Nowadays low sex drive is more and more common among women.
I don't need to tell you why it's important to have sex, so it should come as no surprise that many women are concerned when they find their sex drive decline.
Fortunately, there are many reasons why your sex drive may be plummeting.
The hard part is finding out which one is contributing the most in your body.
In this article, I'm going to go over the most common causes (both obvious and not so obvious) as to why your libido may be decreased.
In addition, we will also talk about how to boost your libido and get back your sex drive.
The Connection Between Testosterone and Sex Drive
Do women have testosterone?
The answer to this question is a YES, they absolutely do.
Not only do they have testosterone (like men), but testosterone levels in women also correlate with libido and sex drive (1).
What's interesting is that unlike men, women can actually remain sexually active for their entire lives (provided they have normal hormone balance).
Because of this link between testosterone levels and sex drive (2), it becomes very important to monitor this hormone (in both males and females, but especially in females).
Not only can Testosterone boost your sex drive, but it can also improve your overall mood, improve your muscle mass and potentially help with weight loss.
Sound pretty good right? So, is there a catch?
Is using Testosterone safe for women?
It turns out that as long as testosterone is used correctly - meaning transdermally and in normal physiologic dosages, that it is safe to use.
We will cover what may potentially cause low testosterone in women and ultimately lead to low sex drive, but for now, just remember that there is a link between testosterone levels and libido.
9 of the Most Common Causes of Low Libido in Females
While testosterone is an important factor in sex drive, it's certainly not the only factor.
Causes of low libido range from imbalances in other hormone levels to changes in neurotransmitter levels and everything in between.
Below is a guide to helping you solve why you may have low testosterone, but realize that other factors not discussed here may be at play as well.
#1. You may have Low Testosterone Levels
Since we've already given this one away, let's jump right in.
If you are suffering from low sex drive then checking your testosterone levels should be the first step you take.
You can do this by checking both your free and total testosterone levels in the serum:
As you can see from the example above this patients testosterone level is obviously low at less than 3 ng/dL with a range of 3-41.
In addition to having low total testosterone this particular patient also has low levels of DHEA at 26.7 with a range of 41.2 - 243.7.
If you weren't aware DHEA is another androgen and can be used as a substrate for Testosterone creation.
This pattern is classic for patients in their 40-50's and/or around menopause.
Because here's the deal:
All women (and men) over time will eventually develop low testosterone.
While some of the slack from low testosterone can be picked up by other androgens from the adrenals (like DHEA), this assumes you have proper adrenal function and no other hormone imbalances.
In reality, most women do experience a decline in both free and total testosterone around their 40's to 50's which may result in decreased libido, depressive-like symptoms and muscle atrophy.
It's very easy to identify low testosterone when it's outside of the reference range as in the example above, but what about women who have "low normal" testosterone levels?
It turns out that many women have testosterone levels in the bottom 25% of the reference range but still present with all of the symptoms of low testosterone.
In these women, it's also a good idea to consider testosterone replacement therapy as they stand to gain the same benefit.
In addition to age and menopause, many other factors can influence testosterone levels as well (elaboration below).
It's also worth pointing out that low testosterone levels (especially in postmenopausal women) have been associated with an increased risk of all-cause mortality (4) (death from all causes) - giving you yet another reason to replace your low levels.
What to do about it:
- Confirm low testosterone levels by checking both free and total testosterone in the serum. Your levels should be in the upper 50% of the reference range.
- If low consider the use of Testosterone replacement therapy through either the transdermal route or through injections. As long as dosing is low and remains physiologic the risk of adverse side effects is very limited.
- Consider using DHEA which is an androgen and testosterone precursor. DHEA is a hormone, so be careful with dosing (high doses may cause symptoms of too much testosterone and/or may be converted to estrogen instead of testosterone). Start with 25mg every 2-3 days to see how you tolerate dosing, you can even measure testosterone levels after 2-3 months of use.
- Consider using Maca and other supplements to naturally balance testosterone and androgen levels. Studies have shown that maca can help improve libido and sex drive and reduce the sexual dysfunction associated with SSRI anti-depressants. Maca can work for both men and women, in fact, maca was consumed by Inca imperial warriors before battles to boost their strength and ferocity.
#2. You may have Hypothyroidism or Autoimmune Thyroiditis
This is a big one (and the fact that my blog centers around thyroid function do not hurt either), but hypothyroidism can be a big contributor to low sex drive in women.
Hypothyroidism is severely underdiagnosed and even mismanaged in patients who have a known diagnosis of hypothyroidism.
This has to do with an outdated treatment paradigm and a T4 based treatment obsession that is almost pathologic.
As a result, many patients do not get enough T3 thyroid hormone and continue to suffer from the side effects of hypothyroidism despite being "treated" and despite having "normal" TSH levels.
If you want to know about testing for hypothyroidism and why current lab tests aren't very reliable please see this post.
What's important here is how thyroid hormone alters other hormones in the body:
Low tissue levels of thyroid hormone can lead to low testosterone levels (5).
We already know why testosterone is important for libido, but now we know there is a connection between hypothyroidism and low testosterone.
Low thyroid can influence both estrogen/progesterone (6) levels and alter menstrual cycles and fertility.
This explains why so many patients with hypothyroidism (even some on T4 replacement) still have issues with fertility.
Estrogen and progesterone levels (along with testosterone levels) are necessary for proper sexual health.
Alterations in these hormones further impair sex drive and libido.
Autoimmune thyroiditis is often associated with low testosterone states.
It is estimated that up to 90% of hypothyroidism in the US is caused by autoimmunity (7).
For many patients that means autoimmune thyroiditis or Hashimoto's thyroiditis.
This is important again because testosterone alters the immune system and low levels of testosterone (and other androgens) are associated with an increased risk of developing autoimmune disease (8).
In addition to this association, it appears that the autoimmune component likely plays a role in reducing sex drive in both genders.
What to do about it:
- Get a complete thyroid hormone panel and find someone who can help properly replace thyroid hormone. For most individuals, this means proper use of the T3 thyroid hormone (either in the form of NDT and/or Cytomel/liothyronine).
- Consider using supplements to help boost immune function: Zinc, Fish oil, Vitamin D/K2, and probiotics
- Take steps to naturally boost T3 thyroid hormone while reducing reverse T3 levels
#3. You may have Vaginal Atrophy
In addition to the decline in both progesterone and estrogen levels that accompanies menopause, many women also suffer from vaginal atrophy (9).
Vaginal atrophy refers to a reduction in the normal vaginal tissue volume which leads to a myriad of problems including painful intercourse and increased risk of developing urinary tract infections.
This helps explain why many women suddenly develop multiple urinary tract infections post menopause.
The change in vaginal tissue results in anatomical changes which increase the risk of UTI's.
In addition, the normal vaginal secretions that accompany intercourse are decreased which results in smaller amounts of natural lubricant.
Estrogen is a growth hormone that helps support normal vaginal, breast and endometrial growth.
Painful intercourse and an increased risk of UTI's obviously reduce a woman's overall desire for sexual intimacy.
Couple this with the normal decline of testosterone and we have a perfect set up for reduced sex drive at/around menopause.
The good news is that this problem is relatively easy to fix...
What to do about it:
- Consider transdermal estrogen and progesterone replacement. Bioidentical hormone replacement therapy (even if used systemically) can help restore vaginal health and mucosa and reduce painful intercourse. Note that this effect may not be seen for several months after starting hormone replacement. This will require a prescription from your provider/physician.
- Consider vaginal estriol replacement therapy. If you want to avoid systemic bioidentical hormone replacement therapy then you can opt for vaginal applications of estriol by itself. Estriol is considered a weaker estrogen and vaginal application reduce systemic absorption of this hormone resulting in low serum levels. This will require a prescription and applicator for proper use but the restoration of the vaginal mucosa is seen rapidly (usually within weeks).
- Consider judicious use of vaginal lubricants during intercourse. As long as UTI's do not limit your desire for intercourse then using lots of lubrication can offset the decline in natural lubricants seen after menopause. Opt to use water-based lubricants without any extra fillers.
#4. You may have Insulin Resistance
Like hypothyroidism, insulin resistance goes underdiagnosed by many providers.
Insulin is important when it comes to libido because of how it interacts with other hormones.
High insulin levels can alter testosterone levels. It can actually either increase or decrease testosterone based on other factors, but most patients experience a reduction in testosterone as insulin increases (10).
In addition, high insulin also leads to weight gain.
Weight gain by itself is associated with a decrease in libido and sex drive probably mediated by a combination of both biochemical/hormonal issues and psychologic issues (11).
In either event, insulin resistance is not something you want to have if you are interested in improving your libido.
Luckily insulin resistance can be treated with the proper approach.
What to do about it:
- Get your fasting insulin, blood sugar and Hgb A1c tested. Your fasting insulin should be less than 5, your fasting blood sugar should be less than 85 and your Hgb A1c should be less than 5.5.
- Consider making dietary changes and other lifestyle factors (including exercise) to reduce insulin levels and naturally boost testosterone, you can see the complete guide here.
- Consider the use of insulin-sensitizing supplements: alpha lipoic acid, berberine, chromium, and magnesium.
#5. Your Weight may be Contributing
This may go without saying, but as weight increases, libido seems to drop (12).
Why exactly this happens is unclear but it probably has to do with a combination of factors including:
- Decreased self-esteem
- Changes in neurotransmitter levels altering desire
- Changes in autonomic function
- Changes in hormone balance (including high insulin, low testosterone, etc.)
Another important factor is the current weight loss treatment paradigm.
Weight loss strategies are targeted at reducing calories consumed and increasing calories burned, unfortunately, this approach falls short and doesn't lead to long-lasting weight loss.
The approach of caloric restriction leads to further hormone imbalance and may further reduce libido and sex drive in many patients.
This is complicated further when we consider that most providers and physicians are not comfortable with bio-identical hormone replacement, making treatment for these disorders difficult.
Moral of the story?
Use the following case studies below to help guide you in understanding how to achieve long-lasting weight loss and the approach necessary...
What to do about it:
#6. Depression or other Mood Disorders may be contributing
It has been established that decreased sexual desire and libido have been associated with numerous psychiatric conditions including depression (13).
What you may not realize is that depressive type symptoms are almost always the result of some other problem in the body...
Depressive-like symptoms can range from high levels of inflammation, changes in neurotransmitter levels, changes in gut microbiota and even a deficiency in B vitamins.
What's important here is that many factors may be influencing your mood. If your mood is down then your sex drive and libido will naturally fall as well.
If you are suffering from this problem your focus should be on finding the underlying cause and fixing that problem...
Another big problem with depression is that the current treatment paradigm for reversing depressive symptoms involves the use of SSRI's (selective serotonin reuptake inhibitors).
This is a problem because the very medication used to help treat depression has been associated with sexual dysfunction (14)!
This causes a double whammy for those patients suffering from depression.
What to do about it:
#7. Your Partner may have Low Testosterone
This may not be intuitive at first but the truth is that it takes two to tango.
If your partner is suffering from any of these problems (men are susceptible to many of the same problems as women when it comes to libido), then it will be difficult to have sustained and consistent intercourse.
A lack of desire on the part of either partner may result in diminished libido for both partners.
Your decreased libido may be in part due to your partners decreased libido which means that both must be treated to maintain optimal results!
If you have noticed that there is a lack of desire in both parties then make sure both you and your partner get properly evaluated.
#8. Your Stress may be too High
Stress is inversely correlated with libido and sex drive.
Basically the more stress you have the less likely you are to have the desire for intimacy.
This, at least in part, appears to be mediated through cortisol levels (15).
As you may recall cortisol is secreted from your adrenal glands, and in addition to secreting cortisol, your adrenal glands also secrete DHEA (another androgen).
Because of this relationship, it's important to manage stress appropriately and use adaptogenic herbs if necessary to reduce the impact that stress has on your body.
In fact, studies have shown (16) that the adaptogen ashwagandha may improve the number of sexual encounters, the satisfaction of these encounters and the number of success during these sexual encounters.
This studies highlights the link between adrenal function and libido (especially in women) but doesn't necessarily elaborate why this connection is present.
In addition, it has also been shown that males suffer from erectile dysfunction while under high levels of stress (17).
What to do about it:
- Consider using adrenal adaptogens with emphasis on supplements containing ashwagandha for an extra boost to libido
- Consider adrenal glandulars to help balance adrenal function
- Manage stress levels while ensuring your body proper rest after exercise, eating a nutrient dense diet with enough carbohydrates and ensuring you are sleeping at least 8 hours per night
#9. Your Medications might be Causing it
And last, but certainly not least, your sex drive may be diminished because of prescription medications.
Other medications like narcotics, anti-anxiety medications and even ADD medications can also cause problems with sexual activity - but in my experience, the blood pressure and antidepressants seem to be the most common.
Unfortunately, nowadays it is very common to be placed on depression medication if your provider can't figure out what's wrong with you (this happens frequently for hormone imbalances), which may make your problem even worse.
Recall that hypothyroidism can cause mood disorders and sexual dysfunction. If you try to mask the symptoms of hypothyroidism with antidepressants then you are doing a disservice to the patient by complicating their symptoms even more.
Another problem is that you may react differently than the next person when it comes to any given medication.
This can make pinning downside effects very difficult.
If you suspect your sexual dysfunction is related to prescription medication then must be vigilant about diagnosing the underlying cause of your primary symptoms.
If you are on an SSRI for depression then you must find out what is causing your depression so that you might be able to ultimately get off of that medication.
This is easier said than done, but it is certainly possible with the right provider.
Recap + Final Thoughts
At the end of the day, it's important to realize that your sexual health is very important.
Sexual intimacy has been shown to provide several benefits to the body and a reduction in your sex drive, or sexual health should not be ignored.
Through a careful and thoughtful approach, it is possible to both diagnose and reverse sexual dysfunction.
If you are suffering from a decrease in libido get evaluated by your current provider with an emphasis on the 9 most common causes above.
Whenever possible focus on hormone imbalances (in my experience these tend to the major cause of sexual dysfunction in women).
This may require evaluation by a physician or provider who specializes in hormone balance.
Now it's your turn:
Are you suffering from low libido or low sex drive?
Has anything helped?
Why or why not?
Leave your questions or comments below!
References (Click to Expand)