Testosterone Replacement Therapy and Sex Drive

Testosterone replacement therapy improves libido or sex drive.
There is a definite relationship between your testosterone level and your sex drive or libido. Low libido describes a decreased interest in sexual activity. It’s common to lose interest in sex from time to time, and libido levels vary throughout your life. It’s also normal for your interest not to match your partner’s at times.

While many things can contribute to a loss of libido, long-term, or chronic loss of sexual desire, particularly in older men and women, could be a symptom of age-related testosterone deficiency.

What Is Libido?

Libido is the biological term for sex drive or sexual desire. Both men and women have a “libido.” Many things impact a person’s libido or sexual appetite. Brain function, learned behavior, your diet, your emotional states, and of course, hormones like testosterone all influence your libido or sex drive.

Doctors and medical researchers cannot say that having low testosterone definitively "causes" a decreased sex drive. But the two conditions are certainly related and often happen together. Men and women as well with age-related testosterone deficiency almost always report a decreased desire for sex or lack of libido; we simply cannot say that there is a direct cause and effect relationship between the two conditions. 

What we do know for sure is that as men age and testosterone drops, so does their interest in sex and their ability to perform sexually. We also know that testosterone is essential for normal erectile function. The relationship between low testosterone and erectile function is a complex one. One thing is certain; however, men with low testosterone also are highly likely to suffer from both ED and a decreased sex drive.

What Is the Relationship Between Testosterone and Libido?

Testosterone is the most critical male hormone. We know that testosterone is responsible for building muscles, sexual maturity, and the other things that differentiate a boy from a man after he hits puberty. Even once a man’s sex organs are fully mature and functional, testosterone continues to play a vital role in sexual health and sexual performance.

Throughout a man’s life, your testosterone levels factor into your sex drive or libido. Dropping testosterone levels are an unfortunate fact of aging, and without hormone replacement therapy, one of the more undesirable impacts of low testosterone is its effect on sexual health and sexual performance.

In men, low testosterone can lead to a decreased libido as well as erectile dysfunction. In women going through menopause, we now know that the sexual health issues experienced, such as low libido and vaginal dryness, are more related to the drop in testosterone than of estrogen that occurs in menopausal women.

Does Testosterone Therapy Help Increase Sex Drive In Women?

Current research indicates that testosterone replacement can increase sex drive and improve other symptoms of “female sexual dysfunction” or FSD that are often experienced by women entering and going through menopause.

Unlike men, who lose testosterone slowly over time, women experience a sudden drop in testosterone when they enter menopause. The symptoms of FSD include vaginal dryness, lack of libido, loss of sensitivity, and painful intercourse. It was once thought that the sexual health issues experienced by menopausal women were due to the loss of estrogen that occurs in the post-childbearing years. However, current research indicates that it is more related to a drop in testosterone.

The vaginal dryness, lack of libido, and painful intercourse that many women suffer during their perimenopause and menopausal years can all be helped by testosterone replacement therapy.

Sharon Parish, MD, professor of medicine in clinical psychiatry and professor of clinical medicine at Weill Cornell Medical College, presenting the results of her research entitled, "How I treat women with testosterone deficiency," to  Endocrine Today said, "Among postmenopausal women and women who experienced surgical menopause or premature ovarian failure, studies show that low testosterone levels are closely correlated with reduced coital frequency and loss of sexual desire and researchers have observed a positive relationship between [increasing] free testosterone levels and the rating of sexual desire…."

Low Testosterone and Erectile Dysfunction

Low libido and erectile dysfunction are intimately related. Men with low libido often suffer from erectile dysfunction and vice versa. Erectile dysfunction or ED is also a common symptom of low testosterone.

As with loss of sex drive or low libido, we cannot say that low testosterone is a direct cause of ED, but men with low testosterone are 100% more likely to have problems with ED than are men with normal testosterone levels.

In addition, research has found that testosterone replacement therapy may be able to help certain men suffering from erectile dysfunction.

Erectile Dysfunction, commonly known as “ED,” is defined as “the persistent inability to achieve or maintain an erection that is satisfactory for sexual intercourse.” But there are varying “degrees” of ED. You may be considered to have a form of ED if:

• You can’t get an erection that is hard enough for satisfactory intercourse
• You lose your erection before you can complete the sexual act.
• You cannot achieve an erection at all. This is known as “complete ED,” or the condition doctors used to call “impotence.”

Erectile dysfunction has many causes. Getting and maintaining an erection is a complex process; anything that interferes with that process can cause ED. Some of the most common causes of erectile dysfunction include:

• Heart disease
• Clogged blood vessels (atherosclerosis)
• High cholesterol
• High blood pressure
• Diabetes
• Obesity
• Peyronie’s disease — development of scar tissue inside the penis
• Low testosterone

We know that low testosterone leads to erectile dysfunction, decreased sex drive, and other sexual health issues in men. It is a biological fact that as men age and testosterone drops, so does their ability to perform sexually. We also know that testosterone is essential for normal erectile function. The relationship between low testosterone and erectile function is a complex one.

One thing is certain; however, men with low testosterone also are quite likely to, and usually do, also suffer from ED. But that does not mean that their ED is caused by their low testosterone.

Low testosterone impacts a man’s health in several ways that can lead to ED. For example, men with low testosterone also tend to be overweight, have hardening of the arteries, and have diabetes, all of which are known to contribute to ED. In addition, men with low testosterone are also often weak, tired, stressed, and/or depressed — all of which can lead to erectile dysfunction and/or a lack of desire for sex.  

Does Testosterone Replacement Therapy Improve Sex Drive?

Absolutely. Research and the results we regularly see in our own clinic indicate that testosterone replacement therapy increase libido. In fact, improved erections and increased sex drive are one of the first benefits most men on testosterone therapy report.

Though we are still not 100% sure as to why one of the very first improvements patients notice within the first few weeks of testosterone injection therapy is an increased libido or sex drive.

There could be several reasons why treating your low testosterone with testosterone replacement can increase your sex drive. The main one, researchers believe, has to do with certain "neurotransmitters" in the brain, such as dopamine and serotonin.

Dopamine and serotonin are called "feel-good chemicals" because they are both involved in mood. People who are anxious and depressed have low levels of these chemicals. Dopamine and serotonin also are involved in sexual arousal and gaining and maintaining orgasm in both men and women. Testosterone is a known precursor to the production and release of these chemicals.

Patients diagnosed with low testosterone almost always have a reduction in the production of these "feel good" brain chemicals. This is why mood swings, anxiety, and depression are common symptoms of low testosterone.

Just as testosterone replacement can improve mood by boosting the production of serotonin and dopamine, that also improves libido. Testosterone can improve your sex drive in several less direct ways as well. Eliminating feelings of depression, improved energy, and improved body image can also have a physical and psychological effect of increasing sex drive!

What Does the Clinical Research Say About Testosterone and Sex Drive?

Researchers haven’t exactly unraveled the mystery of just how testosterone increases libido; however, there have been many studies that indicate that it does, in fact, increase libido or sex drive. For example, a large study of men in Massachusetts published in The Journal of Clinical Endocrinology and Metabolism found that about 11% overall said they had a lack of sex drive. The researchers then tested all the men’s testosterone levels.

About 28% of men with low testosterone had low libido. Interestingly enough, these men were relatively young, with an average age of 47; older men might have worse sexual symptoms.

According to a study recently published in the prestigious New England Journal of Medicine, testosterone therapy has been confirmed as being helpful in increasing sex drive in men with low libido. The study found that testosterone replacement therapy was effective in boosting mood and increasing sexual desire in men with sexual health issues.

The men in the study all had a self-described "decline in sex drive" and/or erectile difficulties. In interviews before starting testosterone treatments, they also reported being moody, depressed, and "unmotivated."

The lead researcher on the study Dr. Peter Snyder of the University of Pennsylvania, concluded it was clear that "Testosterone improved sexual activity, sexual desire, and improved erectile function."

Similarly, a 2018 "mega-study" or study of studies  published in Current Opinion in Urology concluded, "The available literature supports a role for [testosterone replacement therapy] in men with low testosterone levels, ED, and low libido, with symptomatic improvement in these men." The study also said, "Testosterone therapy has also shown consistent benefit in improving libido in men with low testosterone levels at baseline, with no additional improvements once testosterone levels are normalized."

Now that you know a bit more about testosterone replacement therapy and sex drive, why not contact us today and learn more about the many benefits of testosterone replacement therapy.