Testosterone (T) is one of the hormones that play a major role in regulating the libido of both men and women.
In fact, libido is only one of the many aspects of sexual well-being which T regulates. It’s also important for erectile function and orgasms, as well as overall energy and mood.
Testosterone plays a role in sexual desire by activating specific areas of the brain that control sexual behavior and by promoting the production of nitric oxide, which helps to increase blood flow to the genital region.
It’s important to note that the relationship between testosterone and sexual function is complex, and other factors, such as psychological and social influences, also play a role.
Moreover, some people may have low libido with normal testosterone levels, while others may suffer from low T and still have most of their sex drive preserved. Thus, the relationship between T and sexual activity is complex and varies between individuals.
How does testosterone affect sex drive?
Sexual desire is defined as a motivational state that prompts individuals to seek out and engage in sexual activities.
These prompts are processed by the brain, and more specifically by areas such as the mediobasal hypothalamus and limbic system. According to research, these areas also happen to have a lot of receptors for androgens, such as testosterone.
The importance of testosterone for penile growth and the activation of these receptors in the brain is also confirmed by animal models, which show that problems with these receptors lead to impaired sex drive and sexual behavior.
Furthermore, testosterone may affect the brain regions mediating human sexual behavior via testosterone conversion into estrogen by the aromatase enzyme.
Healthy men with experimentally induced states of low T reveal that exogenous testosterone restores sexual desire levels, except in cases when coupled with aromatase blockers such as anastrozole.
Indeed, research clearly shows that low testosterone in men can have a negative effect on libido, and lack of sex drive is one of the most commonly reported symptoms of male hypogonadism.
In women, the interaction between libido and testosterone appears to be more complex, as there is no clear correlation between testosterone deficiency and sex drive. However, administering testosterone in postmenopausal women with sexual health problems may lead to improvements in sexual desire.
Does testosterone affect how long you last in bed?
Testosterone in men is also linked to erectile function and energy levels. Low testosterone can lead to difficulty maintaining an erection and low energy levels that may affect how long you last in bed. Thus, having healthy testosterone is important for normal erectile function and sexual performance.
How changes in T levels affect sex drive
There is a significant correlation between testosterone levels and sex drive in males. A study that used a 14-point scale to assess levels of libido in men showed that total testosterone increases by 3.4 ng/dl (0.12 nmol/liter) for each extra point of sex drive.
Nevertheless, the difference in mean T levels between men with low libido vs. those with normal sex drive was small.
The research also suggests that the levels of free and bioavailable T may be a slightly better predictor of sex drive levels in men than total testosterone.
Furthermore, most of the men with low libido actually had normal T levels, which highlights the importance of other factors for the male libido, such as psychological state, comorbidities, etc.
More specifically, the researchers reported that 23% of people reporting low libido also had testosterone levels under the physiological norm of 300 ng/dl.
This was higher than the 14% overall incidence of low T amongst all participants in the trial, so people with low libido were more likely to also have low testosterone. Still, the remaining 67% of men with reduced sexual desire had normal T levels.
Can you have low T and a normal libido?
Not everyone with low T had a symptom of low libido. The research also showed that 12 % of the men with low T and hypogonadism still had normal libido.
Studies also show that increasing the levels of testosterone over the physiological limit does not appear to exert any acute effects on libido levels.
According to one study, sexual desire was not affected by a single injection of long-acting testosterone undecanoate in healthy men which led to supraphysiological T levels for 2-3 weeks.
It’s important to note that the participants already had healthy testosterone and libido levels before the intervention. The frequency of sexual intercourse also remained unchanged.
Can testosterone therapy improve libido?
Testosterone replacement therapy (TRT) is one of the most effective FDA-approved therapies for men with low T. By normalizing serum testosterone levels, TRT can also help improve all your symptoms of low T, including your libido.
It’s important to note that TRT can increase your sex drive only if your lack of sexual desire is caused by low T levels. Your libido will return to levels that are normal for you and depend heavily on many other factors.
Thus, the increase of libido during TRT will vary from one individual to another depending on personal traits, mental state, the presence of other diseases, etc.
Low libido is one of the first symptoms which improve during TRT in men with low T
The benefits occur after the third week of the therapy and reach a maximum within 2 months on average. TRT may also help reduce erectile dysfunction and improve sexual satisfaction if those complaints were caused by low T.
Studies suggest that TRT may also have small beneficial effects on libido in men with normal testosterone levels. A meta-analysis of 17 trials reports that the effect of TRT on men with normal T ranges from none to moderate across the different studies.
Note that low libido is not an approved indication for the use of TRT in men with normal testosterone levels
Testosterone therapy is also not approved for use in women. Yet, some physicians may prescribe low-dose TRT off-label in postmenopausal women with hypoactive sexual desire disorder (HSDD).
Studies report that TRT may help improve libido in women with HSDD, regardless of their pretreatment T levels.
What’s the best testosterone for sex drive?
TRT comes in various forms, including testosterone injections, creams, gels, patches, implants, and pills.
If you have low libido due to low T, then any form of testosterone will help increase your sex drive. That’s because all forms of TRT can reliably increase serum T levels in men with hypogonadism.
Furthermore, the effectiveness of testosterone therapy for improving sexual desire depends mainly on the individual’s underlying health conditions, age, and the severity of their hormone deficiency.
However, some forms of TRT, such as testosterone injections, can lead to a faster increase in serum T levels and, thus, quicker management of symptoms like low libido.
Injectable testosterone is usually administered by intramuscular injections every few weeks. For example, research reports that 200 mg of testosterone enanthate taken once every 2 weeks can lead to a notable improvement in libido.
Studies also suggest that testosterone injections are the preferred form of TRT by most patients for being affordable and having the highest overall satisfaction rate.
Can testosterone supplements improve your sex drive?
Studies report that even the most common ingredients in dietary supplements which claim to boost testosterone levels are poorly studied regarding their effects on testosterone in humans.
Moreover, some researchers even note that about 10% of the most popular ingredients in T boosters may actually decrease testosterone levels. Thus, testosterone supplements are unlikely to affect your libido by increasing T levels.
On the other hand, some of the ingredients in testosterone boosters may affect sex drive because they act as aphrodisiacs rather than having any effect on serum T
Popular aphrodisiacs, which are also backed up by some scientific research, are Fenugreek (Trigonella foenum-graecum) and Maca (Lepidium meyenii).
For example, one study reports that taking a fenugreek extract for 6 weeks can significantly increase sex drive in men when the effects were compared to a placebo. Yet, there was no effect on hormonal levels such as testosterone.
Several other trials also report that Maca supplementation can significantly improve libido in healthy men, as well as those with sexual dysfunction. Most notably, one trial in 175 healthy men reports that Maca supplementation for 12 weeks can increase sex drive. Yet, all studies report that Maca does not affect testosterone levels.
Furthermore, some of the common ingredients in testosterone boosters may also have the opposite effect and decrease libido. For example, saw palmetto extract, which can be found in some testosterone boosters, has been reported to cause reduced libido as one of its potential side effects.
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