In my gynecology and natural medicine practice I treat
literally thousands of women of all ages who are suffering
from hormone imbalances. Typically, patients coming to see me
enter my office citing such common complaints as hot flashes,
irregular bleeding, night sweats, weight gain, fibrocystic
breasts, headaches and fatigue. Unfortunately, they are often
less comfortable discussing their sex drive or sexual
function. When asked, I am often told that they "don't feel as
sexy as they used to" and "sex isn't as enjoyable as it was
decades ago" but "I guess that's what happens when you aren't
twenty any more!"
Clinically, these women are suffering from hypoactive
sexual desire disorder, more commonly referred to in lay
language as "low libido". As a physician, I am vehement that
women should not assume that problems with arousal and desire
are a natural consequence of aging. A woman's libido and
sexual response is complex and can be dependent on multiple
factors including emotional intimacy, non- biological stimuli
such as smells, sounds and touch, and biological factors
including hormone production and balance. For the purpose of
this newsletter, I will focus on the latter variable impacting
sexual desire and response: hormone production and balance.
In my practice I found a high correlation between estrogen
dominance and less frequent sexual activity as well as
reported reduced sexual pleasure. As I have discussed in both
my book From
Hormone Hell To Hormone Well and in previous newsletters,
the human body produces three sex hormones: estrogen,
progesterone and testosterone. Typically, women in their
twenties evidence a physiologic balance of these three
hormones which later becomes their baseline for normal,
healthy hormone production. As women age, however, their
hormone levels begin to shift and this can occur as early as
then end of the second or the beginning of the third decade of
life. Progesterone is the first hormone to drop off in levels
of production, actually dropping 120 times faster than
estrogen levels. When progesterone levels begin to fall an
imbalance occurs and the female body is said to be estrogen
dominant.
Estrogen dominance can cause many physical, mental and
emotional symptoms. Among these are: water retention,
fibrocystic breasts, depression, dry and wrinkly skin,
irregular and sometimes heavy bleeding, a higher
predisposition for breast and/or uterine cancers and- yes-a
much lower libido. Without the progesterone required to
balance estrogen production, the female body's sexual anatomy
is handicapped. This is evidenced by vaginal atrophy (loss of
muscle tension), decreased vaginal mucus production (vaginal
dryness) and decreased clitoral blood flow leading to reduced
responsiveness. It should be obvious to even the lay person
that the traditional medical community's response of giving a
woman with low sex drive more estrogen (usually in the form of
synthetic estrogen replacement therapy) will not have the
desired effect of increasing sex drive. Of even greater
concern, is that adding more estrogen will most likely amplify
the body's negative symptoms and harmful side effects known to
be associated with estrogen dominance.
The fact that progesterone deficiency and estrogen
dominance is most often the underlying physiologic cause of
low libido frequently surprises my patients. They have somehow
come to think of testosterone as the sex drive hormone.
Testosterone does influence libido but it acts differently in
men and women. Let me explain.
Remember when I said that progesterone was the first
hormone in women to slough off in production, well
testosterone is the last. Most women will not experience a
drop in their testosterone levels until they are
post-menopausal, usually late forties to mid- fifties. At that
time, an individualized prescription of human-identical
hormones will almost always include testosterone replacement.
It should be noted that women who have undergone a complete or
partial hysterectomy resulting in their entering surgical
menopause will more immediately require a comprehensive
complement of all three sex hormones, e.g. estrogen,
progesterone and testosterone.
In men, progesterone is the biochemical precursor of
testosterone. When progesterone levels begin to drop in men,
testosterone levels also fall. This occurs when a man enters
male menopause- or andropause- usually sometimes in the mid to
late forties. While this article is dedicated to the
discussion of women and sex drive, it should be noted that
hormone imbalance can also result in decreased libido and
sexual performance for men. Again, human-identical hormone
replacement can be an effective treatment of choice.
In many cases, human-identical progesterone therapy can
sufficiently treat hypo-active sexual desire and response. In
addition to the literal physical benefits related to sexual
function including increased vaginal lubrication and improved
clitoral response, human- identical progesterone replacement
therapy may also positively some of the more subjective
variables impacting sexual desire. For instance, frequently
women report to me that their sex drive is also positively
impacted when the human-identical progesterone I prescribe
helps them to stop retaining water, more easily lose the extra
weight hugging their thighs and abdomen, and stabilize their
mood and energy swings.
In treating thousands of women with low libido, I have
found that human-identical hormone replacement therapy almost
always is a precursor for positive changes in a woman's
feelings of sexuality as well as self-perception and
self-confidence. With life expectancy for women extending well
into the eighties, it should be good to know that, with human-
identical hormone replacement, it can be possible for sexual
desire and pleasure to be just as potent and enjoyable for the
young-at-heart as it is for the young-in-years!
For information about male hormone imbalance, click
here.
As a woman enters her
mid-thirties and until she is in her late forties, she can be
said to be pre-menopausal. A woman in this lifecycle is in her
middle reproductive years. It is during these years that the
balance of hormones produced by the endocrine system first
begins to shift. Progesterone, the "feel good" hormone, is the
first hormone to decline and drops 120 times more rapidly than
estrogen.
