Let’s take a look at what hormones do influence sex function that have the current focus in medicine. For women, the three main sex hormones are estrogen, progesterone, and testosterone. I will focus attention on estrogen and testosterone. Estrogen provides vaginal mucosa healthy, keeps the vaginal muscle tone, and urinary tone. During perimenopause and into menopause, many woman begin to experience atrophy of vaginal mucosa which often causes intercourse to be uncomfortable and painful. This experience may lead to desire issues as painful intercourse does not equal pleasure. Often with some form of estrogen supplementation, women find improved sexual intercourse experiences and return of desire for sex.
Testosterone is considered the sex hormone for both men and women. How testosterone actually binds to receptors within the brain circuitry is unknown. But it’s most likely thought that it’s action is based in keeping trophic activities, meaning neuronal growth. Remember my blog on neuroplasticity and our ability to change our brain. This makes perfect sense that with testosterone present (or not), we keep neurons firing together or they wire together.
When we have sufficient hormones available, structures within the limbic system are induced which cascades into sexual responses. So when we are deficient in such hormones, it certainly may be that hormone replacement may help “nourish” this rich brain circuitry.
As I mentioned earlier, sexuality is multi-dimensional. Physical causes of sexual decline provide a piece of the puzzle to help guide treatment. For women, hormone replacement has not shown to be efficacious to most women. In men, another story. Low testosterone with replacement, does result in increased libido when testosterone levels increase.
Ultimately, sexual desire is a result of who you are physically, emotionally, mentally and spiritually. If you’ve are on hormone replacement and not experiencing improvement in sexual function, then it’s time for further investigation into all of who you are as an integrated being. All medical inquiries into low libido should begin with an integrated evaluation and a treatment plan that addresses each dimension to promote sexual well-being and recover your libido.