That libido/hormone thing again

The New York Times
http://www.nytimes.com/2007/04/10/he...th&oref=slogin

April 10, 2007
Personal Health
A Lively Libido Isn't Reserved for the Young
By JANE E. BRODY

Here's a new word for you: obsolagnium. You may not find it in an
ordinary dictionary. But if you are over 50, you may well be familiar
with the concept, because it means "waning sexual desire resulting
from age."

In fact, it is rarely age per se that accounts for declines in libido
among those in the second half-century of life. Rather, it can be any
of a dozen or more factors more common in older people that account
for the changes. Many of these factors are subject to modification
that can restore, if not the sexual energy of youth, at least the
desire to seek and the ability to enjoy sex.

Nor is it just hormones. Addressing only the distaff half of the
population, the Boston Women's Health Book Collective, in its newest
work, "Our Bodies, Ourselves: Menopause," points out: "Our sexual
desire and satisfaction may be influenced by our life circumstances,
including the quality of our sexual relationships, our emotional and
physical health, and our values and thoughts about sexuality, as well
as by the aging process and the shifting hormone levels that occur
during the menopause transition."

The same, of course, is true of men. Difficult life circumstances can
do much to dampen anyone's libido. Stress at work or home, looming
bankruptcy, impending divorce, serious illness, depression, a history
of sexual abuse and a host of medications are among the many things
that can put a big crimp in your desire for sex at any age.

Feel Attractive, Be Attractive

As people age, both physical and emotional changes occur that can
influence libido. Wrinkles, hair loss, declining muscle mass and
accumulation of body fat, among other age-related changes, can make
men and women feel less attractive. And if you don't see yourself as
attractive, your brain may respond by dampening any impulse you might
have to be intimate with someone.

I have no studies to corroborate this idea, but I strongly suspect
that older people who stay in shape physically, keep their brains
stimulated and remain interested in a variety of activities are likely
to feel more attractive and be more attractive - and thus more
libidinous - than those who let themselves go to pot, as it were. I'm
not suggesting that people in their 60s and 70s start dressing and
acting like 20-somethings, but there are any number of age-appropriate
actions that can help people see themselves - and help others see them
- as sexually desirable beings.

Of course, illness, both mental and physical, can seriously disrupt a
healthy libido at any age. Diseases of the adrenal, pituitary or
thyroid glands can diminish sexual desire, as can depression and
anxiety. Likewise, several common cancers - especially cancers of the
breast, testes or prostate or the drugs used to treat them - may
suppress the desire for sex.

Many commonly administered medications can interfere with sexual
desire, performance or both. Among the most frequent offenders are
antidepressants and antianxiety drugs, blood pressure medications and
opioid pain relievers. High doses of alcohol likewise blunt desire as
well as performance. Even drugs taken to curb heartburn can curb the
desire for sex. In some instances, changing the dose, switching to a
different drug or taking a brief drug holiday (say, for the weekend)
can boost libido.

A Change of Scene

While a drug like Viagra may help a man temporarily overcome disease-
or medication-induced erectile dysfunction, it does nothing to
increase desire, which is essential for these potency-enhancing drugs
to work.

Knowing how to please each other sustains sexual interest for many
long-established couples. But for others, familiarity can breed
boredom; they lose interest in doing the same old thing the same old
way time after time.

Novelty is a well-established sexual stimulant. An unattached man or
woman in midlife or beyond who had all but forgotten about sex meets
someone new and attractive, and suddenly the flames of sex are
reignited. This can happen, too, to very old people. Stories abound in
assisted living and nursing home facilities of elderly widows and
widowers whose long-dormant sexuality is reawakened by attraction to a
new, albeit equally old, partner.

Of course, changing partners is not a realistic option for those in a
long-standing monogamous relationship in which sexual intimacy is just
a fond memory.

But there are ways for such couples to introduce novelty - ranging
from a change of venue or techniques to an exchange of fantasies or
even the introduction of sex toys - that may rekindle sexual feelings.

Even young couples can find their interest in sex diminished by a fear
of interruption or being overheard by children or an elderly parent.
It can take some effort - and perhaps a lock on the bedroom door and
background music - to reduce the risk of distractions that blunt the
flame of desire.

Women may think that the decline in estrogen at menopause is
responsible for their loss of interest in sex. But estrogen loss is
only an indirect factor; it can result in vaginal tightness and
dryness that renders intercourse painful rather than pleasurable. The
use of lubricants and a dildo or more frequent sex can often
counteract these effects. But for some women, the use of a vaginal
estrogen cream or suppository is necessary to make sex comfortable and
more desirable.

The Testosterone Factor

But the real libido hormone, for both men and women, is testosterone,
which women produce in their ovaries and adrenal glands. As other
ovarian hormone levels drop after menopause or surgical removal of the
ovaries, so does the amount of desire-boosting testosterone. This has
prompted some women to use testosterone replacement therapy to get
their sex lives back on track. One drug commonly prescribed off-label
is Estratest, a combination of small doses of estrogen and
testosterone. Some doctors tailor-make low-dose testosterone
preparations for women. A testosterone patch for women has not been
approved by the Food and Drug Administration because of insufficient
safety data.

Women taking testosterone should be carefully monitored, because safe
levels of the hormone for women have not been determined. Common side
effects include unwanted hair growth and a deepening of the voice.
Women who have had breast or uterine cancer or diseases of the liver
or heart should avoid testosterone replacement.

Sexual desire among men, too, can be squelched by low levels of
testosterone. While there is no official recognition of male
menopause, men experience declining levels of hormones as they age -
what some experts called andropause - that can affect sexual desire
and performance. Other symptoms of this deficiency may include
enlarged breasts, loss of body or facial hair, and osteoporosis before
age 65.

Testosterone replacement is helpful in restoring the sex drive only of
men who have low levels of the hormone. A test of testosterone levels
should be done and other causes (besides age) should be ruled out
before the hormone is prescribed. Risks include prostate enlargement
and prostate cancer.

Copyright 2007 The New York Times Company