How Your Hormones Really Affect Your Sex Drive + What To Do About It

Integrative Medicine Doctor By Sara Gottfried, M.D.
Integrative Medicine Doctor
Sara Gottfried, M.D., is three-time New York Times bestselling author and a graduate of Harvard Medical School and MIT.
How Your Hormones Really Affect Your Sex Drive + What To Do About It
Our editors have independently chosen the products listed on this page. If you purchase something mentioned in this article, we may earn a small commission.

Dr. Sara Gottfried is a Harvard-trained MD, best-selling author, and leading expert on hormones. That's why we're thrilled to team up with her for a new series this week on balancing your hormones for better health. If you're inspired to learn more, check out her new course, How to Balance Your Hormones for Glowing Skin, Deeper Sleep & Better Digestion.

This statistic troubles me: 57 percent of women prefer Facebook to sex. While the data doesn't come from a scientific source (Cosmopolitan), it reflects a general feeling of “meh” that many of my patients have toward sex.

I see it daily in my functional medicine practice, and the symptom points to a larger, more disturbing problem.

I consider sex drive to be the canary in the coal mine of overall physical and mental health—and sadly, the state of women’s health, longevity, and happiness is declining in many ways. As a result, low libido is common, but few understand that the root cause is hormonal, not some intrinsic problem or lack of love and connection. Or people know hormones and sex go together but don't really know which hormones matter or how they interact to create sexual interest, toe-curling orgasms, or robust health. Or even more important: what to do about it.

I believe that sexuality is a portal to other areas of your life, and when you optimize your sex life, there are many downstream benefits that you may not realize. You'll find freedom in other aspects of your life where there once was struggle. And when you upgrade your sexual energy, you heal from the inside out, which is far better and more sustainable than seeking the latest Band-Aid. This is true for single folks as well as people in long-term relationships.

After years of working with people who want to get their mojo back, I know that low sex drive, poor energy, lousy sleep, skin problems, and bloating aren’t diseases that can be fixed fast with a pill or shot. These are usually hormonal problems, meaning our bodies are trying to tell us that something is wrong.

The Root Causes of Low Sex Drive

I'd estimate that 70 percent of low sex drive cases are due to misfiring hormones. Of course, there are other considerations, such as communication and intimacy, emotional currency, sexual variety, mismatch of expectations and style, frequency and type of sexual connection. For a healthy, deepening sexual connection, these areas need to be explored, mined, and renegotiated.

Many women believe as I did that they don’t have to worry about their hormones until menopause, but the truth is that your hormones start to change in your 20s. DHEA and testosterone begin to decline. Cortisol, the main stress hormone, can start to climb and rob your other sex hormones. For some women, estrogen and/or progesterone can drop, leading to estrogen dominance or PMS. You may experience high testosterone (such as with polycystic ovarian syndrome) or low testosterone (as a result of excess stress or aging). Or your thyroid may start to sputter.

Other hormones get in on the act—including oxytocin, insulin, and ghrelin—but these are the main hormonal problems I see daily as part of the story of low libido. Here, I'll share what symptoms you might experience with each hormone. Note that I've included only a partial list for each—to learn more, check out my new mindbodygreen course.


1. Cortisol is too high, too low, or a combination.

It’s important to understand that dysfunctional stress in the body is the root cause of most, if not all, hormone imbalances. You may or may not be aware of how stress is being generated in the body, and one of the earliest signs can be lower sexual interest or desire.

The underlying reason for wayward cortisol varies from person to person, but it’s important to know if cortisol is off for you. For me, cortisol crashed in my mid-30s after having a baby—I was trying to be all things to all people, running myself ragged as a working mom and OB/GYN, and chasing a dream that didn’t belong to me as a surgeon and academic. My poor husband felt neglected and rejected as my libido tanked, and it took taking on my own hormones to understand the central role of cortisol in sex drive and my more global energy.

Signs of unbalanced cortisol:

  • Feeling wired but tired
  • Running from task to task, feeling overwhelmed
  • Sugar or carb cravings
  • Difficulty falling or staying asleep
  • Feeling burned out or fatigued, particularly under stress
  • Increased belly fat or weight gain
  • Unstable blood sugar—too high, too low, or both
  • Skin conditions, such as eczema

2. Estrogen is too high, too low, or a combination.

Estrogen is the main female hormone. It causes the female body to grow breasts and hips (in men, too much can lead to man boobs and estrogenic fat deposits at the hips). When it’s in balance with its counter hormone, progesterone, your period arrives on time, your skin is clear, and your mood is stable. When it’s too high or low, you may experience one or more of the following symptoms.

Signs of unbalanced estrogen:

  • Bloating or water retention
  • Abnormal Pap smears
  • Heavy or excessively light (even absent) periods
  • Breast tenderness or cysts
  • Mood swings or PMS
  • Rapid weight gain, particularly at the breasts or hips
  • Migraines
  • Red flush of the face, or rosacea
  • Vaginal dryness or atrophy

3. Thyroid is too low.

When your thyroid gland in your neck is underperforming, you feel flat and lackluster in most areas. Your hair thins, particularly eyelashes and the outer third of the eyebrow. The origin varies from person to person, and could stem from autoimmune destruction (Hashimoto’s thyroiditis) or be secondary to high cortisol, or even result from exposure to endocrine disrupters like bisphenol A or flame retardants.

Signs of low thyroid:

  • Fatigue, particularly in the morning
  • Weight gain
  • Mood problems, such as low-grade depression
  • Headaches
  • Dry, strawlike hair that tangles easily
  • Hair loss or thinning (particularly lashes and outer third of eyebrow)
  • Decreased sweating
  • Cold hands and feet, or intolerance of cold
  • Constipation

4. Testosterone is too high, too low, or a combination.

Testosterone begins to decline in your 20s, which is why you don’t respond to weight training with the same gusto that you did as a teenager. But the worst culprit when it comes to low testosterone is taking oral contraception. The Pill raises your sex-hormone-binding globulin, which is like a sponge that soaks up the free (and therefore biologically available) testosterone in the body. As a result, you may experience low sex drive, vaginal dryness, and even pain with insertion. Even worse, the problem may not resolve when you go off the Pill: One study showed that up to one year later, your hormones may still be out of whack.

High testosterone is one of the defining characteristics of polycystic ovarian syndrome, which affects about 10% of American women. Low testosterone is very common with age, contributing to depression in both men and women, low sex drive, and grumpiness—but it doesn't have to be.

Signs of unbalanced testosterone:

  • Acne or greasy skin
  • Rogue hairs, especially on face, chest, or arms
  • Skin tags
  • Anxiety or depression
  • Fatigue
  • Loss of confidence and agency
  • Poor muscular response to high-intensity or weight training
  • Irregular menstruation (every 35 days or less often)
  • Infertility or subfertility

How to Regain Your Sex Drive

For far too long, there has been this prevailing belief that declining sex drive is simply inevitable, that it's a part of being a modern and busy woman (or man), that it's part of aging, that it's part of life after childbearing years, that it's part of long-term monogamous relationships, etc. I disagree. It’s not normal.

Nothing annoys me more than a doctor who brushes aside pain points like low libido as simply a “symptom of aging.” I believe it's both possible and important for a woman to maintain a strong sex drive long past her childbearing years. It takes a little work—maintaining balanced hormones, trying some proven botanicals, a little self-love, and a steady diet of quality orgasms—but is more than worth it in the long run. Of course, libido will naturally wax and wane. Ultimately, it’s your choice.

Every day we hear about a different method to boost your sexual energy, your life force, your libido. Take this supplement! Read 50 Shades of Grey! Increase variety! Drink green tea. Don’t have any caffeine. Have sex in the morning only! Try this fantastic new lubricant! Eat fewer carbs. Eat more carbs. Eat carbs before protein. Eat carbs at night. Eat oysters! Drink less. Drink more. It’s totally confusing and often not based on any scientific research.

Instead, here are some of the most proven ways you can rev up a flagging sex drive:

1. Add an adaptogen.

If your cortisol is too high, too low, or both within the same day, I recommend taking a double adaptogen like ashwagandha. I mix a pure organic powder with hot water and drink it twice per day as a tonic for stress.

2. Change up a boring sexual routine.

You may need to bring in some variety along with resetting your hormones. My favorite is orgasmic meditation (OM), a cross between mindfulness and genital stroking, for 15 minutes as popularized by Tim Ferriss in The 4-Hour Body.

I find that OM is a wonderful practice for people who are tired of sex, or tired of how fat they feel, or just tired. It fills your tank with oxytocin, and we all need more of that! Oxytocin raises testosterone in men and lowers cortisol. In women, it raises estrogen and helps the thyroid work better.

3. Make a medicinal maca shake.

I’m a fan of occasionally drinking your nutrition, especially if you’re on the go and find it hard to eat well. I found during my hormonal recovery that my blood sugar is most stable when I started my day with yummy protein shakes. (You can hear more about my personally formulated medicinal shakes in my new mbg course.)

Maca is a libido-boosting herb native to Peru that's proven to nourish endocrine glands. Studies show that it raises sex drive in women and reduces anxiety and depression. It’s my herb of choice for women with low estrogen.

4. Visit your health professional.

If you’d rather mop the floor than have sex, there’s a good chance there’s a hormone problem. Get help with sending a search-and-rescue operation after your lost libido by visiting a collaborative functional medicine doctor who will work with you to identify the root cause and find a natural solution.

Sometimes the culprit is overwork and high stress; sometimes it’s a medication, like the Pill or an antidepressant. Get the help you need to test your hormones and come up with a smart plan.

My hope is that you prefer sex to Facebook, and that starts with getting your hormones back on track. It’s important to your health that you make sexual pleasure a priority but not the stuff of Hollywood movies. Instead, choose the real, organic, yummy approach to sex that is your birthright and underpins optimal physiology.

Keep your focus on the natural remedies, the proven potions that truly work for you and that truly stick. Then it’s a matter of keeping your hormones in balance so that you can keep the fire stoked.

Related reads:

Sara Gottfried, M.D.
Sara Gottfried, M.D.
Sara Gottfried, M.D. is three-time New York Times bestselling author of The Hormone Cure, The...
Read More
More from the author:
Correct Hormone Imbalance For Better Skin, Improved Digestion & Less Fatigue
Check out How To Balance Your Hormones
Join world-renowned Dr. Sara Gottfried to balance your hormones for good with this powerful new course.
View the class
Sara Gottfried, M.D.
Sara Gottfried, M.D.
Sara Gottfried, M.D. is three-time New York Times bestselling author...
Read More

More On This Topic

The Essential Guide To Effective Communication in Your Relationship
More Health

Popular Stories


Latest Articles

Latest Articles

Sites We Love

Your article and new folder have been saved!