Low Libido and Hashimoto’s – Dr. Izabella Wentz, PharmD
Among the many symptoms of thyroid disease, there is one in particular that significantly impacts people’s relationships and overall happiness, yet it’s a symptom people seldom seek help for: low libido (low sex drive). In general, libido concerns are something we keep to ourselves.
Talking about sex makes us blush and isn’t really socially acceptable in our society – thus, many people suffer in silence.
But let’s face it… without libido, we would not survive as a species. ?
While low libido may not seem like it would be a symptom caused by thyroid issues, it can be.
In fact, research has shown that women with thyroid disease experience a higher prevalence of low libido at some point in their lives. This goes for men, too – with some 59-63 percent of hypothyroid men suffering from diminished libido, along with other sexual function issues (such as erectile dysfunction, delayed ejaculation, and sperm abnormalities). [1]
Fortunately, through many of the lifestyle changes that will help to address thyroid issues, we can also improve libido, as well as overall sexual function, for both women and men.
Additionally, there are specific measures you can take to impact libido directly.
So let’s talk more about this… What are the specific causes of low libido, and how does having Hashimoto’s increase your risk?
In this article, you’ll learn:
- Common causes behind low libido (and how the thyroid can affect this)
- Why conventional approaches to low libido don’t typically work in those with Hashimoto’s
- Natural solutions to increase low libido in both men and women
What is Libido, and What Can Affect It?
The term “libido” refers to one’s sex drive, or one’s interest in sexual activity. Libido naturally ebbs and flows, but may decline as the result of many things. For example, it can decline if someone is stressed out or simply tired much of the time.
While having a low libido can be temporary, sometimes it may linger on. Diminished libido can be the byproduct of erectile dysfunction (ED) in men, vaginal dryness in women, or hormone imbalance.
In particular for women, times of hormone fluctuation, as seen with menstruation, taking birth control pills, transitioning to menopause, or even pregnancy and breastfeeding, can result in an impact on libido. As many pregnant women will likely report, hormone levels can make a BIG difference in libido.
A low sex drive can also be caused by a number of chronic health conditions, including thyroid and autoimmune diseases. For example, many women who have Polycystic Ovarian Syndrome (PCOS) have shared with me their own challenges with having a low sex drive. [2]
Low libido can be a double whammy for those in current relationships, as they may feel frustrated and inadequate about themselves, as well as feel like they are somehow letting their partner down. It can be quite devastating to a couple’s intimacy and sense of connection.
Having little or no interest in sex can be a difficult topic to talk about (whether that conversation is with a partner or a physician!), so many people remain silent.
Unfortunately, when sex is brought up with a physician, it is often related to a specific physical symptom (e.g. erectile dysfunction or vaginal dryness) versus a discussion focused on one’s sexual desire. The topic is just too embarrassing for many people (and some physicians, I might add!).
I truly believe, however, that a few questions about libido at regular health exams could really help many people.
Common Causes of Low Libido
Many of the root causes of low libido can be worsened by having a thyroid condition such as Hashimoto’s. By the end of this article, you’ll be better able to see the numerous connections between the major causes of low libido and thyroid disease.
Here are some common causes of low libido (and remember… all of these causes can be addressed and improved upon!):
Psychological Stress
One cause for low libido may have to do with a person’s body image or the relationship itself, which can lead to psychological stress. When a person has body image issues, such as feeling overweight or unattractive, it can lead to a lack of interest in sex. [3] Feeling sick, tired, overwhelmed, or stressed… all these feelings can easily take one out of the mood.
Or, if a person loses trust in their partner, that can be a “turn-off” and result in a lack of interest in having sex. It’s amazing what our bodies can tune into. Some women I’ve worked with have had “libido problems” that were the result of a partner who was cheating or being abusive. One woman didn’t even know that her partner was cheating, but somehow her body did… crazy, right?
Furthermore, if a man or woman is experiencing sexual “performance” problems (erectile dysfunction, premature ejaculation, inability to orgasm, etc.), it can create a lot of stress around sex due to “performance anxiety,” resulting in a diminished libido, possibly for both partners. [4]
Adrenal fatigue in particular can be both the cause and result of symptoms which are connected to hormonal imbalance, ongoing stress, weight gain, mood swings, and fatigue. This is because adrenal dysfunction is the body’s adaptive response to chronic stress. During the initial stages of stress, cortisol production ramps up, and synthesis of other important hormones declines, favoring survival over reproduction. If this goes on for too long, cortisol production becomes downregulated, and we end up feeling burned out and with deficiencies in the other hormones that are made from pregnenolone (such as DHEA).
Addressing adrenal dysfunction can help you re-establish mental focus, healthier sleep patterns, and energy… which of course can help your libido. And 81 percent of participants in my course, the Adrenal Transformation Program, did report that this program improved their libido! You can learn more about this in my book, Adrenal Transformation Protocol.
All types of stress (work, family, lack of quality sleep) can play into whether an individual will feel “in the mood” or just feel moody. A new baby in the house, while totally wonderful and snuggly, can cause stress of its own (or just a complete lack of sleep and self-care, as any mom and dad can tell you!).
How does adrenal fatigue impact libido? When it occurs, the body thinks it’s in survival mode instead of thriving mode. Consequently, the adrenal glands can divert the production of “nice to have” hormones (like progesterone) from seemingly unneeded systems such as the body’s reproductive system, to fuel survival via the production of cortisol (a hormone required for survival). This makes sense – if we’re in survival mode, our bodies are too stressed out to worry about procreation, so no need for libido.
This follows with my Izabella Wentz Safety Theory, which is that from an evolutionary standpoint, our bodies continually adapt to our environment – even developing a chronic disease like Hashimoto’s – to help protect us. We develop Hashimoto’s because we aren’t eating well, or we’re experiencing too many toxins, food sensitivities, stressors, infections, and the like. Our bodies go into survival mode in such cases. Hypothyroidism may then lower our libido, make us less fertile, and possibly make us less attractive to potential partners (or at least we may feel this way when we experience increased body weight, hair loss, dull skin, etc.).
After utilizing protocols for adrenal balancing, my clients have shared that they finally have more energy, lose weight, feel stronger, feel calmer, feel less emotional, and have noticed their libido return. After doing the targeted interventions outlined in my adrenal program and book, many of my clients have reported feeling more like “themselves” and even see major improvements in symptoms that had been with them for decades, in just two to four weeks.
Our adrenals and the hormones they produce impact nearly every aspect of our physical and emotional health. When our adrenals are in balance, our energy increases, thinking becomes more clear and focused, people magically become less annoying, stress becomes easier to handle, pain lessens, and good-quality sleep comes more naturally. There are so many connections here to restoring sex hormones and libido.
If your libido is low, it’s important that you do not blame yourself or stay in negative thought spirals, as this will just worsen your stress (my book includes guidance on improving your mental health as well). But taking charge of your own health can help immensely. When we take steps to feel happier in our mindset and healthier in our body, we tend to feel more empowered, confident and attractive… and this can go a long way in the bedroom!
Postpartum Issues and Prolactin Levels
As a new mom, I believe that this “protective” mechanism (that I discuss in my safety theory article) contributes to postpartum thyroid issues. Elevated prolactin levels, which are found in breastfeeding moms, are known to perpetuate auto-antibodies and reduce libido. This could be a way of evolution preventing us from having too many babies all at once!
Interestingly, women (and men) with Hashimoto’s and hypothyroidism, even those who are not breastfeeding, tend to have more frequent elevations in prolactin compared to people without hypothyroidism and Hashimoto’s.
A recent study suggests that some 30 percent of people with subclinical hypothyroidism may have elevated prolactin levels. [5]
Breast tenderness, milky discharge from breasts outside of breastfeeding/pregnancy, enlarged breasts in males, libido issues, acne, excessive hair, infertility, and menstrual irregularities, may all be clues that your prolactin is elevated.
Interestingly, two recent studies found that women with Hashimoto’s and elevated prolactin are less likely to respond to levothyroxine, selenium, and vitamin D. [6] Women with normal prolactin levels will see their levels of thyroid antibodies reduced with using thyroid medications, selenium and vitamin D, three of the potential therapies for reducing thyroid antibodies I shared in my comprehensive article on reducing thyroid antibodies.
I’ve had a few clients with documented elevations in prolactin, and I have seen that lowering prolactin levels can help with reducing thyroid antibodies. Studies have, however, documented that bromocriptine, a medication used to lower prolactin levels, can reduce flares in lupus, another autoimmune condition.
In place of bromocriptine, I have previously utilized B6 for lowering prolactin levels. This vitamin has been shown to help regulate prolactin levels in women with hyperprolactinemia.
I first learned about prolactin elevations when I worked as a consulting pharmacist, as I often reviewed the medical histories of patients taking psychotropic drugs, and screened them for side effects. Antipsychotic medications can lead to elevations in prolactin, and so I was always on the lookout for this side effect (typically breast growth in men). In the case that someone presented with elevated prolactin and was taking a medication that was typically associated with the side effect, I would recommend switching medications. However, some individuals are “well-controlled” on their medications, and in that case, B6 would be suggested to mitigate the effects of the prolactin. I don’t recall the dose of B6 we used to recommend to mitigate the effects, but a study of high dose B6 was done with 200 patients taking antipsychotic medications and revealed that B6, taken at a dose of 300 mg twice per day over the course of 16 weeks, was able to reduce prolactin levels by 68 percent. [7]
In women, one study found a normalization of prolactin levels with the return of menses within 37 to 94 days of starting just vitamin B6. [8]
The dose used in studies is high-dose vitamin B6, up to 300 mg twice daily – however, B6, in the pyridoxine form, has been associated with side effects, especially when used in doses above 300 mg per day, long term.
This is because pyridoxine has an intermediary metabolite that has a super long half-life, meaning that it can build up in the body and become toxic. When used in high doses, the pyridoxine form of B6 can lead to neuropathy, which is nerve damage that can cause tingling, numbness, pain, sensitivity, and weakness. Often, this is felt in the hands and feet, but neuropathy can also cause dysfunction inside the body, interfering with digestion, sexual function, and so on.
I generally like to start with the active form of B6, P5P, at a lower dose of 50 mg. I think this can be enough for most people to lower their prolactin levels, as many moms who are weaning their nurslings report that anything over 50 mg of B6 can help suppress milk production.
As P5P is the active form of B6, lower doses are required to see benefit, and it does not build up in the body, as B6 in the pyridoxine form can.
I recently added P5P (50 mg) to the Rootcology portfolio because of its ability to support prolactin levels, libido, histamine tolerance, oxalate elimination, better sleep, and the production of neurotransmitters. [9]
Pure Encapsulations also makes a P5P (50 mg) supplement which I recommend.
Additionally, B6 in the pyridoxine form is made by Douglas Lab: Pyridoxine HCl (100 mg). Klaire Labs also offers a high dose supplement that contains 250 mg of B6 in the pyridoxine HCl form. (I do recommend using this with absolute caution, and only if the P5P form did not work for you.)
In addition to vitamin B6, an integrative protocol consisting of the following can help reduce prolactin levels as well:
- Chasteberry (Vitex agnus-castus): This herb has been traditionally used to regulate prolactin levels and menstrual cycles. I recommend taking Chaste Tree (Vitex) at one capsule, twice daily (may shrink prolactinomas).
- L-tyrosine: I recommend taking 500 to 1500 mg daily, or within an adrenal blend like Adrenal Support from Rootcology.
- Boswellia (Frankincense): This herb may also help with lowering prolactin levels. Because high prolactin levels are common in Hashimoto’s, I’ve added boswellia into my new Systemic Enzyme formulation. You can add it as a standalone supplement too – I really like Boswellia by Pure Encapsulations.
- Omega-3 fatty acids: Studies have suggested that omega-3 fatty acids may help reduce prolactin levels by reducing inflammation and balancing hormones.[10]
- Magnesium: Low levels of magnesium have been linked to high prolactin levels, so getting enough of this mineral may help reduce prolactin levels.
- Exercise: Regular exercise has been shown to help lower prolactin levels, as well as improve overall health and well-being.
- Reducing stress: Stress can lead to high prolactin levels, so finding ways to reduce stress, such as through yoga, meditation, or therapy, may help lower prolactin levels.
It’s worth mentioning that sometimes this elevation of prolactin may be due to a small benign tumor on the pituitary gland, known as a prolactinoma. I have had a few clients with prolactinomas in the past, and they did report their prolactin levels reducing with B6/P5P.
Additionally, as I already mentioned, various medications, such as antidepressants and antipsychotics, can raise prolactin levels. If you’re taking these medications and have high prolactin levels, talk to your doctor about alternative options.
A few years ago I had symptoms associated with elevated prolactin levels, that I think were partially caused by extended nursing, combined with sleep deprivation, and perhaps the stress of the pandemic… and forgot about this protocol until my friend Dr. Jolene Brighten mentioned it. ?
After weaning my little one, I used P5P, Vitex and my Adrenal Support supplement (which features L-tyrosine), and found that this was a big game-changer for my levels of motivation, breast tenderness, and mood. It also helped to normalize my periods!
I recommend measuring prolactin levels within one month of starting a treatment, to see if improvement has occurred.
Please note, you would not want to take Vitex or L-tyrosine concurrently with bromocriptine, due to drug-herb interactions. (All affect dopamine prolactin production!)
Exacerbated Stress Due to Thyroid Symptoms
Another thing to consider when digging for potential root causes of low libido, is that thyroid symptoms can exacerbate stress. Many of the common symptoms of thyroid disease, such as hair loss and weight gain, can exacerbate self-esteem, low energy, and sexual performance issues, often seen with low libido. Again, studies have shown a higher prevalence of sexual performance and libido issues in both men and women with thyroid disease. [11]
Physical Symptoms
There are also many physical symptoms that can be at the root of low libido. Pain is probably one of the biggest ones that my clients report impacting their quality of life, in and out of the bedroom.
Women who used to work out or enjoy a particular sport may no longer do so if they start experiencing some type of ongoing pain. They may also be told that being physically active again could worsen a medical condition, such as high blood pressure or coronary artery disease. Other chronic health conditions, like arthritis or even lower back pain, can sometimes affect our, or our partner’s, ability to enjoy intimacy.
The good news here is that these conditions have, at their foundation, issues relating to inflammation, and inflammation can be addressed. N-Acetyl Cysteine (NAC) and turmeric/curcumin are just two supplements to consider relating to inflammation and pain reduction (and may result in possible improvements in thyroid antibodies as well).
Women may also experience a wide variety of vaginal and pelvic pain. The list of possible issues is long (ovarian cysts, endometriosis, pelvic floor dysfunction, menstrual irregularities, vaginal dryness, yeast infections, and more), but know that most of these conditions can be significantly improved upon or even resolved. As an example, just by treating their thyroid, many women see improvements in lubrication, libido, and pain.
Finally, let’s talk about a lack of quality sleep, which I mentioned earlier as a stress factor, especially for all new moms (and dads). There have been some really interesting studies done relating to the importance of sleep in having a healthy sexual desire. Sleep deprivation can cause mood changes, irritability, and fatigue, which can impact whether someone feels frisky or not.
Thyroid issues may increase your risk for inflammation as well as sleep apnea. [12]
Interestingly, I have seen – with both clients and readers – that there is a very high incidence of people with Hashimoto’s also having sleep apnea. The good news is that there are protocols to address this condition. I’ve seen clients not only get a better night’s sleep on a consistent basis, but also reduce their cortisol levels (and, in doing so, better support their adrenals), by addressing sleep apnea.
Hormone Changes
Another common cause of low libido has to do with the natural fluctuations of our sex hormones. They – along with our adrenal hormones and mindset – need to be balanced in order for us to look forward to, and enjoy, intimacy.
Let’s start with drops in sex drive in women.
We know that women’s sex hormones fluctuate throughout various events and periods (no pun intended ;-)) in our lives (and much – although not all – of this is by design and perfectly normal), including:
- Throughout the menstrual cycle
- When using hormonal birth control pills
- When having a hormone imbalance condition, such as PCOS [13]
- During pregnancy
- While breastfeeding
- During the transition to perimenopause (estrogen starts to decline in our 30s, and perimenopause typically starts in the 40s)
- Menopause (typically happens around age 50, but this can vary) [14]
Most studies show that libido peaks at the time of ovulation in normally cycling women who are menstruating. (This makes sense from an evolutionary standpoint, as that is the most likely time for a woman to get pregnant, so she needs to be at her friskiest.) At this time, our testosterone is elevated, which increases our libido. This shows how wonderfully our bodies were designed: our libido increases right as a new egg requiring fertilization is released by our ovaries.
I still remember when I first got off of hormonal birth control pills and was tracking my cycles. It was so interesting to notice that my husband smelled really, really good after a jog around the time of my ovulation!
Later in our cycle, however, we may experience libido-busting premenstrual symptoms, like PMS, irritability, and cramping. This is a time when our progesterone levels dive after no egg fertilization occurs. It may be perfectly normal for a woman to have a decrease in libido during this time. However, every woman is unique in their cycle (especially when it comes to cycle length, the severity of hormonal changes, and associated symptoms!), so if you are concerned as to how you are feeling, bring that up to your doctor.
When using hormonal birth control pills, a woman’s production of natural estrogen and progesterone becomes suppressed. Levels of testosterone and DHEA (our two libido-supporting hormones) also get suppressed, and ovulation basically turns off. This can cause a lot of side effects such as low libido, as well as a variety of hormone imbalances. [15]
The process of aging causes changes in our sex hormone levels (including estrogen, progesterone, testosterone, and DHEA) over time as well, starting as early as our 30s. This is all perfectly normal for the most part… but there can be issues relating to hormonal imbalance along the way, such as with PCOS. [16]
PCOS is a challenging condition that is characterized by menstrual irregularities, infertility, insulin resistance, and a variety of symptoms such as fatigue, excess weight, stress, hair loss, or excessive hair growth. Women with PCOS are three times more likely to be diagnosed with Hashimoto’s. [17] Just like with thyroid disease, PCOS is associated with an increased risk for anxiety and depression disorders; and some women with PCOS experience libido concerns. [18]
The condition is tied to sex hormone imbalances – in particular, higher than normal androgen levels, which can prevent ovulation. Many of the same suggestions I would offer for someone having thyroid concerns relating to libido, may help with PCOS, including managing insulin resistance. (Myo-inositol may also help improve insulin sensitivity, as well as mood.)
Trying to get pregnant when hormones are imbalanced, especially if you have a thyroid issue, can require some special care. Once pregnant, libido may be affected due to changing hormones. Many women suffer from fatigue, a feeling of unattractiveness, and fears of the future, as they progress through their pregnancy. Often, a woman’s libido kicks into high gear at the end of the first trimester (after hormone havoc takes over her body with an increase in estrogen and progesterone levels, which can also cause symptoms such as nausea and fatigue early on)… but then declines in the third trimester.
By the time women reach menopause, their testosterone levels may be reduced to only a quarter of what they were in their early – and friskier – 20s. Declines in estrogen, testosterone, and DHEA can also result in vaginal dryness, painful intercourse, and incontinence (involuntary urinary leakage) – all significant libido busters. But all are conditions that can be resolved.
Symptoms of menopause can also contribute to a diminished sex drive. Hot flashes, night sweats, and poor sleep have been frequently reported in studies relating to decreased sexual desire. Many of my clients complain about these symptoms and their impact on relationships! The good news is that many of the same lifestyle interventions I recommend for thyroid health, such as adrenal support, improve these menopausal symptoms as well.
As progesterone and estrogen decline in menopause, the ratio of estrogen levels to progesterone levels can negatively impact the production of DHEA. If the ratio of progesterone becomes insufficient compared to estrogen, the resulting condition is called “estrogen dominance.” This can cause mood swings, anxiety, and weight gain in women. (Learn more about how estrogen dominance can affect thyroid health.) [19]
Men are not exempt from experiencing declines in their sex hormone levels as they grow older.
In men, free testosterone levels peak in their 20s and decline by about one percent per year in their 30s. Symptoms linked to low testosterone include low libido, as well as a number of symptoms that are also seen in menopause (such as mood swings, anxiety, and depression). Men may suffer from ED as well. (I’ll talk a bit about Viagra in a moment, as this drug is often prescribed for ED in men, but does not always help with libido issues.)
Thyroid issues can increase the decline in sex hormone production. Both our sex and thyroid hormones are part of an overall hormone communications network in our body, referred to as the HPA (Hypothalamic-Pituitary-Adrenal) axis. A sluggish thyroid can reduce the production of sexual hormones required for optimal sexual function and a healthy libido. [20]
The common issue mentioned earlier, estrogen dominance, can be a trigger for autoimmune conditions in both men and women. Estrogen dominance can also worsen hypothyroid symptoms by increasing the activity of Thyroxine Binding Globulin (TBG) hormone, which further reduces levels of free thyroid hormone in our bodies.
Hypothyroidism in men results in a decrease in sexual hormone binding globulin (SHBG) – a protein made by the liver that binds to androgens and estrogens – with free testosterone reduced in approximately 60 percent of males. Reduced testosterone production can lead to symptoms such as infertility, depression, erectile dysfunction, low libido, and reduced muscle mass. [21] (I recommend that you check out this article about how thyroid disease affects men, for more information on this topic.)
We’ll talk about how to address these hormonal imbalances shortly. There are many natural solutions.
Mood and Emotions
We’ve likely all used the phrase, “I’m not in the mood tonight.”
Well, mood can definitely be a root cause for low libido. We talked earlier about how a lack of sleep can cause irritability and moodiness. Other negative emotions can also cause problems, and bottling things up inside can often magnify your concerns. For some people, this can result in a case of the blues.
We know from the research that people who are depressed are more likely to experience low libido. One study found that more than 70 percent of depressed patients who were not taking depression medications, had a loss of sexual interest. [22]
But some anti-depressants, including Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), can cause lowered libido as well. In my experience as a pharmacist, these side effects were very common, and psychiatrists would sometimes prescribe a second antidepressant with a different mechanism of action, Wellbutrin, to counteract the sexual side effects of these medications.
While many of my clients say they like to do some serious cocooning (hiding away from everyone and just hunkering down alone) when they are feeling down, my approach is to double down on activities that boost oxytocin. Did you know that our bonding and hormone of love, oxytocin, helps counter the negative effects of our stress hormone, cortisol? Yes, it does!
While the best known way of boosting oxytocin is through physical connection bonding with others – snuggling, kissing, making love – I share additional oxytocin-boosting strategies in my Adrenal Transformation Protocol book. These include laughter, spending time with a pet, using essential oils like lavender, warming up the body in a hot bath with Epsom salts, and even spending time in nature!
Finally, it’s important to note that anxiety and mood disorders have a higher prevalence in patients with thyroid dysfunction. [23] In my own practice, I have found that mood disorders are very common in those with thyroid conditions. Many studies have associated abnormal levels of TSH, T3, and T4, with depression. You can read more about that, along with my personal experience, in my articles on anxiety and mood disorders related to Hashimoto’s.
Conventional Approaches to Addressing Low Libido
People don’t often bring up the topic of low libido with their doctors. In a 2018 poll conducted by researchers from the University of Michigan, only 17 percent of adults above age 65-80 said they had discussed their sex life with their doctor! [24]
If the issue is brought up, today’s conventional approach is definitely lacking. Some will at least review existing medications, in particular those prescribed for depression and anxiety, and switch out any with known effects. Others may suggest reducing stress, getting relationship counseling, and spicing things up in the bedroom.
There are also a few typical standard-of-care protocols that may be recommended. Let’s talk briefly about what’s available for women and men.
Conventional Approaches for Women
Two products are currently on the market for women, which are supposed to improve libido. One is called flibanserin (Addyi), which is a daily pill, and the other is bremelanotide (Vyleesi), a prescription injection that you use before sex. Both are only for premenopausal women, which is a possible drawback. While I don’t know a lot about the injection, it seems that it comes with a list of possibly serious side effects, including that it increases blood pressure, which could be dangerous for those with hypertension. [25]
The daily pill has not had a lot of positive results, and has even been flagged by the FDA as a substance that could be high risk. Its benefits seem limited and it has numerous side effects. The potential benefit? One more day of increased sexual desire per month. The side effects of this additional day? The possibility of low blood pressure, dizziness, nausea, and fatigue on a daily basis! Additionally, alcohol (known as the original libido booster by many) is not recommended while a woman is taking this medication. I’ve talked to a lot of practitioners at conferences, and not one has been excited about this as a viable solution.
Other possible treatments include hormone therapies such as estrogen hormone replacement therapy. Estrogen doesn’t really “fix” libido, but may address symptoms such as hot flashes and vaginal dryness, which can impact libido. Unfortunately, there are potential side effects and health risks (related to breast cancer), so this option isn’t right for a lot of women.
Androgen replacement therapies (testosterone and DHEA) are also possible, but are not viewed as conventional therapies by most doctors. I’ll talk more about estrogen and androgen therapies in a moment.
Conventional Approaches for Men
The standard of care for low libido in men is often a prescription for Viagra (the blue diamond pill), or a similar type of medication. The issue with Viagra is that it is really a medication that addresses blood flow issues relating to ED. Viagra and other drugs like it do not address other possible root causes for a man having low libido or low testosterone.
Low testosterone can be a risk factor – beyond libido – for many other significant health issues, including diabetes, heart disease, and even cognitive decline. [26] There are ways to naturally support healthier testosterone hormone balance, and I’ll discuss them in a minute.
10 Natural Solutions to Increase Libido in Both Men and Women
Addressing thyroid dysfunction can help restore libido and sexual function! In a 2018 study focused on the connection between the thyroid and libido, thyroid hormone levels appeared to be the causative factor for libido and sexual dysfunction issues in men, while thyroid antibodies appeared to play a more important role in low libido in women. This is important information to know, as there are many ways to optimize thyroid hormone levels and reduce thyroid antibodies.
With those two goals in mind, here are a few core recommendations to help you improve a low libido.
1. Consider your prolactin levels. As mentioned above, elevated prolactin is common in those with Hashimoto’s (even for those who are not breastfeeding), and this can impact libido. B6 supplements may help to improve this, but may also lead to toxicity in higher doses because of the buildup of pyridoxine in the body. I recommend Rootcology P5P or Pure Encapsulations P5P as gentler and safer options, starting at a dose of 50 mg. P5P may also have other benefits such as improved mood, sleep, blood sugar levels, and resilience to stress.
2. Talk about it! Talk about libido concerns with both your partner and doctor. For your partner, it is important that they understand what is going on, that it can be improved upon, and that it isn’t (or is) related to issues in your relationship. For your doctor, it is important that they know if you (or your partner) are experiencing low libido, as it can be a symptom of thyroid disease as well as other health issues, including chronic pain, depression, hypertension, diabetes, and cardiovascular disease.
The factors that influence a low libido (lack of sleep, stress, adrenal dysfunction, underlying anxiety issues) should be identified and tackled. Your doctor will also want to evaluate all medications you take, to see if any of them have known libido-related side effects. Libido health should be a topic for every annual checkup, but not every doctor will ask these types of questions. If you are not seeing a functional medicine practitioner, you might want to find one that will take more of an integrated view of your thyroid health. (Find out more about what a functional medicine practitioner can do for you, and where to find one.)
3. Optimize thyroid medications to improve libido. Sometimes just tweaking your thyroid hormone medication can help. In a 2019 review of existing research, it was found that optimizing thyroid hormone levels was associated with a dramatic resolution of libido (as well as sexual dysfunction) in both male and female patients with hypothyroidism or hyperthyroidism. [27] We know that thyroid medications have a narrow therapeutic index and that careful dose titration is key to their effectiveness. Doses that are incorrect by even just a tiny amount can result in ongoing or even new symptoms, so it’s important to ensure your current dosage is correct. (You can read more about thyroid hormone medication optimization in this free eBook.)
4. Support your adrenals. First, get tested for adrenal dysfunction. Once you know the status of your adrenal health, you can work to improve it with the Adrenal Recovery Protocol in my book, Adrenal Transformation Protocol, which outlines a four-week protocol designed to help you recover from adrenal dysfunction. The protocol is divided into four sections: replenish, re-energize, revitalize, and rebuild resistance. Each phase of the protocol is meant to be done sequentially, where you are essentially allowing your adrenal system to properly rest, then recover. The book also focuses on improving sleep, balancing blood sugar, improving stress management, reducing overall inflammation, addressing nutrient deficiencies, and building up resilience with adrenal adaptogens. You can order the book here!
Adaptogenic herbs are natural products that supplement the body’s ability to handle stress and are thought to normalize and support the HPA axis. I recommend Rootcology Adrenal Support, which contains adaptogens like ashwagandha and licorice, to promote healthy cortisol levels and rejuvenate the adrenals. For more in-depth information relating to adrenal support, check out my article on adrenal health.
5. Consider libido-specific adaptogens. In my book, Adrenal Transformation Protocol, I cover the most helpful adaptogens for libido boosting, including shatavari, ashwagandha, and maca. I specifically recommend maca as part of my adrenal-transforming protocol for libido support, as I’ve found that it helps my clients with their energy levels and overall mood, as well as symptoms of hormone imbalance (brain fog, memory, metabolism, hot flashes).
My Maca Latte recipe, which I recommend you drink daily during the protocol, is a healthy go-to for a midday slump! The Peruvian herb maca can help support your body’s stress response and optimize adrenal health. It can also help with menopause symptoms that might affect sexual desire, such as night sweats and hot flashes. Studies have shown that maca may help improve libido in both women and men. [28] I like Symphony Natural Health’s Femmenessence products, which are products specifically formulated for women. This company also has products formulated for men. Please note, maca is an adaptogen. However, it may have different effects on different people, and could be stimulating to some. I recommend starting with a low dose, to see how you tolerate it, and working your way up.
6. Focus on improving your quantity and quality of sleep. Cortisol and DHEA balance go hand-in-hand with sleep and mood. Essentially, when these two hormones are balanced, sleep and mood will be too. [29] Better sleep will not only help with fatigue and mood, but will also naturally boost your DHEA levels, and therefore your libido. Better sleep will support your adrenals as well. You can find my comprehensive sleep article here. (All of these recommendations are applicable to you and your partner. As they say, it takes two to tango!) If you suspect you or your partner might suffer from sleep apnea, please bring that up with your doctor. Treatment can be very effective.
7. Improve mood and reduce anxiety. I recommend incorporating stress management techniques, like massages and journaling, into your daily routine. Oxytocin-boosting strategies such as those mentioned above can be extremely helpful for this as well. Reach out to loved ones and your best support community to get a healthy dose of oxytocin each day. (Oh, and just because you might not “be in the mood,” doesn’t mean a little hand-holding or shoulder massage won’t generate some nice levels of oxytocin, for both you and your partner.) You may also consider supplementing with selenium and myo-inositol, which have been shown to improve mood and reduce anxiety in people with Hashimoto’s. (Rootcology’s Selenium + Myo-Inositol supplement contains both!) These strategies may help reduce symptoms that can act as barriers to intimacy, as well as help in reducing thyroid antibodies, leaving people with an improved sense of well-being… a perfect way to set the mood.
8. Consider sexual hormone replacement therapy. In women, estrogen hormone replacement therapy (HRT) can reduce vaginal dryness and pain during intercourse, as well as reduce hot flashes and night sweats, which could aid in libido improvements. [30] As mentioned previously, this is often prescribed as a conventional standard-of-care treatment. However, estrogen dominance can be a trigger for Hashimoto’s, so caution should be taken if considering this option. Testosterone therapy is another potential treatment for women and can result in increased vaginal lubrication, heightened sexual arousal, and increased libido. [31]
For men, testosterone hormone replacement therapy is also an option. As mentioned earlier, this is not the same as Viagra. Viagra is focused on improving blood flow to the penis, to address ED. Testosterone, on the other hand, is involved in a multitude of processes throughout the male body. It is involved in protein and muscle formation, helps manufacture bone, control blood sugar, and regulate cholesterol, supports a healthy immune system, aids in memory and mood, and yes, helps men get in the mood. But a healthy testosterone level is about much more than libido, so men should get tested and know their numbers for testosterone, as well as other sex hormones. For men with hypothyroidism, levothyroxine treatment can help with depression and libido. [32]
There are pros and cons associated with hormone replacement therapies, including breast cancer concerns (with estrogen) and side effects (aggressiveness and skin breakouts from testosterone therapy). You should work with a doctor to discuss what might make the most sense for you or your partner. Thyroid hormone therapies may have to be tweaked, as sexual hormone replacement may impact thyroid hormone levels. Note that there can still be other root causes for low libido that may not be addressed by these therapies. A functional medicine doctor is trained to look at all of these possibilities, so it’s important to consult with one if you are considering this as an option. In the meantime, you can check out this interview I did on the topic of hormone replacement therapy to learn more about it.
9. Consider DHEA supplementation. Deficiencies in DHEA can contribute to low libido. DHEA can be boosted naturally with melatonin (getting lots of sleep), magnesium (supplements and Epsom salt baths), licorice, and meditation. In my Adrenal Transformation Protocol book, I discuss natural ways to boost DHEA. Supplements specifically designed for adrenal support can help to balance DHEA and cortisol. These include the “ABCs” of adrenal support (adaptogens, B vitamins, and vitamin C), magnesium, licorice, and phosphatidylserine. DHEA (dehydroepiandrosterone) is an androgen that has many important functions in the body for both men and women. It makes other sexual hormones (including our other libido-supportive sexual hormone, testosterone), and has been shown to support desire, arousal, and orgasms. [33]
One study in women with adrenal fatigue showed increased libido after the administration of DHEA. Other research has shown that DHEA supplementation resulted in a reduction of thyroid antibodies. [34] The recommended daily dose range is generally 10 to 50 mg for women, and 25 to 100 mg for men. (Women need less DHEA than men.) However, starting low and slowly increasing should always be the approach. Some professionals give women even less DHEA – as low as 2 to 5 mg per day. I have personally found that many women with Hashimoto’s tend to do better with the lower dose range.
CAUTION: DHEA is available without a prescription in the United States and a few other countries, but like other hormone therapies, I always recommend only using DHEA under the guidance of a practitioner, to find the right dosage for you. There can be side effects with taking too much DHEA, so DHEA levels should be tested prior to starting supplementation, and then monitored.
DHEA can also be applied topically, which can be especially helpful for women experiencing vaginal dryness and vaginal discomfort. Practitioners have used vaginally-applied DHEA to address symptoms typically related to menopause, such as vaginal dryness, vaginal tissue integrity, and pain during intercourse – as well as to address libido concerns. In 2016, the U.S. Food and Drug Administration (FDA) approved a product named Intrarosa®, which contains the active ingredient prasterone (DHEA). This product was approved to treat women having moderate to severe pain during intercourse. The research supporting DHEA and the approval of Intrarosa® also showed many promising benefits relating to reduced vaginal dryness and irritation, strengthened vaginal musculature, and increased libido.
To date, vaginally-applied DHEA is still only available through prescription, either as Intrarosa® or an off-label customized prescription. However, there is an over-the-counter topical cream for the vulva that has been out on the market for a few years now, developed by a longtime gynecologist, obstetrician, and women’s hormone expert named Dr. Anna Cabeca. Her product, Julva®, is a cream that contains DHEA and other natural, soothing ingredients (Alpine Rose stem cells, coconut oil, vitamin E, emu oil, and shea butter). Many women have seen it dramatically improve their vaginal dryness and irritation, as well as their libido. If you’re interested in trying her cream, I’m excited to announce that she has a special offer available to our community. You can try seven nights of Julva® for free – just pay a small fee to cover shipping costs.
10. Finally, for a healthy libido, decompress and do something to help you get in the mood. We’re all running around with too much to do and too many daily stressors. It is important to take some time each day to decompress, unplug (yes, really!), and pamper oneself.
I like using essential oils and taking a nice warm Epsom salt bath at the end of my day (after reading my baby a bedtime book, of course!). Then I like to do some reading of my own…
I suggest you read a romance novel instead of spending your evening checking emails and Facebook. ? Hashimoto’s advocate Tara West happens to be a (hilarious) romance author… Many women with Hashimoto’s are a part of her fan club and credit her work for helping with libido! Check out her books on Amazon.
The Takeaway
Many factors can lower a person’s libido, and having a thyroid condition can alter it as well. While it can be a difficult subject to discuss, please know that there are strategies you can consider to help improve your libido.
If you’re struggling with low libido and energy alongside symptoms like food cravings, mood swings, and poor sleep, it may be your adrenals, and you can improve adrenal function to feel better! I’ve seen many people recover their energy and libido simply by following targeted adrenal protocols just like the ones I detail in my latest book, Adrenal Transformation Protocol.
These gentle protocols are easy-to-follow, and unlike other recommendations you may get about libido from practitioners, they do not include any hormone treatments.
I’m so excited to share this book because I truly believe that it will help so many more get their health back and feel like their best selves again! You can order your copy here.
Optimizing thyroid medications, supporting your adrenals, trying maca, improving the quality of your sleep, reducing anxiety levels, decompressing with relaxing daily rituals, and considering hormone replacement therapy are great places to start. You may also wish to consider DHEA, or try the topical cream Julva®, which contains DHEA.
I recommend working with a functional medicine practitioner who will help you identify the root causes of your low libido. To help you find one in your area, download this FREE directory of functional medicine doctors.
And don’t forget to include your partner! Maybe he/she needs some pampering, too. ?
I hope this helps you on your journey!
I love staying in touch with my readers! For continued updates and interaction, join our online communities on Facebook, Instagram, Pinterest, and TikTok. Sign up for my newsletter to get helpful information, new research, resources, giveaways, and more, delivered straight to your inbox!
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Note: Originally published in 2019, this article has been revised and updated for accuracy and thoroughness.
