH by the LHRH agonist and manifests clinically as either increased bone pain or increased urinary symptoms.19 This flare reaction usually resolves after 2 weeks and has a similar onset and duration pattern for the depot LHRH products.33,34... 

Tamoxifen 20 mg PO twice a day continuously until progressive disease 10% Thrombocytopenia, anemia, thromboembolism, hot flashes, decreased libido, nausea/ vomiting 1. Protective effect on bone and lipids. 2. Increased risk for endometrial cancer. 

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