Makindo Medical Notes

Clinical History

1. Onset and Duration: Determine when the change in libido started and whether it has been gradual or sudden.
2. Relationship Factors:
   • Quality of the patient’s relationships
   • Recent conflicts, life changes, or stressors
   • Communication patterns with their partner(s)
3. Psychological Factors:
   • Depression or anxiety
   • Stress, including work-related or financial concerns
   • History of trauma or abuse
4. Medical History:
   • Any chronic conditions (e.g., diabetes, hypertension, cardiovascular disease)
   • Previous or ongoing hormone-related conditions (e.g., hypothyroidism, low testosterone)
   • Reproductive history (e.g., recent pregnancy, menopause)
5. Medication History: Ask about medications that may impact libido, such as:
   • Antidepressants (e.g., SSRIs)
   • Antihypertensive
   • Contraceptives or hormone therapies
6. Lifestyle Factors:
   • Alcohol or substance use
   • Sleep patterns and fatigue
   • Diet and exercise habits

Physical Examination

1. General Inspection: Assess overall health, BMI, and signs of obesity or malnutrition.
2. Vital Signs: Check blood pressure, heart rate, and BMI.
3. Endocrine Examination:
   • Look for signs of hypothyroidism (e.g., dry skin, hair thinning).
   • Assess for signs of hypogonadism in men (e.g., gynecomastia, testicular atrophy).
4. Genital Examination (if indicated): Only if there are symptoms that suggest genital pathology or atrophy.

3. Investigations

1. Blood Tests:
   • Hormone Panel:
     • Testosterone levels (in men) for hypogonadism
     • Oestradiol, FSH, LH (in women, especially perimenopausal or postmenopausal)
     • Prolactin levels to rule out hyperprolactinemia
   • Thyroid Function Tests: To assess for hypothyroidism.
   • HbA1c/Glucose Levels: Screen for diabetes if clinically indicated.
2. Psychological Assessment: If a mental health condition is suspected (e.g., depression, anxiety).
3. Further Imaging: Consider MRI of the pituitary gland if prolactin levels are high to assess for prolactinoma.

Possible Causes of Loss of Libido

• Psychological Causes:
  • Depression or anxiety
  • Relationship issues or lack of intimacy
  • Stress or trauma history
• Endocrine Causes:
  • Hypothyroidism
  • Hypogonadism (low testosterone in men, low oestrogen in women)
  • Hyperprolactinemia (e.g., due to prolactinoma or medications)
• Medication Side Effects:
  • Antidepressants (SSRIs, SNRIs)
  • Antihypertensive drugs (e.g., beta-blockers)
  • Oral contraceptives or hormone treatments
• Lifestyle and Social Factors:
  • Alcohol or drug misuse
  • Sleep deprivation
  • Low physical activity levels
• Chronic Illness: Conditions like diabetes, cardiovascular disease, or chronic pain.

Management

1. Treat Underlying Causes: Address any identified medical, psychological, or relational factors.
2. Psychological Support: Consider counselling, psychotherapy, or sex therapy, especially if relationship or mental health issues are present.
3. Medication Review:
   • Adjust medications if feasible (e.g., switching antidepressants if impacting libido).
   • Consider hormone replacement therapy in cases of hypogonadism or menopause.
4. Lifestyle Modifications:
   • Encourage regular exercise and a balanced diet.
   • Minimize alcohol and avoid recreational drugs.
   • Promote good sleep hygiene.
5. Follow-up: Regularly assess the patient’s response to interventions and adjust as necessary.