What is a sex drive?
It seems like an easy question to answer, but every answer uncovers more questions. If you feel physical desire for someone, is that a product of your sex drive? Do you feel desire because of the connection you have with someone? Or do you feel connected because of desire?
The drive to have sex is deeply personal. But it is also a product of biology. Hormones have a huge impact on your sex drive and can raise or lower that drive independent of what we consciously desire. That can be an uncomfortable relationship but an important one to recognize if you want to understand your own sexuality.
This may be particularly true for women. The relationship between testosterone and libido in men is well-understood, but the complex connections between hormones and sex drive are less clear in women. Still, exploring what we do know is vital, especially if you are struggling with your libido. Significantly, menopause and hormone imbalances related to high levels of progesterone have been shown to have a negative impact on a woman’s sex drive. But both may potentially be addressed with hormone therapy, giving you more control over your sexuality.
What Is Low Sex Drive?
To begin, it is important to clarify what we mean by sex drive. There are infinite valid reasons for a woman to not want to have sex, either in specific instances or more generally. But when we are talking about a woman with low sex drive, we mean someone who would like to feel sexual desire, but just doesn’t. In severe cases that result in significant distress, you may be diagnosed with hypoactive sexual desire disorder. However, lack of sex drive doesn’t have to reach the point of a diagnosable condition to be troubling and warrant attention.
Why Testosterone May Not Be the Answer
There are also many reasons for low sex drive in women, including relationship problems, physical health concerns, and emotional issues. Often, however, the root cause of a low libido often lies in hormones and the balance between them.
The hormonal phenomenon most clearly connected to low sex drive is menopause. This waning of desire for sex is primarily caused by the fall of estrogen that prompts the end of the reproductive years. But no matter what your age, estrogen, progesterone, and testosterone can all have an impact on sex drive, and manipulating hormones has the potential to restore desire. However, this is a complex science and one that is still evolving.
While estrogen therapy has often been recommended to postmenopausal women, androgen-based solutions have historically been considered the first choice for women prior to menopause. As a 2016 study by researchers at Emory University notes:
Pharmaceutical companies have invested heavily in the development of androgen therapies for female sexual desire disorders, but today there are still no FDA approved androgen therapies for women. Nonetheless, testosterone is currently, and frequently, prescribed off-label for the treatment of low sexual desire in women, and the idea of testosterone as a cure-all for female sexual dysfunction remains popular.
Indeed, some studies do support the use of testosterone to boost sex drive in women (although results have been mixed). Others have found that combining estrogen with testosterone led to greater sex drive than estrogen alone in postmenopausal women. But research has not established an association between low serum testosterone levels and low sexual desire. This absence led the authors to conclude:
The likelihood of an androgen-only clinical treatment will meaningfully increase women’s sexual desire is minimal, and the focus of pharmaceutical companies on the development of androgen therapies for the treatment of female sexual desire disorders is likely misplaced.
So is there a better solution? Many believe that the answer lies in understanding the role of progesterone.
The Science of Progesterone and Sex Drive in Women
Researchers have repeatedly found that higher levels of estrogen have a positive effect on a woman’s sex drive. And that makes sense—after all, countless postmenopausal women can attest to the efficacy of estrogen therapy in restoring their sex drive. However, the impact of estrogen on sexual desire is not about estrogen alone.
Estrogen and progesterone levels rise and fall throughout the reproductive cycle. But they don’t rise and fall in unison. Rather, their proportions change to guide reproductive processes—the preparation of the uterine lining, ovulation, menstruation, etc. These changing proportions also have a significant effect on sex drive. As one study by researchers at the University of California, Santa Barbara notes, “With respect to within-cycle, day-to-day fluctuations in subjective desire, we found evidence for positive effects of estradiol and negative effects of progesterone.”
These findings are logical from a biological perspective, as estrogen is dominant and increases significantly prior to ovulation. Having a strong desire for sex at this point in the menstrual cycle greatly increases the chance of pregnancy. After ovulation, however, estrogen falls sharply. And while it does begin to rise again in the days following ovulation, so too does progesterone—and progesterone levels begin to exceed estrogen. During this phase of the cycle, many women find that their sex drive diminishes. After all, there is no reproductive advantage to sex during this part of the menstrual cycle. And while humans are not entirely beholden to biology and our relationships with sex and desire are infinitely complex, biology can and does continue to play a vital role in our lives.
Without adequate estrogen, your body may not be receiving the signals it needs to desire sex. For women who are struggling with low sex drive, it is therefore worth examining whether the relationship between estrogen and progesterone has become unbalanced.
Creating Balance to Regain Your Sexual Desire
If you google “how to lower progesterone levels”, you will be treated to over 12 million results…none of which are about how to treat low levels of progesterone. That’s because there is no safe or effective or even logical way to lower your hormone levels. But in this case, hormonal manipulation isn’t about an absolute amount. It’s about balance; by raising your estrogen levels, you may be able to establish a healthy proportion between estrogen and progesterone and recapture your desire for sex.
One of the safest ways to do that is bioidentical hormone replacement therapy (BHRT). BHRT uses hormones that are chemically and structurally identical to your own in doses that are tailored to your body. Because BHRT is custom-compounded, it is available in a range of administration methods to suit your preferences and lifestyle. By working with a practitioner who specializes in hormonal health and BHRT, you can develop a personalized treatment plan that allows you to feel the way you want at every stage of your life.
There is nothing inherently wrong with not wanting to have sex. You might not want to have sex at any given time with any given person for a variety of reasons, and the decision to enhance your sexual desire must be made by you—not your partner. You should always know that you have options and resources if you are pressured into having sex. But if you want to have sex, there is treatment available.
Ultimately, seeking hormonal treatment for your sex drive is about choice. It’s about navigating the emotional and physical decisions that make up your sexuality without worrying about if your biology is taking those choices away. It’s about you setting the course for your own life and deciding what your future will look like.
If you are struggling with a low sex drive, BodyLogicMD can help. The BodyLogicMD network is comprised of top medical professionals specializing in hormone health and hormone replacement therapy. A BodyLogicMD-affiliated practitioner will design a personalized treatment plan to address your symptoms and help you achieve your health goals using the best therapies available today. Contact a local practitioner to schedule your first appointment, or take the BodyLogicMD Hormone Balance Quiz today.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended to diagnose, treat, cure or prevent diseases.
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.