How do hormones affect sex drive across different life stages? Photo / 123rf
Both men and women experience ever-changing levels of hormones over time, but what impact does this have on desire and daily life?
From weight gain to filthy tempers, our sex hormones have a lot to answer for. Of the 50 hormones each of us has in our bodies, the trio of oestrogen, testosterone and progesterone play crucial roles in puberty, fertility and sex drive.
“Hormones are chemical messengers produced by glands in the endocrine system and released into the bloodstream,” explains physician and intimate health expert Dr Shirin Lakhani. “They work together in the body, like an orchestra, and an imbalance can occur at any life stage and have an effect on others.”
One of the main female hormones is oestrogen - which also influences hair growth, body weight, bone and muscle growth, skin and libido - the primary form during your reproductive years being estradiol. Progesterone helps regulate your blood pressure and improve your mood and sleep.
Meanwhile, testosterone, the “male hormone”, affects sex drive, sperm production, bone density, muscle mass and strength.
But women have it too: “Testosterone is crucial in helping confidence and boosting women’s libido,” says Lakhani.
Scientists are working to understand links between sex hormones, sex drive and overall health and disease - here’s what we know about how they change over our lives...
“In males, testosterone production is already happening in the womb, as it’s required for development and growth of the penis and scrotum,” says Professor Rod Mitchell, a professor of developmental endocrinology at Edinburgh University. “Then in puberty, high levels of testosterone are needed for further growth of the genitalia and to support the start of sperm production, and this continues into adulthood. In females, oestrogen isn’t required in childhood, but in puberty it rises for breast development and periods to begin.”
Testosterone is typically high at this age, required for sexual function, fertility and general health, according to Mitchell. “Testosterone is high in your 20s and so is your sex drive,” says Professor Annice Mukherjee, known as “the hormone doc” on Instagram. But it’s not necessarily all thrills: it is common for young men to have sexual anxiety because of inexperience.
“You may think erectile dysfunction [ED] only happens in later life, but 8 per cent of men in this decade report it,” says Mukherjee.
“Antidepressants can suppress testosterone and sex drive, as can other health issues, including chronic stress, chronic fatigue, uncontrolled diabetes and severe obesity.”
“Teens to late 20s are the most fertile years, but it doesn’t mean the desire is necessarily there, " says Mukherjee. In fact, some studies show that female desire may go up just as fertility starts to decline towards the end of your 20s.
“Although fertility declines thereafter, many women remain fertile and can fall pregnant for a couple more decades yet,” she says.
Natasha Silverman is a sex therapist at Relate and says the concept of libido and “sex drive” comes up regularly for couples of all ages in sex therapy. “We’re taught that sex drive is ‘high’ or ‘low’, but that isn’t how sexual desire operates. After the initial honeymoon phase, a year or so into a committed relationship, the overwhelming majority of women see a reduction in their ‘spontaneous’ sexual desire, but in reality, most are not losing their sex drive, but just moving into a different kind of sexual desire.
“They might think, ‘I’m elbow deep in the dishwasher and sex is the last thing on my mind. Can we just watch Netflix?’ So around this time, tensions can build, but it’s normal to not desire sex with a person they don’t feel appreciated by.”
Silverman has observed that when spontaneous sexual desire dampens down for one partner, sexual pursuit by the other may dramatically increase, because the higher-desire partner is attempting to quell the anxiety that comes from feelings of being unwanted. “Again, this may seem like someone has a ‘super-high sex drive’ when in reality, it’s stemming from a place of insecurity and needing reassurance through sex.”
“Many men continue to have a strong sex drive through these years, though testosterone slowly decreases by around 1 per cent each year after the age of 35,” says Mukherjee. “The stress of work, family and other health issues can significantly impact sex drive and testosterone levels.”
You may notice that your sex drive is strongest in this decade. One study found that, between 27 and 45, women had sex sooner in a relationship and enjoyed more desire.
The average age for a woman in the UK to have their first child is now 31, and hormone levels wildly fluctuate during pregnancy, birth and child-rearing years. “In the second trimester of pregnancy, women can notice a boost in libido and a lack of desire at other times,” says Mukherjee. “Breastfeeding, raising children and trying to work all create fatigue, which has a negative impact on sex drive - and sleepless nights with a young baby can contribute to reduced interest.”
But it’s not all bad news, insists Silverman. “Once ‘spontaneous’ desire fades, most women will move into having ‘responsive’ desire (when before sex you weren’t sure you were in the mood but afterwards realise, ‘I’m so glad we did that!’) or ‘contextual’ desire, for example, you’re relaxed on holiday with a cocktail in hand, feeling sexy.”
The mistake many couples make, Silverman says, is continuing to initiate sex throughout their relationship in the same way as the very beginning. “People evolve, hormones change and so do our sex lives and intimacy,” she says.
Sex should still be enjoyed if you’re in good physical and mental health, but this is when neglecting a healthy lifestyle in earlier decades can start to impact. Mukherjee explains: “This is when issues such as heart disease, diabetes, high cholesterol and obesity rear their head. It’s not so much age itself, but these issues that age brings - and the drugs used to treat them - that make ED more common. Erections are less firm and frequent.
“Type 2 diabetes is also rising in epidemic proportion in the Western world and can have a significant independent impact on sexual function in men.” Like women, men at this point in their lives can suffer fat redistribution such as “man boobs”, insomnia and poor concentration and memory, says Lakhani.
Mitchell says that although testosterone levels are reducing at this age, “there is no dramatic decline in sex hormones, or a so-called ‘manopause’. Most men do not require testosterone replacement in later life”.
You might notice an increase in libido during perimenopause, says Mukherjee. “It may be evolutionarily - a last chance to fall pregnant before menopause. Also testosterone can increase at this time, hence some women experience hormonal acne.”
This decade can be challenging for many mid-lifers because we are working and caring for parents as well as children because we’re all having babies later. But it’s our hormones driving the menopause.
“It’s the decreasing oestrogen and progesterone causing menopause symptoms such as fatigue, hair loss, hot flushes, memory and sleep issues, depression, joint pain and loss of libido,” says Lakhani. But not every woman will suffer.
“Indeed for some, an ‘empty nest’ and less fear of pregnancy increases libido,” says Mukherjee. “HRT [hormone replacement therapy] can help make you feel more on top of life - and more up for sex. Menopause-associated reduced sex drive can also be treated with testosterone in doses specifically licensed for women.”
Interestingly, Silverman observes that around the same time many women are beginning HRT and have increased sexual desire, many men become more prone to erectile issues.
“This can be intimidating for males who’ve been used to being the pursuer,” says Silverman. “The combination of her increased sexual desire versus his unstable erection can also increase tension, anxiety and frustration within the couple.”
Testosterone levels certainly decline, but it’s not clear how much is required to achieve arousal, says Mukherjee. Some men with “low” testosterone show normal sex drive, while others with high levels have sexual problems.
“If men’s overall physical and mental health and relationships are good, then they can still absolutely have a good sex drive,” she adds. It’s worth seeing a GP to first rule out medical conditions (such as diabetes and blood pressure), but drugs such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are widely available.
“Once menopause symptoms start to resolve, the post-menopause years can certainly be an empowering life stage,” says Mukherjee. “That’s not talked about in the media enough.”
“Older couples often come to sex therapy with ‘low libido’ after episodes of ED, painful sex or ‘anorgasmia’ [inability to orgasm],” says Silverman. “But of course these things all impact libido.”
She suggests avoiding blaming hormones and instead encourages trust, affection and “lots of talking”. Age is no barrier to having an enjoyable sex life - whatever your hormones are doing.
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