Functional Medicine Protocol for Low Libido in Women

Low libido is a common problem for women. According to a study done on over 2,000 women, 26% of premenopausal and 52.4% of postmenopausal women have low libido. This article will discuss libido and the signs and causes of low libido in women. We'll then discuss functional medicine testing to assess the root causes of low libido in women and functional medicine treatments for 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 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 causes that are associated with low libido in women:

Medications

Medications such as oral contraceptive pills (OCPs), commonly known as birth control, can cause 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, 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 cause low libido. The lack of exercise and physical activity can also be linked to low libido.

Other Medical Diagnoses

Additionally, low libido can be caused by 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 the root causes 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 cause low libido, and thus levels should be measured.

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Functional Medicine Treatment Protocol for Low Libido In Women

Functional medicine treatments aim to resolve the root causes of low libido. Below are some evidence-based treatments that functional medicine practitioners recommend for increasing 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 boosting 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 increase 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 showed that maca improved 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 effective in the treatment of low libido and sexual dysfunction in premenopausal women, and the North American Menopause Society recommended vaginal DHEA for the treatment of vaginal dryness while also acknowledging a positive impact on libido with this treatment. The journal "Endocrine" published a study in 2019 on 50 premenopausal women taking 25mg of DHEA three times per day. Results obtained via questionnaires showed 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 seen 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 seen 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 saw 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 recommended dosages, patients should always work with their providers to determine the right dosage for them.

When to Retest Labs for Women

Hormone labs should be redone in three to six months for most women, although this will vary depending on symptoms, age, treatments, and initial lab findings.

Micronutrient panels are typically redone every three to six months, depending on the lab company and the test methodology.

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Summary

Low libido in women is an unfortunately common problem that affects women of all ages. Functional medicine testing can help reveal the underlying cause of low libido and thus help to create a personalized treatment plan that may include functional medicine options such as the nutraceuticals discussed above.