Hello and welcome to Healthcare Magic. Thanks for your query. You have mentioned that you are suffering from multiple sexual problems such as poor libido, erectile dysfunction and premature ejaculation. In addition you have other symptoms like reduction in muscle size, fatigue, etc. Now, there can be a variety of causes for this problem - both medical causes as well as psychological causes. So, the first and most important step in management is proper evaluation. This will include a detailed medical, sexual, personal and social history, a thorough physical examination and certain investigations, as per the necessity. This is both informative to the doctor and serves as an opportunity to educate the patient and clarify his doubts. Firstly, any medical causes (like diabetes, hormonal problems, blood flow problems, vitamin deficiencies, etc.) need to be ruled out. For this, you may need to undergo a some blood tests like testosterone levels, thyroid function tests, blood sugars, etc. Further treatment should be targeted according to the findings on evaluation. If there are any underlying medical problems resulting in the erectile dysfunction, then those problems have to be first treated. If the problem is more psychological, then removing the person s doubts and fears, and improving his self-confidence levels will also definitely help in improving sexual performance. So, I would advise you to consult a psychiatrist or a sexologist in person to have a detailed assessment and evaluation done. Wish you all the best. Regards, Dr. Jonas Sundarakumar Consultant Psychiatrist & Sexologist