man’s feelings about himself, his perception of his partner’s sexual desire toward him,
feelings of being emotionally connected, and contextual vari ables may all negatively (as
well as positively) affect sexual desire.
Environmental. Alcohol use may increase the occurr ence of low desire. Among gay men,
self-directed homophobia, interp ersonal problems, attitudes, lack of adequate sex educa-
tion, and trauma resulting from early life ex periences must be taken into account in ex-
plaining the low desire. Social and cultural co ntextual factors should  also be considered.
Genetic and physiological. Endocrine disorders such as hyperprolactinemia signifi-
cantly affect sexual desire in me n. Age is a significant risk fact or for low desire in men. It is
unclear whether or not men with low desire a lso have abnormally low levels of testoster-
one; however, among hypogonadal men, low desire is common. There also may be a crit-
ical threshold below which testosterone will af fect sexual desire in men and above which
there is little effect of test osterone on men’s desire. 
Culture-Related Diagnostic Issues 
There is marked variability in prevalence rate s of low desire across cultures, ranging from
12.5% in Northern European me n 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 lo w desire. Guilt about se x may mediate this as-
sociation between East  Asian ethnicity and sexual desire in men.
Gender-Related Diagnostic Issues
In contrast to the classification of sexual d isorders in women, desire  and arousal disorders