When low desire is about more than hormones

When low desire is about more than hormones

There is a very important difference between what you want to do and what you’re willing to do. It’s easy to miss this point in a low libido consultation, often framed as a request for testosterone.

If we rush to prescribe, we can inadvertently repeat something that has happened to a woman for much of her life: we can miss her.

Some of the deepest trauma exists in the gap where something should have happened, but didn’t. When a compassionate witness is absent, the nervous system adapts. Many women learn early that it isn’t safe to ask for what they really want or need; instead, they become experts at anticipating everyone else’s needs.

An unseen child often grows into a woman who gives and gives and gives. Then menopause arrives. Changing physiology and neurobiology can expose relational patterns that have existed for decades. The capacity to keep overriding yourself begins to diminish, and emotions that have been pushed down become harder to ignore.

Many women say they have gone off sex. Often it is about years of sex being another place where they have given more than they have received, and being a good partner has mattered more than discovering what they themselves want or enjoy.

Desire needs space

Testosterone will not make us want sex with a partner where the relational dynamic still asks us to give far more than we receive. Desire rarely flourishes where there is chronic self-abandonment.

The women who do best are often those who begin, perhaps for the first time, to believe that their pleasure, needs and boundaries matter just as much as everyone else’s.

Please prescribe testosterone when it is indicated. But the low libido consultation needs to be about much more than hormones. We need to ask what it is like to be this woman, what her nervous system has learnt about relationships, and whether she feels safe to ask for what she needs. The most therapeutic part of the consultation is often not the prescription. It is asking questions that help a woman feel seen.