Treatments-General advice for men and women

The treatment for low libido depends (obviously) on the cause of the problem. An easy example is if a doctor sees that a patient is taking a medication causing sex-related side effects. Another “no-brainer” would be to simply treat any underlying medical conditions that reduce someone’s sex drive.

Sometimes, it’s a matter of making the right “lifestyle changes” such as getting adequate sleep, exercising, cutting down on alcohol, eating a healthy diet, and losing weight. One easy caveat: the healthier you feel, the better your libido will be.

If there is a psychological barrier to sexual relations, talk therapy or sex therapy can be helpful. Therapy can help people improve their self-esteem, deal with previous trauma, and strengthen their relationship with their partner. In addition, research has found that cognitive-behavioral therapy can be beneficial for some women with low sex drive. Then, of course, we must fix the hormones.

Hormonal therapy for Women 

Both estradiol and testosterone have been implicated as the steroid critical for modulating women’s sexual desire. Studies demonstrate that post-menopausal estrogen-only therapies produce increased sexual desire. Testosterone at supraphysiological, but not so much-physiological, levels- enhances the effectiveness of low-dose estrogen therapies at increasing women’s sexual desire, as demonstrated by most clinical studies.

Because effective therapies might require supraphysiological amounts of testosterone, it remains unclear in the literature whether testosterone contributes to the modulation of women’s sexual desire. Nevertheless, in countless reports of sexual satisfaction, women say that physiologic doses of testosterone help their sex drive.

Regarding the benefits of progesterone, it’s not safe to give estrogen without giving progesterone-anyway. However, in the years leading up to menopause, where progesterone levels are low: replacement alleviates symptoms of PMS which can arguably negate any sexual feelings a woman is having, and we don’t need a host of studies to prove this to me-and you? Next, let me dispel the myths about the magic of oxytocin.

Oxytocin for Women

Oxytocin has been the subject of countless articles, looking for evidence of sexual arousal with (mostly) intranasal preparations. While it can indeed increase the feeling of “bonding” with one’s sexual partner, there is no evidence that this hormone heightens sex drive in women. However, oxytocin gel can be useful for women (such as breast cancer patients) who cannot use hormone therapy with estrogen or testosterone. Here’s why.

Many postmenopausal women suffer from vulvovaginal atrophy, causing uncomfortable or downright painful intercourse. Several studies comparing lubricant jelly to oxytocin gel have been quite promising. Vaginal oxytocin gel appears to improves vaginal atrophy as well as all aspects of sexual function in postmenopausal women. Next- what happened to that “female libido pill” we heard about a couple of years ago?

Flibanserin for Women

Flibanserin (Addyi) is a famous pill that got a lot of press in 2019. It is a 5-hydroxytryptamine (5-HT1A)  agonist and a 5-HT2A antagonist. It is approved by the FDA and is currently indicated for treating hypoactive sexual desire disorder in premenopausal women.

But here’s some data you might want to know before getting a prescription. In late 2019, a pooled analysis of three well-done clinical trials was published with the summary of results stating that 100 mg per day of flibanserin was “well-tolerated,” “improved sexual desire,” with results being consistent across different subgroups of women.

However, examination of various medical groups’ data revealed that treatment with flibanserin, on average, resulted in just one-half of an additional sexual encounter per month.  In addition, there was a clinically significant increased risk of nausea, dizziness, somnolence, and fatigue. Needless to say, this drug, while still available, has fallen greatly in popularity and prescribing rate.

Hormone Therapy for Men
When we’re talking about a man’s libido, most of you know that testosterone needs to be improved. There is a minor role for progesterone and even human growth hormone, but it’s basically all about testosterone.

Testosterone replacement therapy 

Testosterone levels should support libido and good energy levels, restorative sleep, an optimized mood, and be metabolically correct for the individual. Those of us in the Functional Medical community look at symptoms and (in general) try to aim for free testosterone of about 15-18 pg/mL. We also consider sex hormone-binding globulin levels and the amount of “free and unbound” testosterone. Now, let’s revisit the oxytocin “situation,” which, unbelievably, seems different for men.

Oxytocin intra-nasal therapy for men

Male sexual dysfunction involves penile erection disorder, sexual desire disorder, insertion disorder, and ejaculation disorder. Often, it is difficult for a man to separate one problem as an isolated sexual dysfunction issue that is totally separate from another. One good example is that if a man experiences erectile dysfunction or premature ejaculation, he will then tend to experience a decrease in sexual desire due to an anticipated “poor outcome.”

Recent studies show that oxytocin can induce penile erection in multiple brain regions, nasal administration of oxytocin can increase sexual desire, and there is likely a correlation between oxytocin and premature ejaculation. The bottom line: intranasal oxytocin may be effective for low sex drive in men.

What about the treatment of low sex drive in women and men?

Is there a role for Cannabis? 

A recent, questionnaire-based study looked at the correlation between cannabis use and possible enhancement of sexual function, including arousal. Over 200 cannabis users “toking up” for sex were asked some pretty explicit questions. Of 202 questionnaire participants, 119 (58.9%) said cannabis increased their desire for sex. Since I’m discussing libido in this article, I’ll leave you with that data. And yes, some answered that smoking pot just made them sleepy and therefore less interested in sex. So-there was that, too. Now, I’ll tell you what really does work!


These chains of bioidentical proteins used in Functional medicine are “magic” when it comes to libido: here’s the scoop!


PT-141 is a “peptide,” Specifically, it’s a natural melanocortin with this amino acid sequence: Asp-His-D-Phe-Arg-Trp-Lys-OH. It was originally studied in men with erectile dysfunction who had not achieved a satisfactory response to viagra. It has been studied and compared to all of the PDe5 inhibitors (viagra, Cialis, and Levitra), and amazingly enough, it is superior to all of them. But of course, there is more to the story. A very nice “side effect” researchers discovered was that PT-141 not only improved E.D.; it also made 100% of the male study subjects want more sex. It was subsequently studied in men and then in women. The results? Raves from men and women! Even raves from Suzanne Somers! Therefore, I prescribe it as an intra-nasal spray, a troche (lozenge), or a subQ injection. My patients love the mint-flavored, stevia-sweetened troches.


Another peptide called (really!) kisspeptin is another way to raise the libido in both men and women. It appears to act on the limbic (emotional) system, making it possible to combine therapy with both PT-141 and kisspeptin for those who require it. But, this is all a delicate, very private subject, and I hope I have given you tools you can use in your own personal life.