when you think of a low sex drive in men you almost always think about testosterone but did you know there's something called primary reduced libido or primary low sex drive in men who don't have low testosterone I'm Dr Reena Malek urologist and pelvic surgeon and today I'm going to talk all about what are the risk factors for men who have reduced low libido I mean what kind of man is more likely to develop low sex drive despite having normal hormone levels now remember sexual desire is complex it's basically feeling the urge to want to engage in sexual activities as influenced by three major things the first is your thoughts your fantasies your imagination like how your brain thinks about it your body's physiological responses meaning how your brain and body respond and lastly your mood and your emotional state what do we know about desire well a recent study called the European male aging study looked at Sexual Health in men who were either middle aged all the way to older men from a variety of European countries and they found that fantasizing about sex is pretty common which most of you probably already know but 70 of men are fantasizing about sex at least once a week and in fact over the course of a lifetime that tends to decrease in young men only one percent report never thinking about sex but when does it become a problem right when we're talking about things like hypoactive sexual desire disorder and what essentially that is it's a clinical diagnosis it's a condition where you no longer have sexual fantasies or desire to engage in sexual activities but the key that makes us a condition is that it causes you to stress meaning that it is bothersome and it's causing a problem either for you or within your relationship and essentially this is something that you find out you have because you've ruled out other causes other conditions or other medications you're taking that could be improved or corrected upon before you go ahead and treat the low desire here now as I mentioned earlier low sex drive can come in two varieties one like we're talking about today is primary meaning that there's no other psychological hormonal medical problem that's causing you low libido whereas secondary reduced libido is something that is due to a medical condition most often it's due to things like low testosterone or having abnormal levels of hormones like prolactin or having psychological disorders or taking medications for those disorders but now let's get back to the group we're talking about the men who have no other issues but have a low sex drive and in fact these men when you've looked at their testosterone levels their testosterone is almost double the level of men who have reduced libido secondarily due to low testosterone levels or what we call hypogonadism now in general these men more often have graduated from higher levels of education meaning they've gone on to college or graduate school they also tend to more often have problematic relationships and problem in their relationship with their partner so this could be that their partner has a lower libido their partner May less often achieve orgasm or their partner might have other diseases that make it more difficult for them to engage in sexual activity so this is more common people who've been in longer term relationships in terms of symptoms that they don't relate to their low libido sometimes they are more likely to have what we call somaticized anxiety and what that means is they have physical symptoms like maybe a headache or abdominal pain that are actually a manifestation of anxiety so they have anxiety but they're actually feeling it as a physical complaint now this is more likely to be seen in men with low libido and this may be because they're tending to focus a lot on their body and their possible physical problems so this kind of develops a vicious cycle when they have low sexual desire their anxiety gets worse and then when they have anxiety that makes their sexual desire worse out generally speaking these men are very healthy when you look at their triglycerides and their cardiovascular risk it's actually less than those of men who have secondary low libido from other conditions so despite being healthy they're less likely to engage in sex or sexual activities with their partner by themselves or with people outside of their relationship so generally it's a kind of a Global Effect now interestingly in men with secondary low libido they saw that having higher levels of Education was also correlated but they also had more levels of free-floating anxiety mean that they had anxiety that wasn't really associated with any sort of specific cause or trigger and more often had depressive symptoms but again these people have a correctable condition that needs to be corrected first what can you do if you have low libido stay tuned next week I'm talking about the pharmacologic options for people who don't have low testosterone for improving libido if you are struggling with a low sex drive and you do have a low testosterone level make sure you check out my video on testosterone replacement therapy to learn more and or make an appointment to see me at www.rinamalekmd backslash appointments as always remember to take care of yourself because you are worth it