Low Testosterone = Low Sex Drive

BY MARK SCHOLZ, MD

Call me an adolescent, but I think men’s egos are hugely impacted by their ability to satisfy their spouse’s sexual needs. But what if there is no “need” that needs gratification? What if your postmenopausal wife could care less about sex? While there are various other reasons besides hormonal ones for poor sexual dynamics—two obvious ones are relationship issues and sub-optimal function of the anatomy—this article is about the one quintessential ingredient for sexual interest: normal hormone levels in the blood.  What can be confusing is that hormone levels and anatomic function both decline as we get older. Therefore, ferreting out the reason for a low libido level may be confusing.

Other than to acknowledge their obvious importance, I won’t comment on how healthy relational dynamics are a prerequisite for romance. Obviously you ain’t gonna feel sexy if you’re angry at your partner.  Nor will I spend any more than the following paragraph discussing methods to restore anatomic function.  These themes have been thoroughly expounded by other writers. This blog is about how normal levels of testosterone are essential for normal sexual activity in both men and women.     

Anatomic Sexual Issues
Men with erectile difficulties often successfully resume normal function with help from Viagra and Cialis. When these pills are ineffective, prostaglandin injections will often restore erections.  For women in the postmenopausal state, when the ovaries stop producing estrogen, genital atrophy develops, resulting in uncomfortable sexual relations.  Topical estrogen creams are usually corrective.  

Testosterone, the Essential Hormone of Romance

The unbreakable link between testosterone and libido can be illustrated by recalling the baffling behavior of older teenage males when viewed through the lens of younger prepubescent eyes.  Back when I was 10 or 11, I remember being mystified by the behavior of the older boys who for no explicable reason had suddenly become girl crazy.  Now, however,  as an adult experiencing the effects of my own internal testosterone production, I readily confess, it’s no longer a mystery.

Testosterone, which fires up after puberty, works like a literal “on/off” switch for sexual desire.  High levels increase genital sensitivity and heat up sexual desire for both men and women.  When testosterone is low, sexual apathy sets in.  In fact, to a person without testosterone, sexual activity seems totally nonsensical.  As a prostate oncologist with extensive experience administering testosterone-lowering drugs to treat patients with prostate cancer, I am constantly in contact with men who have libido at zero levels. Amazingly, without testosterone, even men don’t want sex. 

Diagnosing My Wife

Familiarity with how my hormonally-deprived patients were wrestling with the effects of low testosterone must have helped me figure out what was happening when my wife’s libido suddenly changed after menopause. She, conversely, was oblivious.

I presented her with an impassioned argument and cajoled her into visiting a doctor specializing in bioidentical hormone replacement.  My diagnosis of inadequate testosterone was quickly confirmed.  The doctor (who my wife subsequently fired) overdosed her with a hefty 4-month testosterone injection. Honestly, it was almost too much of a good thing. For her, living with a male-level libido was painfully distracting (all of us guys can easily relate).

It was no surprise to me that, after the 4-month shot wore off, she became very mistrustful of bioidentical hormones. Eventually, she mustered the courage to consult a second physician who upon hearing her history wisely initiated the bioidentical hormones at a much lower dose.  Small upward adjustments in dose have led to restoration of her libido without untoward side effects.

Beyond normalization of libido, my wife reports another important benefit: improved energy levels. When asked about this, she says the increased energy is comparable to a cup of coffee, but without the caffeine jitters.  Medical studies evaluating testosterone replacement have also shown that raising testosterone levels is associated with improved blood sugar control in people with diabetes.

The setting of the sun on a previously healthy romantic relationship is assumed to be a part of the normal aging process. And of course there are a variety of potential causes besides low testosterone levels in the blood.  However, when testosterone levels are suppressed, the absence of motivation for sexual activity is almost guaranteed.  People need to be aware that both men and women can potentially reignite sexual interest back to youthful levels with skillful replacement therapy.