The libido is about as complex as we humans get. Hormones, psychology, self-esteem, metabolic health, childhood issues, stress responses … the intimate layers are seemingly endless once you start diving in. Still, there is great personal and relationship reward from doing the work – a great sex life – when you are willing to investigate your own psyche and improve physical health perameters. When working with low libido, there are significant hormone and medication factors to consider as primary obstacles. Estrogen excess in men and deficiency in women can both play a negative role in hormonal balance and sexual satisfaction. Testosterone starts to diminish in women around age 40 and in men as early as 30, affecting sexual performance and desire.
Testosterone is the “leadership” and “virility” hormone, and maintains healthy cognitive, muscle and bone health. It also plays a primary role in sexual satisfaction and the desire for sex. Testosterone has been used in the treatment of menopause since 1937, but is not talked about enough as an option. Dr. Kathy Maupin recently wrote The Secret Female Hormone, a book on women and testosterone that is a fun, easy read for consumers, and is very educational about the role of this important hormone for women. Testosterone replacement for men is more popular in modern medicine.
Recent allegations that testosterone is harmful for heart health in men were negated by JAMA, and the importance of testosterone in men’s health was reinforced by a collection of more than 25 esteemed medical societies in a collective called the Androgen Study Group. As Dr. Mogentaller, a leading Boston men’s health expert says:
“The primary hallmark of low testosterone is low sexual desire or libido, but another can be erectile dysfunction, and any man who complains of erectile dysfunction should get his testosterone level checked. Men may experience other symptoms, such as more difficulty achieving an orgasm, less-intense orgasms, a smaller amount of fluid from ejaculation, and a feeling of numbness in the penis when they see or experience something that would normally be arousing… Many physicians tend to dismiss these “soft symptoms” as a normal part of aging, but they are often treatable and reversible by normalizing testosterone levels.
Women with low testosterone levels can have similar loss of sensation and decreased pleasure from sexual intimacy that can be corrected with bioidentical hormone replacement.
However, the complexity around libido is driven by much more than hormone levels. So much of sexual compatibility, arousal and satisfaction is between the ears and/or conditioned by what we have learned by previous experiences. Sexuality has deep roots in the study of psychoanalysis, beginning with Freud, and links our lived experiences, our unconscious, and our libidos. Dr. Ron Feintech, a local psychologist and sex therapist says:
“Body image is also a very important psychological factor, particularly in women. It is almost universal to some degree and it really dampens ardor. For the most part, people want sex when the biological substrate of hormonal factors, cardiovascular factors, and neurological factors are in place; when the kind of sex they have been having is worth wanting, and when they can afford to want it”
This is deep stuff to work with, and it takes authenticity, love and connection to be willing to investigate all the elements of our sexual natures.
So, what do we do? In his book The Neurobiology of Love, Stan Tatkin speaks about recreating positive childhood attachments through stable, functioning relationships. Certainly having a willing and loving partner (and/or a therapist) who is available to “do the work” with you to uncover and dismantle the stonewalls is valuable. When looking for a professional to provide guidance on sexual health issues, consider an AASECT certified therapist. The American Association of Sexual Educators and Therapists is dedicated to “promoting understanding of human sexuality and healthy sexual behavior” and, as such, is up to date with the most current research on this subject. Here in Portland, Dr. Feintech of the Couples Therapy Center is a valuable asset to our therapeutic community. Other local AASECT Certified Sex Therapists include: Alison Caswell, LCPC, Jennifer Wiessner, LCSW, and almost certified Kristin Hurley and Yara Perez. Also Michele Keef, LMFT, her partner, Sex Coach Darryl Kiel, and Sex Coach Krista Haapla.
In the world of herbs, vitamins and nutrition, there are many adjunctive treatment strategies that can be helpful, but none as powerful as testosterone and/or seeking the psychological roots of the issue. As Dr. Rodney Voisine reminded us in his recent talk on Healthy Weight, losing 10% of your body weight can increase testosterone by 30% alone for all genders. Adipose tissue creates excess estrogen, dampening testosterone like a wet blanket on a fire. Taking nutrition into your own hands can be an important first step in feeling healthier and sexier, literally.
While we are talking about nutrition, high-stress hormones (cortisol) and high blood sugar (insulin) lead to high-fat gain (and thus lower testosterone) in a not-so-lovely merry-go-round. Sexual intimacy produces oxytocin, especially in women, which leads to an increased sense of connection and bonding, which can lower cortisol levels. However, sex usually gets pushed to the bottom of the hierarchy when stress elevates, and continues to get ignored until it becomes almost habitual to not be intimate with oneself or others. What is the medicine for this? Stress management practices like exercise, romantic dates, social time with friends, and alone time can give you the boost you need to reprioritize sex and activate libido. A mindfulness discipline like meditation can also enhance relationships, the ability to be present, and improve sexuality. Therefore, using Integrative Medicine and nutrition to rebalance cortisol and reduce insulin levels can also be part of recalibrating the sex connections in your life.
There is a long history of using botanical medicine to “boost men’s virility” and women’s too. Herbs like Maca, Damiana, Asian and American Ginseng, Tribulus and the ever-popular Horny Goat Weed may boost testosterone levels and are known as “aphrodisiacs”, meaning they boost sexual desire. These work in varying degrees for individuals, and are fairly safe to experiment with on your own.
A note on botanicals: Tonic herbs like these often provide the best effect when taken for a period of months. No herb is going to be able to act like the “little blue pill” and give instant, obvious results. Generally, herbs should not be used in pregnancy unless guided by a midwife, herbalist, or Naturopathic Doctor trained in obstetric botanical medicine. Herbs generally should not be mixed with antidepressants or antipsychotics, blood thinning medication, HIV or HCV medications, or chemotherapy. If you are taking multiple medications we recommend meeting with a pharmacist, Integrative medicine doctor or wellness specialist who can evaluate your medications for drug-herb interactions.
L-arginine is a commonly used amino acid for sexual health because it increases blood flow. All amino acids contain the same carbon, oxygen and hydrogen that make up carbohydrates and fats; what sets amino acids apart are nitrogen bases. The amino groups on arginine make it an endogenous (in the body) precursor to the potent vasodilator nitric oxide, making it helpful for physical sexual response in all genders. A standard dose of 5 grams of arginine has been recommended for erectile dysfunction. Of note: l-arginine is known to be a source of fuel for the herpes simplex virus, making it a poor choice for some of the population.
When it comes down to it, Love is the most powerful drug for libido. Not even necessarily sexual love, but a deep love and connection to (and for) the self. When we are connected to and “ok” with our deepest beings, we are better able to overcome every other aspect of our lives: sex/intimacy flows naturally, cortisol self-regulates, nutrition is balanced, and our relationships function in imperfect perfection. When childhood events derail these early lessons in self-regulation, we survive with the beauty, strength and resilience that we have as a species – but we do not always thrive. Compensation measures can get us through the honeymoon phase and sometimes longer, but when libido has been deeply affected in intimate relationships it is usually a sign of a deeper individual distress calling for Love and Attention.
This year, for Valentine’s Day, give yourself the deep authentic love and attention we all crave (if you can). Have an honest conversation with yourself about libido, and consider getting your hormones evaluated, or trying some of the natural remedies available. Whether single or partnered, consider unpacking some of the baggage around intimacy and open huge new vistas in your sexual potential. After all, if love is the medicine, you have all the answers you really need.
*These statements have not been approved by the Food and Drug Administration.
About the Author
Dr. Masina Wright
