The role that hormones play in sexual desire is a lot more complicated than most people think. For example, the narrative that my patients often come to me with is that more testosterone equals a higher sex drive. That is not always the case, especially for women. I treat women with high levels of testosterone and low levels of testosterone who both have low sexual desire.
That is why low libido is not simply solved by prescribing a testosterone replacement for most women…not to mention the potential nasty side effects of testosterone (like a deeper voice and acne). I ask my patients; do you have pain free sex? Do can you get an erection? Can you orgasm?
If the answer is yes. The cause is very likely not hormonally related. Sexual dysfunction has a lot more to do with mood, attitudes about sex and turmoil in a relationship than it does with testosterone levels, especially in women. For women, sex happens in the brain!
Women want sex that is good for them, and they tend to avoid sex that isn’t. Only 1 in 3 women reliably orgasm from penetration, yet we have been taught by the media and society that penetration is the “right way” to have sex. This leaves 2/3s of women unsatisfied and less likely to pursue more sex. That might be why women in same-sex relationships orgasm significantly more frequently than women who identify as straight, because they are not pursuing the “standard” of sex that we have all been led to believe.
Where your primary care physician may stop after doing some bloodwork to test your testosterone, maybe even estrogen and progesterone, these hormones have a lot more to do with the mechanics of your reproductive system, like preparing your body for menstruation/pregnancy and less to do with the feelings and emotions we experience around sex.
In addition to testing estrogen and progesterone and balancing these hormones where necessary, I like to take a look at the WHOLE picture, the function and the reward of sex.
Do you enjoy the sex you are having?
Are you happy with the level of intimacy in your relationship?
Can you orgasm by yourself and with a partner?
Because when someone tells me “I just don’t feel like having sex anymore” there is usually a lot more to the story than low hormone levels.
It is amazing to see that women in their 60s and 70s who had resigned to the idea that they were never going to desire having sex again are getting lubricated naturally, having better orgasms than they have ever had in their life and pursuing sex with their partners regularly. All by working with me to shift their mindset and learn about pleasure as more than a biological function of arousal, penetration, orgasm.
That is why I feel like the real important hormones and neurotransmitters that often get ignored for a healthy sex life are: dopamine, oxytocin and cortisol.
Dopamine is the hormone that makes you feel more confident, more open to trying something new. The opposite of dopamine is depression, the feeling like there is no joy or no point…even in sex. Good sex can help us achieve the feel-good “high” dopamine gives us and make us want it more.
Oxytocin is calming. It increases sexual receptivity and connectedness and is released after orgasm. It is important in long term relationships for partners to feel bonded, trusting and connected. Be careful though, the oxytocin release after sex can make women feel like any partner, they are with is “the one” so be aware when you’re sleeping with the bad boy who is good in bed.
Cortisol is the stress hormones, and in my experience stress hormones have a lot more to do with sex than sex hormones. In this day and age, we are living in sympathetic overdrive, or more commonly known as fight-or-flight. And that fight-or-flight state shuts down any desire in 80-90% of people. That might even explain why millennials are having less sex than the previous 2 generations. We need to make the effort to cultivate situations in which the sympathetic overdrive shuts down and he parasympathetic nervous state takes over so that we can actually let ourselves experience desire…that’s why vacation sex is real.
Some ways to increase dopamine:
Some ways to increase oxytocin:
Ways to decrease cortisol:
Many people will say that sex used to be so good at the beginning of a relationship and accept that passion fading over time is normal. But for women especially, those factors when you were first dating (gazing into each other’s eyes, holding hands, planning ahead of time) are the most important to intimacy and libido. One of the exercises I use in couples I work with is a “sex date”.
I tell couples to get it on their calendars and make sure to incorporate factors that turn them on (bottle of wine and candles) and eliminate factors that turn them off (kids interrupting and work phone calls).
Make sure you take some time today to increase your oxytocin and decrease your cortisol!
P.S. Join the Pleasure Mindset Bootcamp to get more info on health and sex education!