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Why does the pill decrease a woman's sex drive?

Madeleine M. Castellanos, MD
Psychiatry
In women, testosterone is produced both in the adrenal glands (found above the kidneys) and in the ovaries (yes, they are not just for estrogen!). Since oral contraceptives damper the hormone-producing action of the ovaries, a woman's production of testosterone is somewhat lowered when on the pill. In addition to this, and probably more significant, the synthetic estrogen from oral contraception increases the body's production of sex-hormone binding globulin (SHBG). This is a protein that binds to the sex hormones (testosterone, estrogens, and to a very small extent, progesterone) as they circulate through the bloodstream.

Even though women have only about 10% of the testosterone level coursing through their blood stream than men do, testosterone is a main contributor to their libido and their sexual fantasies. Testosterone also is responsible for maintaining the erectile tissue of the clitoris and the glands surrounding the opening of the vagina that provide lubrication during sexual arousal. When testosterone is bound to SHBG, it cannot be free to be used by the cells of the body, and when there is an increase in SHBG, there is less free testosterone available.  Being on the pill can increase a woman's SHBG levels by 200-400%, dropping their free testosterone levels drastically. This means that those cells, tissues, and systems that depend on testosterone will have decreased functioning. The result is a drop in desire, a decrease in how often women will engage in sexual fantasies, and decreased lubrication at the time of sexual activity, in response to erotic thoughts or direct physical stimulation.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.