Sex File: My libido has disappeared since I retired 

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I am a 64-year-old man now retired from a busy working life. I am reasonably fit, fairly slim. I have so much to be grateful for, but my libido has evaporated. Part of me thinks it's just life for a man in his 60s. I have been happily married for many years and my wife still has a sex drive, which makes things awkward. What are we to do?

Sexual desire has more to do with your brain than it has to do with your penis, so Viagra and herbal remedies are not going to help you, I'm afraid. Viagra has a purely physical effect. It works by improving blood flow to the penis, but it doesn't have any impact on sexual desire. Of course it can provide a confidence boost that may make you want to have sex more frequently. However, if the issue was never about performance, the drug won't make a difference.

In your longer letter you mention you are taking an antidepressant, and that won't be doing your sex drive any good either. In fact, it's possible that it's the main culprit. Even mild antidepressants can flatline libido, but up to 50% of people with untreated depression experience sexual difficulties, so scientists can't be sure whether it is the depression or the drug that causes the problem. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are known to have the highest rates of sexual side effects. These side effects can diminish over time, but if you have been on them for a while it would be worth talking to your doctor to see if you could adjust your dose or switch to a different kind. Noradrenergic and specific serotonergic (NaSSA) antidepressants such as Mirtazapine are believed to cause less sexual dysfunction.

Before you do anything to change the way you take your medication, you should consult your GP. Sometimes simply changing the time of day that you take your medicine can make a difference. In general, the side effects of medications tend to wear off in the hours before the next dose, so if you would like to have sex in the morning when your testosterone levels are at their highest, it might be better for you to take your tablet at lunchtime.

You could also talk to your doctor about taking a short drug holiday. It will depend on how long your specific prescription stays in your system, but if, for example, you wanted to try to have sex over the weekend, you might be able to come off the tablets a few days beforehand and then you can resume taking them after the weekend without the risk of a relapse. Working these strategies out with your clinician is important, but it is even more important to do it with your wife. If she knows how not wanting sex is making you feel, she will be better placed to support you, and indeed stimulate you, when you plan to try to have sex.

Finally, you can tinker with medications ad infinitum, but the reality is that very few people have the same level of sexual desire at 64 as they had at 34. Obsessing over what you have lost is not a healthy way to view the world, and it won't make you want to have sex. Your wife still has a libido, so why not try to focus your energy on satisfying her? Invest in sex toys and lubricants and learn how to give her more, better orgasms. Your wife will relish the attention and you may find that shifting your attention to her satisfaction might reduce the level of distress that you feel, and that in itself might help to spark your own interest in having sex.

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