The stories we tell ourselves and the hormones that follow…
The Female Brain

When women (or men) are suffering from libido decline or any other related sexual disorder, the first thing they want to test and look at are HORMONES. It’s logical right? We are all taught to look to our genitals when our sex life isn’t going right. And sometimes my patients are right. The issue IS downstairs. However, for the VAST majority of partnered and unpartnered individuals who struggle with low sex drive, the answer is usually to look to the brain. Yep. The brain is the body’s most important sex organ BY FAR.

Here’s the deal. The brain has specific areas where it gets activated in response to thoughts of pleasure or pain. In anticipation of one or the other, neurotransmitters and brain compounds are released to create information in areas of the brain that want to protect us or lead us towards pleasure. If we are in a heightened state of anger, fear, or grief, it is unlikely we will be able to override those inhibitory signals to allow for the release of neuro-signaling that gives permission for pleasure, relaxation, and joy. Sometimes we don’t recognize why we are in these states of angst and feel we “should” be feeling one way or another. This can be from repressed or known trauma, disconnect with oneself or partner, and reactivity to external factors that override our protective mechanisms. The result is a depleted receptivity or proceptivity to sex (Wise, N., 2019).

What can we do about this? Well, the first is being careful about your inner chatter. Thoughts are just meaning we give to emotions. We create neural patterns and networks starting from very young children. We come into adulthood with pre-programmed ideas of what is safe vs unsafe. As adults, we use this existing roadmap to refute or confirm the world around us. Of course, we are able to modify these maps, but this takes time and repetition plus meaning. The internal stories we tell ourselves are not always true. And often are untrue when we really look closely.

Those stories, leading to neural patterning, and influencing brain chemistry is ultimately a much stronger influence on our sex life than what our adrenal glands, ovaries, or testicles are pumping out.

In fact, our brains can overtly influence the production of sex hormones which is why the field of psychoneuroendocrinology (the study of the psyche’s effects on the nervous and endocrine systems) is so fascinating.

Unfortunately, it’s also a lot more complicated to look at brain chemistry and alter it. It makes hormone management look easy-peasy. Antidepressants are a gazillion-dollar industry for a reason. Everyone is stressed out. Tired. Burned out. Our grab-and-go food choices, dependence on that 2nd or 3rd cup of coffee, and 5 hours per night sleep routine is screaming out. Yet we blame our hormones for not getting us in the mood. Ummm… no.

It’s also important to ask yourself some tougher questions here too. Do you feel comfortable in your own body? Do you connect with your partner emotionally? What is your motivation for wanting more sex, is it solely to please your partner? Do you withhold sex from your partner but feel sexual with yourself? Remember, the stories we tell ourselves lead us to write our own book chapters. Think wisely.

Brain à Neurochemicals/ Neurotransmitters à Hormonal Influence à Sexual Response

Ok, enough of the psycho-babble… Maybe you’re pretty damn sure it’s hormones and just want to figure out what does what. Here is a blueprint of our key sex-related hormones and how they behave in sexual stimulating and desire-seeking behaviors.

**Now, ladies and gentlemen, what you’ve all been waiting for (Circus Ringmaster voice) … the amazing, the incredible … Hormonal Soup:

DHEA (Dehydroepiandrosterone): Ohhh, I do love this hormone. Fun fact: This under-appreciated hormone is the MOST abundant in the human body. In fact, it is so abundant that scientists have yet to understand its comprehensive and complex role in humans. However, there is plenty we do know. First off, it can help transform into estrogen or testosterone. This is of particular interest in the peri and post-menopausal years. While its conversion is very low, when supplemented it has some potential to raise hormones in mild to modest amounts. It is important for adrenal support during chronic stress. Cortisol, the stress hormone, and DHEA have a balance. Chronic stress can take a toll on sex hormones in general, including DHEA produced, primarily, by the adrenal glands. Fatigue, lethargy, and loss of libido can ensue. It also is produced by the ovaries, testicles, and brain in smaller amounts. It strongly contributes to pheromone production, our own personal scent that lovers are drawn to, whether they realize the allure or not. It is anti-aging and can help with raising low mood. It can help drive sex drive in women more so than men. It is also used in fertility optimization to help improve IVF outcomes and potentially raise egg quality, although this last point is debatable. DHEA is highest in our mid 20s and declines thereafter (Crenshaw, TL. 2007). So what’s not to love here? Well in women who lean high in DHEA may suffer from acne, oily skin, and ultimately may be hyperandrogenic (high male hormones) leading to a common condition in pre-menopausal women called PCOS. While a discussion of PCOS is beyond the scope of this article, just know PCOS often includes blood sugar concerns such as insulin resistance.

DHEA is a BIIIIGGGG player in my practice and I test it frequently in men and women of all ages. When I see levels below 100 µmol/L in most women, I jump all over this. I pay particular attention to low DHEA when a woman has elevated cortisol levels, overweight, low libido, and low testosterone as they have a strong interplay between them.

What lowers DHEA?

Alcohol, stress, obesity, high levels of cortisol natural or medications like prednisone, oral contraceptives, some cholesterol medications, advancing age.

How do we raise DHEA?

Meditation, specifically a form of meditation called Transcendental Meditation, has been shown to raise this luscious hormone while getting your mind right in the process. Win-Win.

Adrenal support intended to balance cortisol. This may be through botanicals like Ashwaganda or amino acids such as phosphatidylserine.

Direct DHEA replacement is honestly where I go the most, in addition to the items above. I prescribe it to a compounding pharmacy (although it is avail over the counter), my experience has largely been more positive with patients receiving a pharmaceutical grade.

The famed author, researcher, sexologist, and physician Dr. Theresa Crenshaw writes “DHEA may be one of the most important hormones for the sexes, fostering the potential for biological and sexual common ground and paving the path to equality” (Crenshaw, TL. 2007).

PEA (Phenylethylamine, not to be confused with palmitoylethanolamide, a pain management compound): Our lust hormone. A natural rush that feels like, and is, amphetamine-like. Our own brain produces this and it causes heightened sexual interest, loss of appetite, racing heart, insomnia. It causes disruption to new lovers’ workdays where fantasy distracts and prioritizes one’s mind. When it is low it is associated with depression and low mood. At excessive amounts, it can cause delusions and psychosis. This neurochemical spikes at orgasm and during female ovulation. It also plummets after heartbreak and can explain the physical pain associated with a new break-up in the form of feelings of “withdrawal”. Because it is. Natural amphetamine withdrawal (Crenshaw, TL. 2007).

How do we raise it? Chocolate is most famous for raising PEA dietarily although some other less favorable artificial items can do it too like diet soft drinks d/t the artificial sweeteners (not an endorsement for diet soda, btw). The amino acid L-phenylalanine is an essential precursor to this molecule and increasing the body’s supply of this compound can make production of PEA most readily available. Direct replacement of PEA is available through supplements but comes with some really yucky, and often not so sexy side-effects like digestive upset, anxiety, and flushing. PEA can also be raised through exposure to sexy material such as written or visual content.

PEA can be explained for why a new lover or person of interest can seem perfect in the beginning of a romance and as PEA fades, which is natural during a healthy relationship, our partner may be revealed to be human after all. For established couples, I encourage partners to write their partner flirtatious emails or texts during the pay, priming both person’s to have elevated PEA levels through the daytime, thus having an effect for later in the evening when work is done.

PEA can also help stimulate testosterone and estrogen, which are also potent drives to sexual desire.

PEA can be raised by certain medications, notably those that treat Parkinson’s disease and depression. However, they come with a lengthy list of side-effects and potential risk, thus should not be considered in most cases. MAO-Inhibitors and Eldepryl are both associated with raising PEA levels, and should always be closely monitored by a physician familiar with prescribing these drugs.

Testosterone

TheI want it and I want it now” hormone.

Testosterone is by far the most directly stimulating sex hormone on the sexual desire system. It activates our drive to want penetrative sex. It is activating to our brain’s response and can directly transform into estrogen, a pro-libido hormone in itself. It may also create extra sexiness in that it maintains assertiveness, self-confidence, and maintains separateness. It is not a cuddle hormone but a wham, bam, thank you ma’am (or sir, whatever you’re into).

Dozens of research papers now support the use of testosterone replacement therapy for women with hypoactive sexual desire disorder but we should be careful to attend to the WHY behind testosterone being low in the first place. From a Functional Medicine approach, we always want to think about sleep, stress, nutrient intake, and exercise. Maintenance of healthy testosterone levels has been demonstrated in women with healthy habits compared to sedentary, overweight, and depressed individuals. Testosterone also can help with metabolism in women beyond just sex. It supports maintenance of lean muscle tissue and ramps up the metabolic furnace of the body. It also helps with cognition. It is produced by the adrenal glands (primarily for women) and minimally in the ovaries. Men produce testosterone primarily in their testicles and the most common form of low testosterone comes from under-production of the testicles in producing testosterone due to metabolic or life stressors.

Fortunately, in both sexes, testosterone is relatively easy to measure although it does cycle throughout the day. Best to measure in the mid-morning typically.

Women with low DHEA, often, not always, will have low testosterone. Raising DHEA as the precursor hormone can, and often does, impact the other. In men, this is seen less-so, although reasons to consider DHEA supplementation in men are still plentiful.

Testosterone replacement therapy in women has shown direct correlation to enhancement of sex-drive. It is typically prescribed in a cream, oral troche, or pellets for women. Replacement of testosterone in men is an important topic and will be covered in a later article. For now, just know, testosterone is critical in men for healthy sex-drive.

A recent peer-reviewed article published in 2021 by Parish and colleagues states “In studies of women with HSDD, transdermal testosterone also improved the frequency of satisfying sexual events, arousal, orgasm frequency, pleasure, responsiveness, and self-image while reducing sexual concerns” (Parish et al., 2021).

This finding has also been my clinical experience in working with thousands of women with reports of low libido over my years in practice.

Estrogen

The feminine, soft, and sensual hormone

Enhances a woman’s sexual allure and pheromones. Supports texture of skin, vaginal tissue, and lubrication. Enhances desire and activates oxytocin. It is what gives women their shape, curves, and softness.

I will not downplay my complete infatuation with estrogen for women for MANY reasons. In fact, I will shamelessly tell you when my ovaries start sputtering along, I will be the first to reach for an estrogen patch. Unfortunately, there is an abundance of misinformation about estrogen, its risks, and downsides. I will discuss hormone replacement therapy in greater detail in a future article. However, for now, I will say that for peri-menopausal women, there is unlikely to be a better option for supporting health, function, and sexual satisfaction than estrogen.

In the work of Komisaruk, Beyer-Flores, and Whipple, research has demonstrated estrogen needs its accompanying masculine hormone testosterone to facilitate sexual response, including orgasm (Komisaruk BR et al., 2006).

A few quick points.

– Can be tested through blood, urine, saliva. All have variable benefits.

– Estrogen replacement can be done with a local estrogen for vaginal support or systemic estrogen for bone, brain, cardiovascular benefits including libido.

– Organic soy products and other botanicals contain phytoestrogens which can have mild estrogenic effects in post-menopausal women.

– Works best with testosterone for libido stimulating effects

Bottom line – LOVE ME SOME ESTROGEN. And so do most partners, whether your choice is male or female partners.

Oxytocin: The “Love” Hormone

“Have you ever wondered why you feel so safe and wonderful when someone you love holds you close? It’s as though an invisible force field suddenly surrounds you, protecting you from harm. Danger disappears, problems fade away, and you feel absolutely secure in the magic of someone’s arms. It isn’t logical. It isn’t even true. An earthquake or hurricane could get you. But none of it matters at the moment because your sense of well-being is so powerful”

– Dr. Theresa Crenshaw from her book “The Alchemy of Love and Lust”

Oxytocin rises in intimately bonded partners, between child-parent, and even close friends whom share a deep bond (love you @FunctionalFertility). Oxytocin intensifies around ovulation and is released during orgasm, bringing a sense of oneness to the experience of sexual connection. Oxytocin, biologically speaking, is required to expel the fetus from the mother’s uterus causing intense contractions. Later, when nursing the infant, oxytocin allows for milk release from the breast in lactating mothers.

Milder versions of post-orgasm uterine contractions can be felt after sex by many women. Many women also enjoy their breasts being suckled by their partner, bringing pleasure, intimacy, and desire. This is likely due to the nerve stimulation and wiring in the brain that arouses some of our deepest primal instincts.

Oxytocin is produced in males as well and touching, closeness, and yes, “cuddling” all encourage flow of this hormone on a regular basis.

Oxytocin is not measure-able in a routine office visit, in the way the other hormones previously discussed are. This is due to the nature of its metabolism. However, we can see elevated levels in research studies in animals and humans during intimate experiences. Oxytocin is prescribed as a compounded medication for men and women wanting to encourage and enhance their intimate bond. Delivered in a nasal spray, it has direct access to the brain encouraging love and social bonding interactions, including sex. While the research is promising, it is not a currently approved FDA therapy and should not be used as a stand-alone for HSDD at this time. When combined with other stimulating agents, oxytocin has a complementary stimulating potential that may augment sexual satisfaction.

Prolactin

Post-baby libido decline? Prolactin is biologically designed to drive down sex-drive, including testosterone levels, a very potent sexual stimulating hormone. Prolactin is a hormone that is primarily released in high levels when a woman is lactating. In pathologic cases, we can see a benign, but bothersome tumor of the pituitary gland (brain) called a “prolactinoma” that can drive down sex drive and may lead to milk release from the nipples in non-breastfeeding women. In men it is critical for sperm production.

For my postpartum mama’s, pumping or nursing is a big job, and requires lots of prolactin but can play a role in your aversion to more pretend or real baby-making with your partners. Never mind the disturbed sleep, baby spit-up, and endless laundry. It does go back down when you’re done nursing your little ones and your testosterone levels will likely surge as a response. Prolactin is inhibitory to testosterone production, which is likely the hormonal link in this story.

Progesterone

Not the sexiest of hormones but an important one. Progesterone is produced post-ovulatory in menstruating females and primarily helps to maintain the uterine lining in preparation for potential pregnancy. As a medication prescription, it can be extremely helpful in women who lean on the estrogen dominant side as it can balance estrogen, help with sleep, and provide a mild anti-anxiety effect. On the flip side, it can also contribute to a decline in sex drive when not appropriately balanced by estrogen, testosterone, and ultimately the neurotransmitter dopamine. It helps to increase natural brain opioids. Decreases uterine contractions and leads to more comfortable menstrual cycles when taken continuously (Crenshaw, TL., 2007).

Progesterone administration can be supportive for women who suffer from premenstrual syndrome (PMS) mood changes and, more severely, from premenstrual dysphoric disorder (PMDD). Finding a balanced baseline between the foundations of health and a healthy sex life is a thin line sometimes.

Ultimately, I would never give a woman progesterone solely to raise her libido. It would be counterproductive. It is inhibitory to many of the very systems we would be trying to jump start. However, I would give her progesterone to sleep better, leading to higher quality rest and rejuvenation, thus helping her make better lifestyle choices like exercise, meditation, and nutritious food. This is how the complexity of hormones with life really work. We have to think about what they do for the whole system.

Vasopressin

The “monogamy molecule”. Helps with memory, cognitive function, and helps mellow the extreme sexual behaviors. Additionally, it helps to support testosterone and attention to sexual response. Rises with sexual stimulation and arousal. Interestingly, the botanical Yohimbe raises this neurohormone but can cause agitation, anxiety, and nervousness.

Assessment of Hormones

Now that you’ve gotten the lay of the hormonal landscape how do you assess the hormones listed above?

Well, if you’re not on hormonal contraceptives – IUD’s don’t count – then you can have most hormones listed above mentioned in addition to a few others that are not mentioned for simplicity’s sake. Ask your doc for a hormone panel that includes:

Women

SHBG

Prolactin

Estradiol on day 3 of menses or day 21

Progesterone (Day 21 or 5 days post-ovulation)

LH

FSH

Testosterone (total)

DHEA-S

DHT

Salivary Cortisol

Thyroid Panel

Vitamin D

Remember, hormones can be influenced by our stress, sleep, dietary patterns, digestion, and the self-talk we loop in our heads. And this is not an exhaustive list by any means. Productive, self-compassionate discussions can go a long way in helping to re-balance hormonal concerns.

It is through the lens of the Functional Medicine matrix that we can see mental-emotional-spiritual processes lie at the center. Identifying the areas where hormonal disruption may be the EFFECT but not the cause of our imbalances requires an understanding of the inter-relationships between body systems.

I encourage working with a certified Functional Medicine practitioner to support your discovery process.

Functional Medicine Matrix by The Institute of Functional Medicine

Writer: Michelle Leary
Writer: Michelle Leary
December 9, 2021

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