Low libido is a common concern for women. According to a study done on over 2,000 women, 26% of premenopausal and 52.4% of postmenopausal women report experiencing low libido. This article will discuss libido and the signs and potential factors contributing to low libido in women. We'll then explore functional medicine testing to assess possible underlying factors of low libido in women and supportive approaches that may help address it.
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What is Libido?
Libido is a Latin word that means "desire" or "lust." We commonly use the word libido when referring to sexual desire. Commonly referred to as a person's "sex drive," libido is a subjective term without definitive measurements; what's considered "low" for one person may differ from another. Low libido often results in a lack of sexual intercourse or sexual experiences, as these no longer hold the pleasure they previously did for the person. Chronic loss of libido is known as Hypoactive Sexual Desire Disorder (HSDD), which affects one in ten women.
Signs of Low Libido in Women
Signs of low libido in women may include:
- Lack of interest in any sexual activity
- Lack of, or rarely occurring, sexual thoughts or fantasies
- Concerned about the lack of sexual thoughts or fantasies
- Difficulty having an orgasm
- Vaginal dryness
- Pain during intercourse
- Lowered sense of arousal
What Causes Low Libido in Women?
Below are several factors that are associated with low libido in women:
Medications
Medications such as oral contraceptive pills (OCPs), commonly known as birth control, may be associated with low libido. It has been shown that OCPs raise the level of Sex Hormone Binding Globulin (SHBG). SHBG acts as a taxi for certain hormones, including testosterone, and testosterone seems to play a role in libido. Low libido is also a listed side effect of selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication.
Blood pressure medications, chemotherapeutics, antipsychotics, and other medications are also linked to low libido.
Micronutrient Deficiencies
Low zinc, vitamin D, and iron levels have all been linked to low libido.
Hormone Imbalances
The thyroid gland produces hormones that every cell in the body utilizes. An underactive thyroid, when the thyroid gland does not produce enough thyroid hormone to satisfy body requirements, can affect every system in the body. One study showed that 50% of women with an underactive thyroid, known as hypothyroidism, had low libido.
As sex hormones are tightly intertwined, there has been conflicting evidence regarding which hormones directly cause low libido. However, estrogen and testosterone seem to correlate strongly with libido. Loss of estrogen can cause vaginal dryness and painful intercourse, which can lower sexual desire. Low testosterone levels have been linked to lower arousal, libido, orgasm rate, and genital sensation.
Stress causes the release of the hormone cortisol. While cortisol is essential and can positively impact the body, high levels of stress and, thus, high levels of cortisol can suppress libido.
Lifestyle
Smoking, recreational drug use, and alcohol use can be associated with low libido. The lack of exercise and physical activity can also be linked to low libido.
Other Medical Diagnoses
Additionally, low libido can be associated with many health conditions, including but not limited to Rheumatoid arthritis, chronic kidney disease, cancer, diabetes, headaches, heart disease, and high blood pressure.
Functional Medicine Labs to Test for Root Cause of Low Libido in Women
The following functional medicine labs can help assess potential underlying factors of low libido in women:
Hormone Testing
A sex hormone test can be beneficial in assessing levels of sex hormones. The Comprehensive Female Panel Plus, by Access Medical Laboratories, shows levels of estradiol, estrone, testosterone (free and total), sex hormone binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), DHEA, and many more hormones. Seeing levels of estrogen, as discussed above, is important as low estrogen levels have been associated with low libido. Seeing free and total testosterone is important, as free testosterone is the amount that is available for use to the body. The difference between free and total testosterone is the amount of SHBG, which acts as a taxi for testosterone in the body. When testosterone is attached to SHBG, it is unavailable for use. Lastly, LH and FSH are two hormones released by the brain and orchestrate the female menstrual cycle, controlling the actions of the ovaries, including ovulation and the release of hormones. DHEA is the precursor to testosterone and thus is important to measure. It is essential to look at these hormones together as they all work synchronously. Additionally, this panel assesses thyroid hormones which, as discussed above, when suppressed, can lower libido.
Stress Testing
The Adrenal Stress Profile by ZRT Laboratories is a salivary test that assesses cortisol levels throughout the day as well as a morning DHEA level. Cortisol is the body's primary stress hormone, and high levels have been linked to low libido.
Micronutrient Test
Micronutrient tests, such as the Micronutrient Test by Spectracell Laboratories, assess a wide array of vitamins and minerals that are essential to the body. As discussed above, low vitamin D, zinc, and iron levels can be associated with low libido, and thus levels should be measured.
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Functional Medicine Treatment Protocol for Low Libido In Women
Functional medicine approaches aim to address potential underlying factors of low libido. Below are some evidence-based approaches that functional medicine practitioners may suggest for supporting libido naturally:
Therapeutic Diet and Nutrition Considerations for Low Libido in Women
While there is no one specific diet that has been linked to improved libido levels in women, there are certain dietary components that may aid in supporting libido and some that may inhibit it.
Supplements Protocol for Female Low Libido
Maca
Maca is a botanical native to the Andes Mountains. Traditionally used for fertility-enhancing purposes in men, maca has been shown to support libido, sperm count, and sperm motility. Maca has also been shown to reduce menopausal symptoms in women. Maca may also benefit libido in women. A randomized, placebo-control trial of 45 women split the women into two groups, one group receiving maca, 1,200mg twice per day, and the other group receiving a placebo for 12 weeks. The results suggested that maca may support sexual functioning.
Dose: 1.5g two times per day
DHEA
DHEA is a hormone made by the adrenal glands. Although it is a hormone, DHEA is available as a nutraceutical in the United States. DHEA is a precursor to testosterone. The Polish Menopause and Andropause Society have deemed DHEA potentially helpful in supporting libido and sexual function in premenopausal women, and the North American Menopause Society recommended vaginal DHEA for the support of vaginal dryness while also acknowledging a potential positive impact on libido with this approach. The journal "Endocrine" published a study in 2019 on 50 premenopausal women taking 25mg of DHEA three times per day. Results obtained via questionnaires suggested improvements in desire, pain, satisfaction, orgasm, lubrication, and arousal. Another study published in the journal "Climacteric" separated 48 postmenopausal women into four groups. One group received DHEA 10mg, two groups received different kinds of hormone replacement therapies, and the last group received vitamin D. The women were given the McCoy Female Sexuality Questionnaire before the start of the study and at 3, 6, and 12 months. Improvements in sexual function were suggested in the DHEA and HRT groups but not the vitamin D group.
Dose: 25 mg- 200 mg
Tribulus
Tribulus terrestris is a botanical native to India. Tribulus has historically been used in India, China, and Greece as a sexual enhancer. A randomized, placebo-control trial separated 60 postmenopausal women into two groups; one group received Tribulus 250 mg three times per day, and the other group received a placebo. After 90 days, participants filled out sexual questionnaires at the beginning and after the study was completed. Statistical improvements were suggested in the Tribulus group for desire and sexual interest, arousal and harmonious interactions with partners, foreplay, and comfort during intercourse.
Dose: 250 mg three times per day
Zinc
Zinc is a mineral required for our bodies to function. Playing a role in DNA and protein creation, wound healing, the sense of taste, and many other biological functions, zinc is a critical mineral for health. Zinc may also be helpful for low libido. A study was done assessing zinc's effects on women with low serum zinc levels and low libido. In the study, 116 women were divided into two groups, one receiving a zinc supplement and the other a placebo. Labwork, including testosterone levels and a sexual questionnaire, was given to the participants before and after the study. The group that received the zinc supplement suggested improvements in sexual desire, orgasm, satisfaction, vaginal lubrication, arousal, and less pain during intercourse as compared to the controls. Additionally, significant increases in testosterone were seen in the zinc group, possibly contributing to the improvement in sexual symptoms.
Although we present suggested dosages, individuals should always work with their healthcare providers to determine the right dosage for them.
When to Retest Labs for Women
Hormone labs may be retested in three to six months for most women, although this will vary depending on symptoms, age, approaches, and initial lab findings.
Micronutrient panels are typically retested every three to six months, depending on the lab company and the test methodology.
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Summary
Low libido in women is a common concern that affects women of all ages. Functional medicine testing can help reveal potential underlying factors of low libido and thus help to create a personalized plan that may include supportive options such as the nutraceuticals discussed above.
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