The Truth About Hormones & Your Sex Drive
Which of these best describes your sex drive?
“Want it, need it, gotta have it!”
“Could take it or leave it...” or
“Don’t even think about it!”
Whatever you answer, there’s no shame.
Women are pretty reluctant to say our libido (or lack thereof) is one of our top health concerns. But when I dig deep with the women I work one-on-one with in my clinic, I find that almost all of them are struggling with their sex drive.
And personally, when I was struggling with hormone imbalance, my sex drive was non-existent. I thought it was just “normal.” After all, as women we are conditioned to believe we should want sex less than men.
Truth: healthy women have robust sex drives!
Our libido isn’t just dictated by whether our partner brings home flowers or we’ve shaved our legs - it is controlled by a complex group of hormones and neurotransmitters. Too much or too little of one or another can cause our sex drive to dwindle away or get out of hand.
That means that if your libido is lacking, you don’t just need to try lighting candles or new lingerie (although if your sex drive is healthy, that would sound fun instead of like a chore!). Balancing your hormones can restore a healthy libido.
Today, I want to explain how your hormones impact your sex drive. I hope this information empowers you - and if you have more questions or need more support, please reach out to me!
What This Article Can’t Do
Before I dig in to all the juicy hormone info, there are a couple other things I want to get out in the open.
First, most of the research on hormones has been done based on cisgender, heterosexual people and in heterosexual relationships. More research on hormones in other populations is long overdue. If you’re outside this group, some of this information will apply to you and some of it won’t - but I’d love to support you in overcoming hormone issues one-on-one until more inclusive research is available.
Secondly - as you're reading this I know symptoms of too much or too little of various hormones are going to jump out at you. But know this: the only way to diagnose hormone imbalances is with proper testing! That means blood, saliva, and/or urine testing.
Treatment for hormone imbalance is highly individualized, and I always recommend anyone who suspects hormone imbalance work one-on-one with a trained practitioner like myself for accurate testing and treatment! At the end of the article, I’ll share about my favorite hormone tests.
OK - disclaimers done - let’s get to the good stuff!
Estrogen - “The Feminine Hormone”
Estrogen is the hormone we associate with women. It makes women softer - both emotionally and physically. Estrogen is responsible for women’s curves: breasts, hips, and more fat on the butt! In studies of heterosexual men, women with higher estrogen levels were rated as more attractive.
It also increases a woman’s receptive sex drive—the part that makes her interested and open to penetration. Estrogen says “Take me now!” Women with higher estrogen levels may have more of a seductive sex drive - they are more likely to be receptive to sex, more likely to flirt and give “I’m available” signals, than they are likely to initiate it.
Testosterone - “The Masculine Hormone”
What hormone causes horniness? Testosterone is the hormone associated with men - but healthy women have testosterone, too. It helps us build muscle and causes us to feel more competitive and aggressive. In the bedroom, testosterone makes us want to initiate sex and governs the drive for genital sex and orgasms. Women with higher testosterone levels tend to have more of an aggressive sex drive and are more likely to initiate sex than wait for a partner to start things up. Interestingly, some post menopausal women have relatively higher testosterone levels (as compared to other hormones like estrogen) and may notice more of an interest in initiating at this phase in their lives.
Testosterone makes us less interested in relationships and commitment and more likely to want time alone (that’s what the Man Cave is for!). Women with higher testosterone levels tend to masturbate more, too. Too much testosterone can make us feel irritable - but too little can make us feel depressed.
Dopamine - “The Pleasure Chemical”
Dopamine isn’t exactly a hormone - it’s actually a neurotransmitter. Dopamine helps us anticipate pleasure - therefore having the drive and motivation to take action. It’s dopamine that makes us anticipate that sex = pleasure.
People who are low in dopamine tend to seem “flat” - they lack interest, enthusiasm, and get-up-and-go.
Testosterone increases the activity of dopamine in our brains, so supplementing with testosterone is often prescribed for women with low libido. But in my experience, this rarely works - or at least not without other support - probably because the issue isn’t just low testosterone, but also low dopamine. (Just another reason why you have to test!)
DHEA - “The Master Hormone”
DHEA is our most abundant circulating hormone. It’s produced both in the Adrenal glands and in the brain, and most of our other hormones are derived from it. DHEA levels peak in our 20s and start to decline from there - faster for some than others based on factors like your genetics and stress. Oral contraceptives are also know to lower DHEA levels.
Ideally, I like to see DHEA levels on the higher end of the normal range because DHEA can:
- Lower risk of depression
- Provide better function in old age
- Protect against immune suppression when cortisol levels are high (from stress)
- Prevent osteoporosis
- Maintain muscle mass
And of course, DHEA plays a major role in sex drive, orgasms, and sex appeal. Higher levels of DHEA in women correlated with higher rates of sexual desirability in studies. Most of our pheromones are derived from DHEA - scents that in the animal world dictate attraction and mating. Pheromones are often what make us feel an “instant connection” or drawn to someone. When a woman complains of low libido, I always test her DHEA levels first!
In times of stress, DHEA levels decrease significantly -and this can cause a cascade of low hormones throughout your body, since most other hormones are derived from DHEA.
Oxytocin - “The Love Molecule”
Oxytocin is a molecule that is triggered by physical touch. Oxytocin levels increase if you hug, hold hands, have sex, hold a baby - and even if you look at a dog! Levels of oxytocin also spike when you’re aroused and when you orgasm - it’s also what causes the uterus to contract during orgasm. If you’re in love, just thinking about the person can make your oxytocin levels go up.
Oxytocin helps you bond and feel love. It’s especially important for maternal bonding, and oxytocin levels rise during breastfeeding. Higher levels of oxytocin both reduce stress and rational thought - making it easier to “fall in love.”
Progesterone - “The Cock Blocker”
Does progesterone increase libido? In my practice I call progesterone the cock-blocking, (or clam-jamming) hormone. Basically, progesterone stops your sex drive. The effect of progesterone on your sex drive is so powerful, monks used to take the herb Vitex (aka Chaste Tree Berry!) to promote progesterone production and block their sex drive. Progesterone actually numbs the erogenous zones, meaning you’re likely to have dull orgasm with more stimulation - or no orgasm at all.
Many women have high levels of progesterone because they take hormonal contraceptives. The birth control pill contains a synthetic form of progesterone called progestin. Great birth control, right? Just kill your sex drive completely!
Progesterone isn’t all bad though - it promotes maternal behavior and has a mild sedative effect. It can make you feel calm, happy, and that everything is a-okay.
Does ovulation make you horny? In the second half of the menstrual cycle (after ovulation), progesterone is naturally higher. That makes sense biologically - once you’ve ovulated, your body won’t drive you to sex for reproductive reasons. When natural progesterone is balanced with estrogen, the dip in sex drive isn’t as strong and some women don’t notice it at all. Others might just be more interested in cuddling rather than going for an orgasm.
Prolactin - “The Nursing Hormone”
Prolactin is mostly associated with lactating women - it is the hormone that triggers your milk to let down after birth. Prolactin also tends to lower your sex drive - that’s why, in general, women have less sex when they are breastfeeding. Depending on your estrogen levels, you might retain some “receptive” sex drive even when prolactin is higher.
Promoting dopamine opposes prolactin. So if your prolactin levels are high and you’re NOT breastfeeding, using dopamine-promoting herbs can help lower prolactin and improve your sex drive. The only way to accurately gauge your prolactin levels is with testing!
Serotonin - “The Happy Chemical”
Serotonin is dopamine’s partner - together they are the two main neurotransmitters in the brain. Serotonin can impact your sex drive whether it’s too high or too low. Certain medications (like SSRIs) can cause high levels of serotonin. Dieting and chronically low calories can cause low serotonin, too.
Very high levels of serotonin dull your sex drive. That's why SSRI antidepressants have lowered sex drive and delayed/weaker orgasms as a side effect.
Conversely, low levels of serotonin can magnify your sex drive. In people with depression, low serotonin levels can even lead to sex addiction. In women with low serotonin, orgasms happen faster and easier. Men with low serotonin ejaculate right away.
Your Menstrual Cycle - “The Conductor”
Your menstrual cycle is like the conductor of all these hormones and chemicals. As the cycle progresses, hormone levels naturally rise and fall, leading to a shift in your sex drive.
At the beginning of your cycle, all hormone levels are low. Mid-cycle, estrogen and testosterone both spike - leading to an increase in sex drive (you’ll be both more aggressive and receptive to sex).
Many women also notice their libido peaks right before they start their period, as progesterone is naturally falling relative to testosterone. Your genitals will be more sensitive and it’s easier to orgasm during progesterone withdrawal.
During menses, some women have an increased sex drive - again because progesterone is lower relative to testosterone. But because serotonin levels can also drop during this time you might be grouchy too. Grumpy and horny!
The natural shift in hormones throughout the month can explain why sometimes you want sex more for the cuddling, emotional bonding, and skin-to-skin contact, - and why other times you just want an orgasm without all the bells and whistles.
Your Hormones & Your Libido
Our sex drive is completely dependent on our hormones. And as you’ve learned in this article, it’s not as simple as “more testosterone makes you horny!” Balanced hormones are the key to a healthy sex drive.
If your sex drive isn’t how you’d like it to be - either too much or too little - looking at your hormone balance is a great place to start. I know you’re sick of hearing me say this by now, but the ONLY way to accurately diagnose hormone imbalance is with advanced testing. You never want to “guess and check” by starting treatments or supplements for what you “think” is the problem. This can cause even greater imbalances that take more time and work to resolve.
Over the years I’ve used blood and saliva hormone tests - but now I almost exclusively use the DUTCH hormone test. This test is a kit your practitioner orders and you complete at home. It uses dried urine (that’s what the D and U stand for in DUTCH) to accurately test various hormone levels. It’s more accurate than saliva testing, and much simpler than blood testing. You just pee on a stick, let it dry, and mail it back to the lab.
Once I know a patient’s hormone levels, we can work together to come up with a plan to balance them. I never share exact protocols publicly because I’ve never had 2 patients who needed the exact same treatment! Hormones really are that unique.
If this article has resonated with you and you think hormone imbalances could be at the root of your sex drive struggles, I hope you’ll book a free 20-minute exploration call with my team. There’s zero obligation, but we’ll dive deep into your issues and then share what we can do to help.
Having come out the other side of hormone imbalance, I can tell you - having my sex drive back is great! (And my husband loves it too.) I want the health and radiance that comes from balanced hormones for all women. Book a 20-minute call for free here!
The Truth About Fertility Apps (And the Exact Ones I Use and Recommend)
In college, I tracked my periods on my wall calendar. A red dot (so subtle!) marked day 1 of my period. It wasn’t very advanced, but it was when I first started paying attention to my not-so-monthly cycle. Back then I also read paperbacks and kept a grocery list on a magnetic notepad on my fridge.
I don’t do any of those things anymore though because - hey, there’s an app for that!
If you’re like me, you keep everything on your phone now, and there are even some amazing fertility tracking apps you can get, too. These apps don’t just help you remember when you last got your period - the best ones can accurately predict when you'll ovulate each month. You can use that information to help you get (or not get) pregnant.
But not every fertility tracking app you can download is actually useful. Some really can help you predict when you’re ovulating, but others are no more sophisticated than my old red-dot method.
Let me explain how and what fertility trackers can and can’t do - and I’ll tell you which ones I use and recommend (even if you have PCOS or irregular periods!).
Why Should I Track My Cycle?
I recommend cycle tracking for all women. Your period is one of the biggest indicators of your overall health - but it’s also really sensitive to changes. Little changes in your cycle can be a clue of a bigger problem, even before any other symptoms show up.
Plus, being aware of your cycle gives you powerful information about your body. As you get more in tune with your cycle, you may even start basing some other patterns around it (like how you eat or your exercise throughout the month).
And of course, the obvious reason to track your cycle is to track your fertility (by knowing when you ovulate). This is not just for women who are trying to get pregnant - you can use this information to help you get pregnant more easily OR to avoid pregnancy without having to use hormonal birth control methods.
Yes - the right fertility tracking app can replace hormonal birth control if it is used correctly!
But if you’re going to rely on cycle tracking to predict your fertility, it’s critical that you use a reliable app - and they aren’t all created equal.
Calendar-Only Apps Can’t Tell You Enough
Unless you are simply trying to get a better sense of cycle length and variations, regular calendar based apps are useless for fertility detection. These are apps like “Period Tracker” that just ask you to track when your period begins and ends.
These apps base their estimation of your fertility on data from your prior cycles, assuming you have a 28-day cycle and Cycle-Day 14 ovulation. But the truth is that fewer than 10% of women actually do. Your cycle length can also vary from month to month. Because most women don’t have this cycle pattern, these apps cannot accurately tell you when you can and can’t conceive.
Which App Should I Use?
If you really want accurate results (and when it comes to getting pregnant or not, accuracy is key) you need a fertility tracker that does more than just count days.
After testing and trying them all, both myself and with my patients, there are three I recommend - one for people whose goal is avoiding pregnancy, and another two for those who are looking to conceive OR who have very irregular cycles (my PCOS sisters, this one is for you!)
Let me break them all down for you.
If You’re Trying To Avoid Pregnancy (And Or Get Pregnant & Have Regular Cycles)
If you want to track your cycle, get a better understanding of your fertile window and monthly rhythms, and/or avoid pregnancy, I think the Kindara Fertility Tracker is the simplest to use and has a great track record.
Kindara is an app that you use along with a basal thermometer (which gives temperature to the second decimal).All you need to do is remember to take your temperature using the thermometer every morning, right when you wake up, and enter that data into the app. You’ll also track changes in your cervical mucus.
Research by the CDC has shown that, when used perfectly, this method of birth control is 99.6% effective!
Kindara reports days to you as either fertile or not fertile, based on your temperature, past cycles, and cervical mucus. If you’re avoiding pregnancy, abstain or use a non-hormonal birth control method when you’re fertile.
At only $4.99/month (and with a free basic version, as well), the Kindara app is a great alternative to hormonal birth control and is a useful tool for tracking your fertility.
If You’re Trying to Get Pregnant - Or You Have Long or Irregular Cycles
If your goal is to get pregnant, or if you have PCOS or irregular cycles (whether you want to get pregnant or avoid pregnancy) I recommend both Oova and the new Priya.
Priya is a vaginal sensor that monitors temperature all day long. It’s a silicone ring that you can wear continuously for up to 29 days - or remove for up to three hours daily - that takes regular temperature readings.
Because it measures core temperature, and because it takes readings all day long, every 6 minutes, the resulting temperature data is much more accurate than taking a single, oral reading.
Priya is able to predict ovulation up to 2.5 days in advance of a LH surge on an ovulation urine test and data in trials suggests it is just as accurate as an ultrasound, which is the gold standard for ovulation testing!
If you have PCOS, or unexplained fertility, using Priya can unlock a huge piece of the puzzle. The same holds true if you have irregular cycles or irregular ovulation from any cause, and are either trying to conceive, or trying to avoid it. It also works if a woman is taking fertility treatments in the form of herbs or medications to promote ovulation.
And if you’re wondering if it’s safe to wear, I have you covered! My first question was about the potential for EMF exposure. What makes Priya cool is that it only connects to the device once an hour for a few minutes, and it’s at a very low power. You can also change the setting and have it connect even less often, 1-2x daily is all that’s needed, and you can remove it before connecting. It will still read and store your temperature, even when disconnected.
I also asked about the potential for biofilm buildup and vaginal microbiome disruption (which is a major issue with other vaginal rings, like Nuvaring). Priya is different because it's made from washable silicone. You can take it out every day and wash it, and it can be removed up to 3 hours per day and still be effective.
Priya is not yet available to the public, but I am testing it with my clients and loving the results. Sign up for pre-orders here.
Another Amazing Option - Especially for PCOS!
Along with Priya, I recommend Oova, which uses urine tests (think pee-on-a-stick pregnancy tests) to track fertility throughout the month instead of temperature. You order a kit with 15 tests, and enter test results into the app for lab-quality results.
Honestly, I love Oova. The technology was developed by a doctor who struggled with fertility herself, and it’s unlike anything else you can buy.
You’ve probably heard of LH tests (AKA Ovulation Predictor Kits) before: you can buy them at the drugstore, and until now they were the best option for at-home ovulation prediction. But the big problem is that LH - luteinizing hormone - is present in your urine all month, and it surges just before ovulation. All an LH test can tell you is that ovulation is coming in the 24 hours or so - and that depends on you taking it at the right time (too early or too late and you’ll miss the tell-tale surge). Plus, interpretation can be confusing: is today the strongest pink line? Was it yesterday? Will it be tomorrow?
If you’re trying to get pregnant, LH tests alone aren’t very helpful because your fertile window is actually 5 days up until you ovulate, and an LH test misses most of that. And, an LH surge doesn’t always mean that an egg has actually been released, as some women don’t release an egg every cycle.
Oova uses super-sensitive, nanotechnology LH tests along with progesterone tests to solve this problem. Progesterone levels rise when an egg is released from the follicle in the ovary where it has been growing. High progesterone levels are also necessary for the vascular development of endometrial lining, and to prevent shedding of the endometrial lining if you are pregnant. By tracking progesterone levels with LH, Oova gets a complete look at your cycle.
You’ll use the Oova tests - which are read by the app, so you don’t have to do any interpretation - to establish your hormonal baseline and then see the changes that indicate your fertile window. It can uncover your exact, unique cycle length, and confirm that ovulation has in fact occurred - so it’s ideal for women with irregular cycles or PCOS!
I love to pair Oova with Priya or Kindara data, too - especially for tricky, irregular cycles who are trying to conceive!
Learn more and get Oova here. Use code BWIH1 for 15% off your Oova order!
Can A Fertility Tracker Really Replace Other Forms of Birth Control?
Like I said before, I recommend tracking your cycle to all women - even if it’s just a simple calendar app for right now.
But the right fertility tracking app CAN replace other forms of birth control as long as you’re doing it the right way. Just like with the pill or condoms, user error is the biggest problem with using fertility tracking as a birth control method.
Before you get started, read all the instructions included with your fertility tracking app - and when in doubt, use a backup method like a condom. My favorite condoms are Sustain Natural Latex Condoms, which are nitrosomine-free (nitrosomine is is a carcinogen that is formed when latex is heated and formed). The rubber they use for manufacturing their latex is also non-GMO and fair trade, which is really significant with condoms, as child labor and harsh working conditions are a big issue in many rubber plantations world-wide.
Do You Track Your Fertility?
If you have experience with the Kindara, Priya, or Oova, I’d love to hear how it worked for you! Got another fertility tracking app you love? Leave a comment and let me know.
And if you’re not yet tracking your fertility but want to give it a try using one of the apps I recommend, save 15% on the Oova kit with code BWIH1!