Docs-Only Special: The Truth About Libido — What Drives Desire and What Kills It

About This Episode

Libido is one of the most talked-about and least understood aspects of human health. People worry about having too little of it, feel shame about having too much, and rarely get accurate information about what drives it, what suppresses it, and what can be done when it changes. In this Docs-Only Special, Dr. Sherry Ross and Dr. Tammy Nelson take on the subject directly.

What Is Libido, Really?

Topics covered in this episode include the biology and psychology of libido — what it actually is, how it is measured, and why it varies so dramatically between individuals and across the lifespan. Dr. Ross explains the hormonal underpinnings of desire, including the roles of testosterone, estrogen, and progesterone.

What Suppresses Desire

One of the most practically important topics covered in this episode is the factors that suppress libido. Topics covered include the effects of hormonal changes (including menopause and postpartum), medications (particularly SSRIs and hormonal contraceptives), chronic stress, sleep deprivation, relationship conflict, body image, and trauma.

The Responsive vs. Spontaneous Desire Distinction

Dr. Tammy Nelson introduces one of the most important concepts in contemporary sex therapy: the distinction between spontaneous and responsive desire. Topics covered include what these two patterns look like, why the cultural expectation of spontaneous desire creates unnecessary suffering, and how understanding this distinction can transform both individual experience and relationship dynamics.

Medical Treatments for Low Libido

Dr. Ross provides a thorough overview of the medical treatments available for low libido, including hormone therapy, testosterone supplementation, and medications specifically approved for hypoactive sexual desire disorder. Topics covered include who these treatments are appropriate for and what the evidence shows.

The Relationship Between Libido and Relationship Health

The episode closes with a discussion of the relationship between libido and the health of intimate relationships — including the ways desire discrepancy is one of the most common and most challenging issues in couples therapy, and what Dr. Tammy Nelson has found most helpful in working with couples navigating this challenge.