Low Sex Drive in Men

A reporter for a major national Men’s magazine recently contacted me and asked if I would comment on some of the surprising and common causes of low sex drive in men. Here are my responses:

• - A frequent, and I would say surprising cause of low male libido is anger toward their wives or significant others. Anger sucks the energy out of a man’s desire for sex. When men make a statement in therapy such as, “I just don’t want to be anywhere near her,” this translates into not wanting to have sex with her either. Anger activates the “fight or flight” response, and most men are more comfortable fleeing conflict with the women in their lives. They become very ashamed of speaking up about their low sexual desire, and retreat to their “man cave.”

 

• - Low male libido is influenced by the biological condition known as “andropause,” the counterpart of menopause in women. This most often occurs in men whose testosterone counts have decreased with age. Testosterone fuels sex drive in men, so low levels of this hormone equates with low sexual desire.

 

• - Physical illnesses, such as heart disease, stroke, certain cancers and hypothyroidism are responsible for low male libido. The same is true for prescription medications such as antihypertensives, (medications used to treat high blood pressure), and antidepressant drugs such as Prozac, Lexapro and Effexor. Physical illnesses and prescription medications cause low sex drive in men because of decreased blood flow to the genitals. This strikes terror into the heart of a guy to even think that he might not be interested, because his sense of self is usually tied up in his virility.

Fears: What Are They, How Do They Develop, Are They Rational?

- Fear is the sensation of “expectation with alarm.” It is the emotion we experience when our autonomic nervous system releases adrenaline, energizing us for “fight or flight.” In this sense fear functions as an absolutely necessary wake-up call motivating us to be hyper-alert, particularly when facing imminent danger. This hyper-alertness enables us to adopt a call-to-action to adequately protect ourselves from anticipated harm.

- Fear develops because most often we identify with it through our negative personal experiences. As a result, it does not logically follow that the way we react to fear is always appropriate. It becomes the worrier in our head that interprets a situation to mean the worst will happen. Then once we become frightened into believing the worst, automatically we begin the process of scanning our world for evidence to support our limiting beliefs. We are then examining fear in an un-empowered way.

- Most fears are irrational. The majority of what we fear is a product of our own personal, negative self-programming. This in turn, makes us feel helpless and fuels the desire to run away.

So how do you get past your fear of something? Here are a few suggestions:

1. Notice it. When you’re afraid, simply step back and acknowledge it. Don’t try to analyze, understand, assess or figure it out – just notice; that’s all. Stepping back helps you gain perspective and serves as a temporary respite from the concerns associated with the fear. Put another way, you’re able to give yourself some emotional space.
2. Distinguish what is real from what is imagined. Most fear is associated with future “what-ifs” and past “could’ve- beens,” but some of it is legitimately in the present. For example, if you were to say something silly at a business meeting and it embarrasses you, that is real. Concluding, however, that you will never be taken seriously by your colleagues again and that you will lose your job is likely imaginary.
3. Ask questions. What is this fear really about? If it came true, what would that mean? What is this fear keeping me from doing? What other questions do these questions raise? If queries such as these seem useless to you, remember this: poor logic lies at the root of practically all fear.
4. Professional assistance. If fear is immobilizing you, or in some other way interfering with your activities of daily living, the services of a trained therapist or counselor may be worth considering. Phobias respond quite favorably to intervention strategies tailored to your specific needs.

We all struggle with fear because of its association with the way we human beings are wired. The challenge is to understand and change the way we respond to it. The next time you’re experiencing fear, don’t F orget E verything A nd R un, decide instead to F ace E verything A nd R emain.

Is Your Teen or Child Buying Prescription Drugs Online?

Sixth-graders are ordering prescription medications over the Internet — illegally. And their parents haven’t a clue.

That’s one of the shocking facts in “You’ve Got Drugs!” an annual report on Internet access to controlled substances from Columbia University’s National Center on Addiction and Substance Abuse. The report, released late last year, also points out that while 18 U.S. states either have or are considering laws that restrict the sale of prescription drugs over the Internet, researchers were able to locate 365 Web sites offering the medications. Of these sites, 85% do not even require a prescription. Some even sell online-only consultations with physicians willing to write prescriptions that consumers can fill at their local pharmacies.

To be sure, many online pharmacies are legitimate. But this type of illegal activity places their reputations in jeopardy. That’s because federal laws and regulations lack both the teeth and the funding to stop these illegal sales.

It is no startling revelation that kids these days are Internet-savvy. One 16-year-old who started ordering illegally off the Internet at age 11 put it this way to the Columbia researchers: “I doubt laws will work because if there is a will, there is still most definitely a way. You find ways and means to get whatever you want.”

This reminds me of a television commercial that ran several years ago, asking: “It’s 10 p.m., do you know where your kids are?” Now the question is, it’s the Internet – do you know what your kids are doing there?

It’s hard enough raising responsible kids without having to worry about what they’re doing behind our backs. Without a doubt, the Internet is a prolific 21st century marvel when it comes to accessing information and the advancement of learning for children. These benefits come at a price, however. The Net is also the largest playground ever for kids to encounter all sorts of temptation.

If your kids have purchased drugs illegally via the Internet, or if you suspect they are trolling Web sites tempting them to do so, here are some options for action:

• - Option 1: Talk to your kids. Explain what’s wrong with buying medications illegally, in terms they can understand. Tell them in no uncertain terms that you strictly forbid them to buy drugs on the Internet. Be specific about the consequences (your choice here), and make it clear that disciplinary actions will be enforced on the very first violation.
• - Option 2: If you suspect or find out that option 1 isn’t working, move the computer out of the kids’ bedrooms and into common spaces (living room, kitchen, etc.). Tell them that the computer will remain in a common area for a set period of time, so that you can monitor their Web use.
• - Option 3: If options 1 and 2 aren’t working, check the computer’s browser history. Yes, this is spying. But if you believe your child is really involved in an illegal activity, you have an obligation to investigate.
• - If options 1, 2, and 3 fail, install parental blocking software or Internet filters. These programs let you create a list of Web addresses and keywords the computer will be unable to open; some also generate reports on Internet use and block certain types of interactions. Popular brands include Net Nanny, Safe Eyes and CyberSitter, and they typically sell for $30 to $60. This is your last resort, short of banishing the computer from your home.

In spite of these actions, as the above mentioned 16-year-old pointed out, “If there’s a will, there is still most definitely a way.” Still, you need to do the right thing. Perhaps your kids will thank you later. Either way, raising children and teens to act responsibly and enforcing appropriate behavior, are the toughest tasks you will ever take on.

Over Procrastination

We all procrastinate, and if you claim you don’t, there’s something other than blood running through your veins, as this phenomenon is simply part of the human condition. But that said, ask yourself if this sounds like you: After exhaustive research you’re still waiting on that one final scintilla of information permitting you to finally spring into action to buy a new house, a new car or accept that job you’ve recently been offered.

So what’s the problem here, after all, details are important right? Well yes, trouble is there’s always one more detail. Many people over procrastinate by demanding to know every fact – even irrelevant ones. For example, you know the car you want and have researched its track record extensively but continue to debate endlessly over paying extra for the optional seat warmers – and you live in the Deep South.

I’m dear friends with a woman who is convinced that before she can launch the speaking business she so passionately claims to want, she has to write five books and have published over 50 articles in her field. I’m not kidding here, I couldn’t make this up.

The next time you’re experiencing “paralysis by analysis,” ask yourself what’s really holding you back. The chances are pretty good that it has nothing do with the seat warmers or credibility as a speaker. Realistically maybe you can’t afford the car, and that aforementioned friend of mine, I’m not so sure she is as stoked as she claims about becoming a professional speaker. So decide already! So what if your rear end is a bit chilly on the only three very cold days of winter. You’ll survive and at the same time will have saved some money. With over procrastination, the devil truly is in the details.

Observations from my Recent Trip to Boise and Salt Lake City: Southwest Airlines

Thanks to everyone that attended my mid-June psychopharmacology seminars in Boise, Idaho and Salt Lake City, Utah. I sincerely hope that all attendees enjoyed and benefited from the trainings. More importantly, I strived to better your condition with regard to this subject matter, as all of you are entitled to a lasting return on your investment of time and money.

I rarely fly Southwest Airlines. I have no bias against this airline, I just tend to choose the other major carriers in that I am able to book a reserved seat. I’m no longer certain I will continue that policy. All of my connections to Boise,Salt Lake City and eventually back to New Orleans were via Southwest on this recent trip.

During this current recession, Southwest has remained profitable, although less so as fewer people are flying these days. When oil prices spiked last year and fuel costs subsequently escalated, the airline still operated in the black. There’s never been a hint of a discussion regarding bankruptcy with this carrier, and they have eschewed charging checked baggage fees – even at the height of the oil price crisis. Yes, fares rose, but no more than what competitive carriers – Delta, Continental and United – were charging.

Why this continuing track record of success despite often trying circumstances? I can answer it in one word: Attitude. From the baggage handlers to the pilots, these people seem as though they really enjoy what they’re doing and actually want to be at work! And how is it that 180 people can be loaded and locked on an airplane in approximately fifteen minutes when it takes the other major carriers at least thirty minutes? Attitude again. Flight attendants, with a friendly smile and a kind word, strategically position themselves in the aisles directing people to the next available seat and to the overhead bins above. Systematically the plane loads from the front to the rear. Passengers simply follow the herd and the cues. No one enters the cabin and rushes to aisle 32. Does anyone really want to be there anyway? At some point on full flights, only middle seats remain for those boarding last, but these folks seem to already know that.

Flight instructions are conducted in a tongue-in-cheek, slightly irreverent-like manner. C’mon, does anyone really not know how to buckle a seat belt or what to do with the oxygen mask that could drop down from the panel above? They make the boring FAA stuff fun.

The ubiquitous, irritating service cart – a mainstay on other carriers – is absent on Southwest flights. Drink orders are taken and simply served on trays, so the aisle is not consumed by flight personnel. This is a model of efficiency for a task that never was rocket science in the first place.

This airline has to have one heck of a training program, and when it comes to success in any business, the tried and true constants always have any always will dominate: Offer a fair price, service that distinguishes you from others, and a positive attitude that resonates with the customer, and they will come back. And on Southwest, they keep coming, and coming and coming.

The Power of Initiative: An Observation from my Recent Trip to Seattle

A couple of weeks ago, I presented three psychopharmacology seminars in the Spokane/Seattle area. On the day of my departure from Seattle, a misty rain was falling making for a slow go to the airport. After dropping off the rental car, I scurried into the main terminal arriving at the security checkpoint 45 minutes prior to my flight. There were at least a hundred people ahead of me, and my Seattle to Denver flight was on time. If I made it to the gate, it was going to be very close.

As I scanned the line ahead of me, I noticed a TSA official with an infectious smile passing out plastic bags to the throng of travelers, anxious as I was, to make it through the metal detector as quickly as possible. As he worked the line, this fellow repeatedly kept saying “we’re here to serve you, and to make this process as smooth as possible. Kindly remove all metal objects and place them in these bags.” I’ve traveled through every major airport in the country and had never seen this done before. Well, belts came off, jewelry was unfastened and change was removed from pockets. His call to action assisted in moving a hundred-plus people through security in under 20 minutes.

I mentioned the expediency with which this happened to another TSA official. He in turn answered, “oh, that’s because of Joel, he does this everyday on his break. It’s certainly not in any of our job descriptions.”

I so admire people whose self-imposed initiative drives them to perform above and beyond what their jobs merely require. In a culture that increasingly touts an attitude of  “that’s not my job,” this man’s actions were indeed most refreshing to witness.

Communicating with Physicians during Office Visits

How well do you communicate with your physician? Do you feel intimidated or inferior in the presence of your doctor? Do you ever develop “white-coat brain lock” when it comes to asking questions? When leaving the office, do you wonder what foreign language or in what tongue your doctor was speaking? If you answered yes to any or even possibly all of the above questions, you’re not alone, because one of the biggest communication gaps going is between physicians and patients.

The relationship you have with your doctor drives the quality of your treatment, and a good relationship – one where you and your doctor exchange information freely and work collaboratively to make the best decisions about your health – is the cornerstone of optimal care. So prepare in advance of your appointment. Come armed with questions, in writing, and politely request that your physician take a few minutes to respond to them. If the doctor answers, “my assistant or nurse will address these issues,” hold your ground and simply say “you’re the expert, I’d much rather hear it from you.”

Understandably, it can be difficult to deal with impatient physicians. Remember though, you are the customer! So don’t leave the office without having your questions answered and understanding everything the doctor has told you. Also, don’t withhold information. Doctors aren’t mind readers, so if you’re not sharing information because you believe it is too sensitive or irrelevant to your visit, please reconsider. What you’re withholding just might be a key piece to the puzzle of finding out what’s wrong and how to treat you.

Building a trusting, positive and rewarding partnership with your doctor takes time, particularly if your visits are infrequent. Trust your instincts as to whether or not the relationship is a good fit for you, and if not, acknowledge that you probably need to hand over you care to someone else.

Have you had any communication difficulties with your physician? How did you handle the situation?

Direct-to-Consumer Advertising for Prescription Drugs

 Those ubiquitous television advertisements for prescription drugs probably won’t disappear anytime soon, but the pharmaceutical industry has reeled in commercial spending and is expected to announce restrictions on its ads. A number of trends are responsible for the changes to the industry’s advertising strategy. Congress has ramped up its scrutiny of drug advertisements. Fewer new medications have been approved by the FDA in recent years, and previous best sellers have lost the benefits of patent protection.

Prior to 2007, consumer-focused drug advertising had generally been on the increase after the FDA relaxed restrictions on television ads in the late 1990s, and reached a peak of $5.4 billion in 2006, according to TNS Media Intelligence, a New York provider of ad data. The ads have introduced TV viewers to such images as the radiant lunamoth promoting Sepracor Inc.’s sleep drug Lunesta, and the benefits of Eli Lilly’s antidepressant Cymbalta because “depression hurts.”

Drug makers count on ads to increase the number of diagnoses of the various syndromes targeted by their medications. And there are studies demonstrating that people who view drug commercials are more likely to ask their doctors for prescriptions. Supporters of drug advertising say the ads increase awareness of disorders and possible treatment outcomes, and can help sidestep medication underuse. Detractors say the ads are misleading and often promise more than they actually deliver.

Where do you come down on the whole direct-to-consumer advertising issue?  Are you a supporter or a detractor?

Welcome

Welcome clinicians, colleagues, friends and caregivers to our blogposts.  We hope these commentaries will bring fresh perspectives, valuable insights and solutions to your mental health medication issues.

Our desire is that you find something of interest in each of these posts, and that you will look forward to receiving them on a weekly basis.  We would love to hear your comments, suggestions or requests for future content.

Sincerely,

Joe Wegmann