Identifying and Treating the Underlying Causes of Low Libido

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There are many causes of low libido, but they do not require a pill or drug therapy to be reversed

The cause of low libido goes well beyond substituting a hormone and assuming someone will then have an increased sex drive. Many current conditions are multifaceted both in risk factors and in treatment approach, and it behooves the option of searching for the magic pill, whether it's pharmaceutical or natural. Instead, an individualized approach to care that accommodates various therapies is required to not only help palliate, but treat the underlying cause. Hormones can be manipulated through conventional and natural treatment, but if the underlying cause is not addressed, then the same contributing processes may appear as other health concerns.

Hormone imbalance is a prevalent and popular reason of low libido, with hormone replacement therapy (HRT) a popular solution for both men and women. HRT can be a sole, or combination of hormones designed as a either synthetic replacement that do not quite match those produced in the body, or bioidentical HRT (BHRT), which do match the structure and hormones made in the body. BHRT has grown in popularity due to a global trend towards “natural” living, and may be compounded with other sex hormones (e.g. DHEA, Progesterone) (Moskowitz, 2006). On the other hand, addressing other hormone-related physiological pathways can provide clues as to why there's an imbalance, versus just symptom relief, as health concerns are usually not in solidarity. In addition to men's testes and women's ovaries, the adrenal glands, two triangular glands of top of each kidney, are responsible for making sex hormones. The adrenal glands also produce cortisol, and when it's too much due to constant stress, then 'adrenal fatigue' can ensue and produce symptoms of sleep disturbances, fatigue, mood swings, body aches and digestive issues. In turn, this shuts metabolites away from making sex hormones and in order to generate more cortisol (Sood, Shuster, Smith, Vincent, Jatoi, 2011).

The connection between low testosterone in men and prevalence of heart disease helps demonstrate the importance of addressing why hormones can be low, and associated conditions. It is unclear if low testosterone levels caused an increase of mortality from heart disease, as an animal study showed that inadequate testosterone levels accelerate atherosclerotic deposits in the arteries. Or perhaps there is another disease process contributing to low testosterone. While replacing testosterone may palliate, it does not explain why both conditions are present in the first place (Malkin, et al., 2010). Another connection lies in heart disease and erectile dysfunction, as the same vasculature in the heart is around the penis, where testosterone replacement may not provide relief.

Prescription drugs such as anti-depressants or other psychiatric medications, birth control, or anti-hypertension medications can contribute to diminished libido due to inferring with our physiology. Anti-depressant drugs act to alter neurotransmitters like serotonin ('happy hormone') and dopamine ('reward hormone'), which are present in various degrees before, during, and after sexual activity. Birth control pills help prevent a woman from achieving pregnancy, but also affects libido by decreasing sex hormones, and increasing sex hormone binding globulin (SHBG), which binds up active sex hormones (Panzer, et. al., 2006). Sexual activity already alters blood flow, and antihypertensive drugs are used to control the same flow through manipulation of arteries and veins, and can then override perceived normal blood flow for arousal, erectile, and orgasmic phases of activity (Papadopoulos, 1980).

Current diagnoses are also important to consider for both psychological and biological reasons of decreased libido. Sex therapists, matchmakers, and love coaches have expressed that their clients are distracted by their other health concerns that their sex drive is has decreased due to constant discomfort or body image, regardless of beauty being in the 'eye of the beholder'. Concerns may encompass symptoms of adrenal fatigue, or others such as depression, anxiety, weight gain, skin rashes, pain with intercourse, erectile dysfunction, or premature ejaculation. However, low libido can also be a symptom of depression, anxiety, an underactive thyroid, or chronic stress, so the symptoms and diagnosis may occur separate or together. Acknowledging numerous factors involved helps guide treatment specific to that person.

Emotions also play a large part in libido due to communication and trust not only with our partner(s), but also within ourselves. Trauma can take on a variety of forms such as abuse (e.g. physical, verbal, sexual, or all of the above), rape, contracting sexually transmitted infection(s), accidental pregnancy, or perhaps family values that taught acts of intimacy were frowned upon, whether for moral or religious reasons. An unwanted reminder in the form of activity or conversation perhaps on accident from whomever we're with can create a defense mechanism of protection and dampen any desire. In addition, negative emotions and experiences especially around one's own sex and sexuality can also be held in the pelvic tissues and surrounding organs, which helps explain why standard treatments are not always effective (Ventegodt, Clausen, Omar, Merrick, 2006).

Communication between partners about how each perceives their romantic lives may decide that they need to do something different to keep intrigue, yet unsure of where to start. Discussions between lovers and with professionals can help be of guide specific to the individuals' needs, and also ensuring safety in the any products used, positions assumed (especially if flexibility is not someone's forte), and hygiene around different types of sexual acts. Most importantly, open expression is imperative once immersed in the act(s) as what could be acceptable during conversation may feel uncomfortable in the midst of it.

A comprehensive approach to addressing low libido is certainly warranted, as any or all factors could be part of an explanation. While society has collectively made leaps and bounds to explore the concept of sexuality, the complexity of etiologies that contribute to sexual dysfunction challenge current beliefs to expand beyond the notion that low libido is purely hormonal. Optimizing a healthful lifestyle, such as a balanced diet and exercise, will benefit many conditions, however, delving further into specific natural or conventional therapy is based on the individual's own underlying cause.

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Malkin, C.J., Pugh, P.J., Morris, P.D., Asif, S., Jones, T.H., & Channer, K.S. (2010). Low serum testosterone and increased mortality in men with coronary heart disease. Heart-British Medcial Journal. 96:1821-25

Moskowitz, D. (2006). A comprehensive review of the safety and efficacy of bioidentical hormones for the management of menopause and related health risks. Alternative Medicine Review. 11(3):208-223.

Panzer, C., et. al. (2006). Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction. Journal of Sexual Medicine. 3(1):104-13

Papadopoulos, C. (1980). Cardiovascular drugs and sexuality. Archives of Internal Medicine (JAMA). 140(10):1341-5.

Sood, R., Shuster, L., Smith, R., Vincent, A., & Jatoi, A. (2011). Counseling postmenopausal women about bioidentical hormones: ten discussion points for practicing physicians. Journal of the American Board of Family Medicine. 24(2):202-210.

Ventegodt, S., Clausen, B., Omar, H.A., & Merrick, J. (2006). Clinical holistic medicine: holistic sexology and acupuressure through the vagina (Hippocratic pelvic massage). The Scientific World Journal. 6:2066-2079.

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