The diagnosis of Hypoactive Sexual Desire Disorder (HSDD) in men is established primarily by history. Men with HSDD report that they would prefer doing almost anything else to having sexual activity. Physical examination may reveal abnormalities such as diminished sensation in the penis, or even diminished size of penis. Hormonal testing may reveal androgen or testosterone insufficiency syndrome and low calculated free testosterone. Some medications lower blood androgen levels. Men who are overweight or who have high serum estradiol values can have high SHBG that lowers testosterone. Other hormonal abnormalities may include Hypothyroidism and Elevated TSH. Low sexual drive may also occur in men with elevated prolactin. Neurologic testing may identify low sensation. Psychological evaluation may reveal low self-esteem and self confidence issues as well as relationship concerns. it is common for Erectile Dysfunction to be a cause of low interest, as that becomes a way to avoid sexual activity.