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The role of testosterone, and perhaps several other androgens, appears to be necessary for the experience of sexual desire in its drive component [32] It appears that a minimum level of androgen is required for the man to be able to experience sexual desire; however the relationship is not completely linear, as the higher level of androgen in blood does not correlate with higher level of sexual desire [18] In addition to the molecules mentioned in Table 133, there has been some speculation on the role of oxytocin [33] and, in a recent report [34], the role of thyroid hormone has been suggested

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19 The rate at which non nancial experts have been excluded, once challenged, increased slightly in 2001 and then declined in 2002 However, the rate at which non nancial experts have been excluded did not decline to the same extent in 2002 as compared to the gures for nancial experts 20 Analysis of future exclusions will provide insights as to whether the exclusion rate has reached its steady state or equilibrium level While not part of this study, the case lings mix could also impact the exclusion rate of nancial experts over time 21 In whole or in part 22 Based on a reading of the published opinions reviewed, reasons for the exclusion of nancial experts were categorized as relating to relevance issues, reliability issues, and/or quali cation issues A particular expert may have been excluded for more than one reason

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47 10 Number of Challenges Partial Exclusions Complete Exclusions Total Number of Exclusions Exclusions as a Percent of Challenges 55 195 250 7 26 33 23 64 87 30 90 120 545% 462% 480% 44 245 289 5 28 33 13 91 104 18 119 137 409% 486% 474% 66 290 356 7 24 31 13 103 116 20 127 147 303% 438% 413%

One conceptual model that is helpful to integrate both physiologic and psychologic factors of sexual desire has been proposed by Helen Kaplan [35] Although this model still requires empirical validation, it represents an interesting tool for the understanding of the dynamics of a man with HSD The model is summarized in Figure 132

Note: Multiple experts could be challenged in the same case Non nancial experts include medical doctors, engineers, forensic scientists, psychologists, and psychiatrists, among others

Expert Witness Challenges (Cases Citing Kumho Tire Co vs Carmichael ) Annual; 2000 2002

Hypoactive sexual desire is a condition that many times is part of another disease or disorder Other

Number of Challenges 19 49 97 165 119 721% 46 17 40 62 895% 816% 639% 2 9 35

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In Frame 3 of the actions layer, type or paste in the following ActionScript, which you can find in Frame 3 of the actions layer of 46fla on the CD-ROM:

Percent Defendant 105% 184% 361% 279%

times, the decrease or absence of sexual desire occurs with no other sexual dysfunction or recognizable pathology In any event, it is critical that the clinician identi es this condition; lack of success in treatment of other sexual dysfunctions, like erectile dysfunction, can sometimes be explained by the presence and lack of proper treatment of HSD The list included in Table 134, taken from Meuleman & Van Lankvled (2005) [2], is a summary of the causes of HSD seen frequently in clinical practice Hypoactive sexual desire is frequent in men with erectile dysfunction In a series of 428 men with erectile dysfunction, Corona and co-workers (2004) [5] reported that 433% of their participants had the condition This group found no correlation for patient or partner s age Men with HSD in this study were not diagnosed as hypogonadic more frequently than men without HSD; however ANOVA showed a signi cant (P < 0005) difference of total, free testosterone and prolactin levels among patients with different severities of HSD No signi cant correlation was found for: follicle-stimulating hormone (FSH) (r = 004), luteinizing hormone (LH) (r = 004), thyroid-stimulating hormone (TSH) (r = 006), or testis volume (r = 008) No correlation was found for: prostate speci c antigen (PSA), blood pressure, lipid pro le, glycemia, and parameters derived from

Number of Challenges 42 30 47 119 764% 682% 712% 721%

Percent Defendant 236% 318% 288% 279%

cause HSD [2]

Exhibit 476 Plaintiff and Defendant Financial Expert Challenges Annual; 2000 2002

47 11

Androgen de ciency Hyperprolactinemia Anger and anxiety Depression Relationship con ict Stroke Antidepressant therapy Epilepsy Post-traumatic stress syndrome Renal failure Coronary disease and heart failure Ageing HIV Body-building and eating disorders

47 12

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Table 135 Clinical indicators of sexual desire Sexual frequency However, sometimes frequency desire: activity can occur with no desire Sexual fantasies Sexual thoughts Initiation of sexual activity

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