By definition, lifelong male hypoactive sexual desire disorder indicates that low or no sex- ual desire has always been present, whereas the acquired subtype would be assigned if the man’s low desire developed after a period of normal sexual desire. There is a requirement that low desire persist for approximately 6 months or more; thus, short-term changes in sexual desire should not be diagnosed as male hypoactive sexual desire disorder.
There is a normative age-related decline in sexual desire. Like women, men identify a variety of triggers for their sexual desire, and they describe a wide range of reasons that they choose to engage in sexual activity. Although erotic visual cues may be more potent elicitors of desire in younger men, the potency of sexual cues may decrease with age and must be considered when evaluating men for hypoactive sexual desire disorder.
Temperamental. Mood and anxiety symptoms appear to be strong predictors of low de- sire in men. Up to half of men with a past history of psychiatric symptoms may have mod- erate or severe loss of desire, compared with only 15% of those without such a history. A man's feelings about himself, his perception of his partner’s sexual desire toward him, feelings of being emotionally connected, and contextual variables may all negatively (as well as positively) affect sexual desire.
Environmental. Alcohol use may increase the occurrence of low desire. Among gay men, self—directed homophobia, interpersonal problems, attitudes, lack of adequate sex educa- tion, and trauma resulting from early life experiences must be taken into account in ex- plaining the low desire. Social and cultural contextual factors should also be considered.
Genetic and physiological. Endocrine disorders such as hyperprolactinemia signifi- cantly affect sexual desire in men. Age is a significant risk factor for low desire in men. It is unclear whether or not men with low desire also have abnormally low levels of testoster- one; however, among hypogonadal men, low desire is common. There also may be a crit- there is little effect of testosterone on men’s desire.
There is marked variability in prevalence rates of low desire across cultures, ranging from 12.5% in Northern European men to 28% in Southeast Asian men ages 40—80 years. Just as there are higher rates of low desire among East Asian subgroups of women, men of East
Asian ancestry also have higher rates of low desire. Guilt about sex may mediate this as- sociation between East Asian ethnicity and sexual desire in men.
In contrast to the classification of sexual disorders in women, desire and arousal disorders have been retained as separate constructs in men. Despite some similarities in the experi- ence of desire across men and women, and the fact that desire ﬂuctuates over time and is dependent on contextual factors, men do report a significantly higher intensity and fre- quency of sexual desire compared with women.
Nonsexual mental disorders. Nonsexual mental disorders, such as major depressive disorder, which is characterized by "markedly diminished interest or pleasure in all, or al- most all, activities," may explain the lack of sexual desire. If the lack of desire is better explained by another mental disorder, then a diagnosis of male hyqaoactive sexual desire disorder would not be made.
Substance/medication use. Substance/medication use may explain the lack of sexual desire.
Another medical condition. If the low/absent desire and deficient/absent erotic thoughts or fantasies are better explained by the effects of another medical condition (e.g., hypogo- nadism, diabetes mellitus, thyroid dysfunction, central nervous system disease), then a di- agnosis of male hypoactive sexual desire disorder would not be made.
Interpersonal factors. If interpersonal or significant contextual factors, such as severe relationship distress or other significant stressors, are associated with the loss of desire in the man, then a diagnosis of male hypoactive sexual desire disorder would not be made.