What happened to my sex drive? Sexual desire, sexual pleasure & the role of testosterone
This week is sexual health week. Sexual health and sexual health clinics are often associated with testing and treatment of STIs such as chlamydia, gonorrhoea, and herpes.
But when we focus on infection, we miss the core reasons why people have sex - pleasure, intimacy, exploration. Health services are notoriously bad at providing space for people to explore sexual pleasure and any difficulties they might be having with enjoying sex.
Many people think having a low libido or low desire for sex is just a natural part of getting older. But this doesn’t have to be the case.
When thinking about causes of low sexual desire it’s worth thinking about the big picture - how do different factors combine to bring us to sexual pleasure or sexual difficulty? These can be biological and hormonal factors, emotional and psychological factors, your erotic world and previous sexual experiences, relational dynamics and communication with partners, and wider social, cultural, and personal beliefs about sex and sexual pleasure.
Often, it’s not just one factor on its own but several factors which come together to reduce pleasure from sex.
A key issue often neglected is the role of hormones and testosterone in particular. There are many reasons for low testosterone in both men and women. Ageing, obesity, menopause, previous use of hormones such as the contraceptive pill or anabolic steroids and performance enhancing drugs, genetic syndromes, and cancer treatment can influence testosterone levels, to name just a few.
Both men and women can experience symptoms from low testosterone. Common symptoms are:
· Lack of sexual desire & low libido
· Lack of enjoyment / pleasure during sex
· Erectile difficulties & loss of morning erections
· Fatigue
· Loss of motivation and drive
· Difficulty recovering from exercise
Many people seek help for these symptoms from doctors or sex therapists but never have a proper assessment of their hormonal status or a holistic exploration of what’s going on. Many men get told their testosterone is normal or never even have their testosterone level tested. Women often get told symptoms are just part of the menopause and to not expect anything different. Equally, some patients see doctors who over medicalise symptoms without exploring other issues.
Proper testing and treatment of testosterone deficiency can radically change people’s lives beyond just their experience of sex. When used appropriately testosterone can not only transform people’s sexual desire and increase sexual pleasure but also their zest for life. Erotic energy is life force energy and this can extend into multiple different areas of people’s lives.
However, testosterone is just one part of the story. The temptation can be for providers to recommend testosterone as a wonder drug and fix all for lots of symptoms. Any assessment should be holistic exploring multiple different factors and be realistic about the contribution of testosterone to any difficulties.
As a sexual medicine specialist I give space for people to explore what’s going on for them in their sexual experience. I bring a high level of medical expertise; together with an understanding of human sexuality and sex therapy approaches to find the right way forward for each person I see. I see both men and women as well as having a specialist interest in gay men’s health.
