Hormone Replacement Therapy Impact on Low Libido in Women

What is a Sexual Drive?

“Sexual response is a complicated affair: that it is a response rather than an innate force is sometimes forgotten. The stimuli needed to trigger the emotions we label as desire and arousal, as well as the physical responses of the body, are highly variable, influenced not only by experience but by culture, morality, newness versus sameness, uncertainty versus predictability. The individual’s openness in attending to the sexual stimuli to allow the mind’s conscious and unconscious appraisal, adds further levels of complexity. This appraisal and subsequent responding involve numerous neurotransmitters and peptides, themselves modulated by, and interacting with sex hormones, most notably testosterone.”

Sexual issues are the most discussed problems talked about with physicians. As stated above, the influences surrounding sexual desire and arousal are complex. Sadly, as with other women’s health issues, a complete and total understanding, accompanied by research, is lacking.


“Hypoactive sexual desire disorder is a common but frequently undiagnosed condition.”

This condition, which can include a lack of motivation for sexual activity and loss of desire to initiate or participate in sexual activity, can also be characterized by distress, poor body image, grief, sense of incompetence, sadness, and worry. The HSDD diagnosis as a category in the DSM 5 has been controversial. Initially, researchers and doctors did not evaluate pre-menopausal and post-menopausal symptoms regarding HSDD. Research has revealed that there are a variety of influences impacting a woman’s arousal and desire. While estrogen and testosterone levels diminish with aging, research is moving closer to understanding the role of brain function in this underdiagnosed condition. A complete analysis of a patient’s psychosocial, medical, and intellectual states is necessary, as with all conditions.

There is a 5-question quiz that your physician can provide that can aid in the diagnosis of HSDD. This alone is not enough, and there should be, as stated above, a comprehensive evaluation of the body done, including thyroid functioning.


This condition occurs when the gonads (sexual glands) produce little to no, sex hormones. This condition can impact teenagers and adults of all genders.

The glands in the brain that signal the sex glands are the hypothalamus and the pituitary gland. When there is a disconnect within the sexual glands, a malfunction interferes with the production of hormones. Two types of hypogonadism exist 1) Primary Hypogonadism, which slows or stops hormone production, and 2) Secondary Hypogonadism in which the brain has difficulties responding to signals that create hormone production.

According to the Mayo Clinic, sexual dysfunction in women can also be attributed to vaginal dryness, medication, chronic health conditions, loss of a partner, stress, mood, and more. Irregular blood levels, thyroid problems, diabetes, high cholesterol, and liver disorders also impact estrogen levels in women. For teenagers, low sexual drives can be part of hypogonadism, causing her/they to enter puberty late.

Reduced sexual desire due to vaginal dryness and shrinking of the vagina can be treated:

  • Estrogen: Available in many forms including pills, patches, sprays, gels, creams, and slow-release suppository or ring. Estrogen does not improve sexual function related to hypoactive sexual desire disorder (lack of sex drive)
  • Testosterone: Replacement isn’t approved by FDA for sexual dysfunction in women but can be prescribed off-label. However, it can cause acne, excess body hair, and mood or personality disorders
  • Prasterone (Intrarosa): A vaginal insert delivers DHEA to the vagina to help ease painful sex
  • Ospemifend (Ospena): A pill that also helps relieve painful sex. Not approved for women who have had breast cancer or those with a high risk of developing breast cancer

There are several lifestyle changes that may help alleviate low libido such as exercise, ways of positively coping with stress, better communication with partner, intimate time set aside, different sexual positions and locations, experimentation, sex toys, fantasy dialogues, and reducing or eliminating smoking, illegal drugs, excessive alcohol.

Chronic Conditions that Affect  Sexual Function

  • Diabetes
  • Osteoarthritis
  • Heart Disease
  • High Blood Pressure
  • Cancer
  • Obstructive Sleep Apnea

Overall, the female sex hormones are estrogen and progesterone. These are produced in the ovaries and in body tissues, while testosterone is produced in the ovaries and the adrenal glands. An imbalance of these hormones can influence a range of symptoms that include but are not limited to:

  • Weight gain
  • Fatigue
  • Depression
  • Anxiety
  • Vaginal Dryness
  • Irregular Periods

Imbalances can occur with anti-hormone therapies used to treat breast cancer and infertility. Additionally, uterine fibroids can have a profound impact on a woman’s libido.

Hormone replacement therapy is one option. However, it must be determined whether this approach is appropriate. Additionally, research differs on which hormones are the best used in treating women with low libido.

Testosterone is produced within the central nervous system. In women, for example, changes in the brain occur with the reduction of serum levels associated with sex hormones and age due to menopause. More research is required to understand if supplemental testosterone impacts the receptor levels and the related to a sense of desire and arousal. To date, large epidemiological studies do not show a correlation between serum levels of testosterone and women’s sexual functioning. For many women, sexual satisfaction was related to emotions and not just levels of sexual hormones.

Sadly, despite the research, many Doctors who prescribe testosterone to men assume the hormone will have the same results in women. Not only is this not true, but it may also cause other problems such as acne, balding, deepening of the voice, excessive facial hair, and enlargement of the clitoris.


 It is commonly understood that when a woman goes through menopause she is moving from a reproductive state to a non-reproductive state. Many changes in a woman’s body occur during this time including the reduction of sexual hormones. Often, women will experience a decrease in sexual desire, but not always. For those that do, other symptoms associated with menopause occur, such as hot flashes, depression, sleep disturbance, and more. For these women, a variety of therapeutic modalities may be appropriate. These treatments must be based upon credible blood tests, as a start.

Androgenix Solutions of Palm Beach County

To help you understand your low libido, you can rest assured that our staff of professionals will listen to you and take the necessary steps in helping you understand what your options may be. Call now. Do not live in discomfort or shame. The staff at Androgenix Solutions of Palm Beach County is here to help.


*Unless otherwise stated, individual results may vary depending on many factors not all patients “feel” or achieve the same results.