The Case of the Month is an actual patient from The Turek Clinic.
He is 32 years old and very concerned: “My sex drive in the tank, Doc.” He continues: “I am happily married, love my wife, work is busy and I just don’t understand what’s going on. I think that my testosterone is low.”
As the visit continues, I delve a bit deeper. He owns a tow-truck business, works full days and then, after hours, takes call for accidents. “The police call me first because I am available and I respond quickly.”
“How many calls do you get a night?” I ask.
“Three, maybe four calls,” he responds.
“So, how much sleep do you really get, on average, every night?”
“Dunno. Maybe 3 hours, maybe less…”
The Big Picture
Sure, testosterone levels matter to sex drive. But so do host of other things. In fact, you might be surprised if I tell you how uncommonly testosterone is the reason for low libido. Here is a short list of reasons for low sex drive that runs through my mind as I talk to him:
- High blood pressure
- Elevated cholesterol
- Heart disease
- Organ failure
- Brain tumor-prolactin
- Social drugs
So, I checked his testosterone and several other labs and they were normal. I discussed that it is unlikely to that he has a major metabolic or hormonal problem. In fact, we crossed almost everything off the list…except stress. “There’s something I think we can do for you,” I told him.
I explained that his shift work and night call all adds up to bodily stress, termed “circadian stress”, similar to constantly travelling across different times zones all the time. I compared him to a cavemen being chased by a raging woolly mammoth: the last thing that comes to mind during periods of self-preservation is having an erection or sex. He needs sleep, pure and simple.
He took my advice. He added a second employee to his one-man business to take call for him at night, and he slept. Regularly. And in a Rip Van Winklian way. I checked in with him three months later and he said: “My life is sooo much better and my sex life is great. Thanks Doc Paul!” Yes, simple answers can fit into a complex world.