A 72-year-old man presents to your clinic accompanied by his 70-year-old husband.

Comprehensive and Detailed Explanation:

Decreased libido in elderly patients can be multifactorial, but depression is a common and important cause that must be ruled out before hormone therapy or other steps. A proper mental health screen should precede further interventions.

Toronto Notes 2023 – Psychiatry / Geriatrics:

“In elderly men, reduced libido may be linked to depression, medical illness, or medications. Depression screening is essential.”

MCCQE1 Objectives (Psychiatry > 71-1: Mood Disorders / Sexual Health):

“Candidates must consider depression as a common cause of decreased libido and assess accordingly before initiating hormone therapy.”

Testosterone testing (D) may follow. Prescribing (C) is premature. Couples counselling (B) may help if interpersonal issues are identified. Interviewing together (A) may inhibit disclosure.

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