San Antonio Express-News (Sunday)
Treating low libido often complicated
Q: I’m a 67-year-old male. For most of my later adult life (50s to the present) I have had a very low libido. My testosterone level was very low, so last year the urologist prescribed shots of testosterone that I’m giving to myself. My testosterone level now is well within the normal range, but I still have a very low libido.
Is there a cause for this, and if so, is there anything I can do about it? I’m divorced and trying to date, but it’s definitely presenting problems. Is this normal in guys my age?
A: It is certainly true that one hallmark symptom of low testosterone is decreased libido, and treatment with testosterone is effective for many men — and is also used by some experts for women. However, low libido has many causes. Libido tends to decrease with age, though this is by no means universal.
When men note concerns with libido, I look carefully at medications. Some prostate drugs and antidepressants can cause trouble, although depression itself can cause low libido.
Other sources are alcohol use and recreational drugs (especially cannabis), as well as many medical issues. Relationship issues, including feeling pressure to perform with a new partner, can lead to loss of libido. When men have had erectile dysfunction, which is common among men with low testosterone, it can commonly affect other parts of sexual health, including libido.
There is often not an easy treatment for low libido. A mental health professional, especially one experienced with sexual health, can be useful in the case of relationship issues or when no physical cause can be identified.
Q: Years ago, I read that putting a drop of Vaseline in the nose helped with allergies. Since COVID, I’ve been diligent in doing this. Am I kidding myself? I still mask, distance, have had
my shots, etc.
A: Petrolatum (petroleum jelly or Vaseline) in the nose is an effective barrier to moisture loss and can relieve the symptoms of dry and red skin due to excess runny nose from colds or allergies. However, it does nothing to prevent allergies or a viral infection, such as influenza or COVID-19, so you are kidding yourself if you think it is protecting you.
This also applies to petrolatum with antibiotics, such as Neosporin or other triple antibiotic ointment (I have read that misinformation frequently). Wearing your mask, appropriate social distancing and getting the vaccine are all effective ways to reduce your risk of getting an infection.
I would also caution against putting a large
amount of Vaseline in the nose right before bed, as there have been a few cases of the petrolatum going down into people’s lungs and causing lung damage. Use just a small amount and stay upright for a while before going to bed.
If you don’t need the ointment for any symptoms, there is no reason to use it to prevent infections.
Q: I am a 92-year-old woman in reasonably good health. I weigh about 145 pounds and have shrunk to 5 feet, 5 inches tall. I attend a 45-minute exercise class at a wellness center three times a week. I am diabetic and have glaucoma. I take Januvia, simvastatin and losartan, and use Lumigan eyedrops at night.
I go about all my daily needs, including shopping and driving. However, for the past two years, I have been having dizzy spells. I stand still, and the dizziness disappears. I carry a cane for walking for greater lengths. I get dizzier during warm weather.
This happens up to five times a day, maybe less at other times. It only happens at home, never while shopping or driving or when exercising.
My doctor has not said much about this except to suggest I should use more salt in my diet. Can you give me a reason why this dizziness occurs? What must I take so that this dizziness stops?
A: Dizziness is a common topic among the patients I see, and it often takes a few minutes to
determine what a person means. Dizziness may mean lightheadedness, as I suspect it does for you. But it may also mean vertigo, a sensation that the person or the world seems to be moving when it isn’t.
Some people with low blood sugar note the sensation of dizziness; you are on a blood sugar-lowering agent, so that is a possibility. You may have any of these, so your doctor should take some time to explore the real issue.
Since the dizzy spells are momentary and seem to happen when standing, my suspicion is that your blood pressure is briefly lower. I think your doctor feels that is the most likely explanation as well, since adequate fluid and salt is one common and effective treatment for symptomatic low blood pressure. However,
I would recommend testing this theory by checking your blood pressure when seated and standing several times, and try to get a blood pressure reading when you are having symptoms.
Medications are a common cause of dizziness due to low blood pressure.
Even eyedrops can lower blood pressure enough to cause dizziness, though it’s not typical for bimatoprost (Lumigan).
Losartan is generally a safe and effective blood pressure medicine, but some people, particularly older people, can get a greater than expected (or desired) drop in blood pressure upon standing, even when on a low dose of this medicine. Those people benefit from decreasing the dose or even changing classes of blood pressure medication. Given that this has been going on for two years, I think a little more evaluation might be of benefit.
Q: We’ve been very interested in your advice about possible interactions between the COVID vaccines and certain medications or treatments. What about the effect of antibiotics on vaccine effectiveness? I was given 10 days of Bactrim for a recurring infection several days after receiving my first Pfizer shot, and then told to switch to a stronger antibiotic (Augmentin) for 10 days about the same time as my second Pfizer shot. Could those antibiotics have reduced the effect of my vaccines?
A: No, antibiotics should not interfere with the effectiveness of any of the available COVID vaccines. I generally recommend that a person who is feeling very unwell due to bacterial infection postpone vaccination, if only because the combination of vaccine side effects on top of systemic infection would be unpleasant. But if you are generally well and have no fever, the vaccine is safe to give, with high effectiveness and low risk of serious side effects.
Dr. Roach regrets that he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med .cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.