Dear Doctor Remien,

I'm a 29 y/o HIV+ male (diagnosed April 2002)and my boyfriend is HIV-. We've been together happily for about a year now, are completely in love and things are going great. Except for one thing - I've been experiencing complete loss of libido off and on for the past 7 months. My doctor put me on hormone replacement therapy (AndroGel) 7 months ago, and although my testosterone levels have increased from ~200 to ~400+, I still have no desire for sex. My doctor also prescribed viagra, which helps, but often makes me feel mechanical since my libido's just not dependent on it for. To add another twist, I used crystal fairly regularly for a few years, and stopped using 1.5 years ago, and have heard that users of crystal meth often experience a loss of libido for 1-2 years after they stop using the drug. I realize I'm still adjusting to sex without crystal, and am also still adjusting to being HIV+ and in a mixed-status relationship, but my boyfriend and I used to have satisfying sex, and now I don't even masturbate anymore. As you can imagine, this lack of sex is causing some distress in my relationship, and makes me feel afraid that my boyfriend will leave me because I can't satisfy him, or that I'll freak out and dump him because there seems to be no solution. We're looking into couples counseling, but can you offer some perspective on my situation? I feel like I'm trying hard to make it work, but am feeling overwhelmed and discouraged.

Thanks for any advice.

I'm afraid I am unable to add much advice on top of what you are already doing. As you are doing, it is important to work with a physician to address the issue from a medical / biological perspective. I am not a physician and do not know the details of the effects of crystal on libido, but believe that crystal use has a wide range of negative consequences on physical, as well as psychological functioning.

It is true that the lack of sex can be very challenging to a young relationship, but it does not have to be the cause of a break-up. I strongly encourage you to follow up on couples counseling. Effective communication between the two of you is essential if you are to overcome the stress and frustrations associated with the libido problem. If both of you are honest and open with each other and care about each other, beyond sexual gratification, then I believe you can cope with this and have a healthy and satisfying relationship.