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In addition to identifying the condition, it is recommended that the main causes of HSD be screened during the initial consultation The evaluation should include the measurement of serum total testosterone and prolactin as a minimum and, depending on the additional clinical signs, further endocrinologic testing might be appropriate
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echo color Doppler The psychologic correlates found were: free- oating anxiety, somatic symptoms, obsessive compulsive traits, and depressive symptoms
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Depression and Relationship Con ict Detection
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Identi cation of depression and the presence of relationship con ict should also be part of the initial evaluation Both can be identi ed through the clinical interview; however, in many instances the use of screening tools can be useful and helpful There are several scales that have been developed for depression detection A short and useful tool, developed for the geriatric population, might be of help for the clinician unfamiliar with depression or with restricted time during consultation, and is included in Table 136 [38,39] The briefness of the scale (only ve items) and good psychometric properties make this a useful instrument for the detection of depression among older men Positive answers for depression screening are
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Diagnosis of Hypoactive Sexual Desire
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The diagnosis of HSD is not dif cult if the clinician asks directly about desire or interest for sexual activity Most patients identify with ease a change in their usual pattern, and this is the way in which the condition is identi ed most of the time in clinical practice Sometimes, it is necessary to investigate the indicators of sexual desire, which, although not as direct as the expression of desire, are often good clinical indicators Table 135 shows a list of clinical indicators of sexual desire The question of how much is too little has not been answered with enough precision However, some re-
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13 proper treatment However, when these conditions are not identi ed by the treating physician, the clinical managing of the case cannot be successful
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Table 136 Five-item version of the Geriatric Depression
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Scale [38,39]
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1 2 3 4 Are you basically satis ed with your life Do you often get bored Do you often feel helpless Do you prefer to stay home rather than going out and doing new things 5 Do you feel pretty worthless the way you are now
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Treatment of Hypoactive Sexual Desire
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Treatment of HSD is directed to the putative cause of the condition There are no effective symptomatic treatments for HSD, as there are for erectile dysfunction (ie phosphodiesterase-5 (PDE-5) inhibitors) Bupropion, an antidepressant medication that has an effect in the re-uptake of dopamine and norepinephrine [41], has been studied, and it has shown a modest effect on women with HSD when compared to placebo (using the slow-release form starting 150 mg/day for one week and then 300 mg/day) [42,43] An early report by Crenshaw and co-workers [44] included men and women who were not depressed, but who had some form of psychosexual dysfunction (inhibited sexual desire, inhibited sexual excitement or inhibited orgasm), and indicated some positive effect on patient s rated libido and global improvement, which was statistically signi cant compared to placebo; unfortunately, it is not clear from the report how many men responded The response rates, though statistically signi cant when compared with placebo in all these studies, is low compared with the ef cacy of PDE-5 treatment for erectile dysfunction; therefore the clinical use of this alternative is limited Testosterone replacement can be of bene t if the patient has hypogonadism [45] In any event, testosterone replacement therapy should be established with the criteria outlined in the chapter Hormones, Metabolism, Aging and Men s Health of this book Likewise, cases of hyperprolactinemia should be further studied and treated; the same chapter in this book offers guidelines for this treatment If depression is identi ed, then appropriate treatment for it should be established A number of antidepressant medications exist, with demonstrated ef cacy and safety Likewise, if a con ict in the relationship is encountered, proper treatment should be established As mentioned earlier, antidepressant therapy can in its turn decrease sexual desire [29] This is sometimes a clinical situation that requires
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