Low Libido in Women: Causes, Workup & Full-Spectrum Treatment Options

Low sexual desire in women—known as hypoactive sexual desire disorder (HSDD) can deeply impact quality of life, relationships, mood, and confidence. It affects up to 40% of women at some point and is common during perimenopause and postmenopause.

  Common Causes of Low Libido in Women

Low testosterone, low estrogen, progesterone imbalance

Low vitamin D, B12, magnesium, iron, omega-3s

PCOS, thyroid dysfunction, diabetes, autoimmune disease

Anxiety, depression, trauma, body image concerns

SSRIs, birth control pills, antihypertensives, anti-seizure meds

Vaginal dryness, pain with sex (dyspareunia), anorgasmia

Lack of emotional intimacy, past trauma, fatigue

Treatment Options for Low Libido in Women

 Testosterone Replacement in Women

• Restores libido, sexual drive, confidence, orgasm intensity, and energy
• Topical creams or gels
• Injectables or pellets (used cautiously in women)

Monitoring: symptoms, as well as T levels, estradiol, and other hormones, blood work initially every 8–12 weeks then every 6-12 months as needed.

  Estrogen Replacement

• Essential for vaginal health, arousal, and natural lubrication
• Routes: transdermal patch, cream, troches, vaginal ring/tablets
• Especially important postmenopause

  Progesterone

• Balances estrogen, improves sleep, reduces anxiety, supports libido indirectly
• Oral micronized progesterone: 100–200 mg at bedtime (bioidentical)

   Clitoral or Vulvar Injections

PRP (O-Shot)Platelet-rich plasma injected near clitoris & G-spot to enhance sensation and blood flow

Clitoral testosterone or PT-141 Research-based use to enhance arousal locally

These are considered experimental and often done in integrative or sexual wellness clinics.

    FDA-Approved Medications

Bremelanotide (Vyleesi) Injection for low libido activates melanocortin receptors;

use ~45 min before sex

Flibanserin (Addyi) nightly; increases desire Works on serotonin/dopamine balance

      PT-141 (Bremelanotide) Peptide, enhances arousal, libido; works in the brain

Kisspeptin, may restore natural hormone production and libido (experimental)

    Supplements for Female Sexual Health

Zinc supports testosterone synthesis,

Boron Lowers SHBG, increases free testosterone

L-arginine / Citrulline, enhances blood flow and genital response

Ashwagandha reduces cortisol, improves libido & mood

Maca Root, traditional libido-enhancer, adaptogen
Omega-3s, supports hormone production, improves blood flow

       Non-Hormonal & Lifestyle Approaches- Pelvic Blood Flow & Sexual Aids

• Shockwave therapy (LiSWT) for vulvar and clitoral blood flow
• Vaginal dilators or vibrators – improve nerve response and tone
• Vacuum clitoral devices – enhance blood flow and sensitivity