A labaratory exam is only warranted when the sexual desire problem is clearly generalized. When a lab exam is required, the following should be considered:
1. Testosterone (T): (see section on "Hormones" in this chapter).
2. Prolactin (PRL): When an abnormal value is detected, it is best to repeat the test at least once and preferably twice since errors are common. When PRL is high, the T level is also often abnormal. More elaborate assessment of an abnormal PRL level involves brain imaging [magnetic resonance imaging (MRI) or computerized tomography (CT)], visual fields, and pituitary function tests. Patients who have repeatedly abnormal PRL levels, who require more elaborate testing, and where the etiology is not apparent, should be referred to an endocrinologist. Values which are higher than normal infrequently occur in a healthy man. When the PRL level is abnormal, one of the most common pathological causes is the use of an antipsychotic medication. An unusual but serious cause is a prolactin-secreting tumor.
3. Erectile dysfunction (ED) often occurs together with sexual disinterest and it may not be easy to establish which preceded the other. Under such circumstances, it is wise to investigate common causes of ED by ensuring that the patient does not have diabetes (obtaining a fasting blood sugar), or elevated lipids [assessing his total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), and triglycerides], or abnormal thyroid function [investigating his thyroid stimulating hormone (TSH)].
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