Hormones & Sexual Health: Libido, Desire & Performance

Vitality Unfiltered Podcast

Hosts: David Bauder, PA-C | Chris Reeves, MD | Stephanie Lattimore, NP

In this episode of Vitality Unfiltered, we tackle one of the most common — yet least openly discussed — areas of health: sexual health, libido, desire, and performance.

Many people experience changes in sexual function at some point in their lives, but very few feel comfortable bringing these concerns up with their doctor. As a result, important symptoms are often ignored, minimized, or misunderstood.

This conversation reframes an essential truth:

Sexual health is health — period.

Changes in libido, sexual desire, arousal, or performance are often not relationship failures or personal shortcomings. They are frequently signals from the body reflecting deeper physiologic changes involving hormones, metabolism, stress, sleep, vascular health, and neurological function.

In this episode, we break down the science behind sexual health and explain why these symptoms should be taken seriously as part of a comprehensive health evaluation.

In this episode we discuss:

• Why sexual health should be considered a vital sign of overall health
• How sexual symptoms can be early warning signs of metabolic or vascular disease
• The critical difference between libido, desire, and sexual performance
• How testosterone influences motivation, sensitivity, and sexual drive
• The role of estrogen in tissue health, lubrication, and blood flow
• Why progesterone affects mood, comfort, and emotional readiness
• How thyroid function impacts energy and sexual responsiveness
• The impact of cortisol and chronic stress on libido suppression
• Why menopause, perimenopause, postpartum changes, and andropause affect sexual health
• The effects of birth control, medications, and antidepressants on libido
• Why sexual symptoms are often dismissed or oversimplified in traditional healthcare
• The interaction between psychological and physiologic contributors to sexual health
• Why comprehensive hormone testing and metabolic evaluation matter

We also explain what a responsible, comprehensive evaluation should look like — including hormone testing, metabolic screening, lifestyle analysis, and personalized treatment strategies.

This episode is not about quick fixes or gimmicks.

It’s about understanding the biology of sexual health, removing stigma, and helping people recognize that these symptoms often provide important insight into overall wellbeing.

Because in clinical practice, we see this every day:

Sexual symptoms are rarely random.
 They are often hormonal, metabolic, vascular, neurologic, or stress-related signals from the body.

And when those underlying drivers are properly understood and addressed, health, confidence, and intimacy can improve in powerful ways.

If today’s episode raises questions about your own health and you’d like a personalized evaluation, our team at Weight Loss & Vitality is here to help.

📞 Call: 571-550-9000
🌐 Visit: weightlossandvitality.com

About Vitality Unfiltered

Vitality Unfiltered is a medical podcast exploring the science of hormones, longevity, metabolism, weight loss, sexual health, and precision medicine. Each episode brings real clinical insights from healthcare professionals who treat these conditions every day.

Our goal is simple:

⚠️ Disclaimer
This podcast is for educational purposes only and does not constitute medical advice. Listening to this episode does not establish a provider-patient relationship. Always consult your qualified healthcare professional regarding medical concerns, diagnosis, or treatment.

Transcript

SPEAKER_02 0:02

Vitality.

SPEAKER_03 0:04

Vitality Unfiltered.

SPEAKER_02 0:06

Unfiltered.

SPEAKER_03 0:07

With David Bowder. Welcome back to another episode of Vitality Unfiltered. I'm David Bowder. Your host today with me is Stephanie Lattimore, nurse practitioner out of our Washington, D.C. location. Today's topic, we're going to be talking about hormones and sexual health. Kind of an interesting conversing topic today, probably something that probably is talked about less than it needs to be talked about because it's an underserved component of healthcare. And in reality, when you think about sexual health, is health. And most of the time, this is a dismissed type topic when an individual comes in to be seen for it, or it's just avoided altogether whether the patient or the client is embarrassed to talk about it, or there's some barriers that are set up for this actually to be taken care of. So what we want to do today is round out a little discussion on sexual health, how hormones matter, and how hormones influence sexual health and the health of an individual. When you think about sexual health, there's a lot of things that are at play here, but most of the time an individual should consider any symptom that they have from a sexual dysfunction component, whether it's ED, low libido, inability to enjoy intimacy, that should be viewed more so as a symptom of a bigger problem that's going on. If it's viewed as, oh, something's wrong with me, that's kind of like looking at it from the wrong side. Because the normal physiology in the body should respond in a favorable way that gives an individual a normal sexual health or lifestyle. So to start off with, if we if we think about the three components that go with this, libido, desire, and performance, how would you go ahead and articulate the difference of those three things?

SPEAKER_01 2:00

I like to break down sexual health into these three categories because a lot of times, as you mentioned, men are reduced to the performance category. Women are left off entirely. So by breaking it down into libido, desire, and performance, we can look into the biochemical or the physiological background of libido. This is on a chemical level, hormonally driven. Then we can look at desire, which is more of a psychological background, may fall on an emotional level. And then lastly, performance, which is the physical manifestation in the realm of sexual health. I can't believe I'm about to share an embarrassing story with you. All over the radio, the song I like big butts. There's a line when a girl goes, makes me so horny. And this is so embarrassing. I remember asking my mom as a nine or 10-year-old, mom, what does horny mean? And she, without blinking, without hesitation, says, Steph, it means ready for romance. And she was so spot on. Ready for romance. She's talking about that emotional piece of this. So when you're looking at sexual health, the takeaway of my tale is you have to break down what is the concern and where does it originate from? Is it the performance aspect for a man or a woman? Is it the desire, that emotional piece, or is it the libido, the sex drive? Where does the problem originate, the concern originate, and is it hormonally driven?

SPEAKER_03 3:50

And and an individual can have all of them. Absolutely. It doesn't have to be limited to one, or it doesn't have to be all of them, or it could just be one. I guess to start off with, we could start going down the hormones and we start thinking about the main hormones that are involved in the desire piece. Okay. But there also could be a psychological component associated with in the desire aspect, also. I mean, it doesn't have to be limited to this. But the first hormone that would be considered is the motivation. And the motivation or the desire would largely be placed on testosterone. However, again, we don't want to say this hormone is the cause of X because it's such a spider web of uniqueness across all spectrums. Just because a testosterone level is normal in the body does not mean that the desire in libido will be there because you still need a balancing of all the hormones. But how we're going to try to break this down are the main hormones that are associated with the different symptoms. So testosterone is largely related to the desire or the motivation for sexual health. The progesterone is a lot of times associated with the mood and the decrease of anxiety. Or anx it has a component of anxiety. If an individual has anxiety, it uh can be difficult to get into the mood. Uh estrogen is largely involved with blood flow and tissue. So the sensitivity aspect of sexual health. And then you have other players like leptin resistance and insulin resistance. Most of the time people would never think of those hormones that those hormones have a relationship in sexual health, but they do. Because when an individual has leptin resistance and insulin resistance, which is largely associated with obesity or being overweight, then both of those things, insulin resistance, insulin, is responsible for driving nutrients into cells, including the cells that make hormones. So as if the nutrients aren't able to be driven into the cells that are making hormones, all of the sex hormones will be diminished. So when you have insulin resistance, all of your hormones can be suppressed, all of the hormones that are related to enhanced sexual health. Leptin resistance, the same way. When you have elevated leptin levels, that can lead to what's called leptin resistance. And then you have the inability for your body to make adequate hormones such as testosterone, progesterone, and estrogen. And then the last hormone that I would throw into the bucket on this one would be thyroid. Again, we go back to thyroid, because thyroid is the main hormone that is responsible for the energy. And if you don't have energy, you're not going to be too enticed or looking forward to any type of intimacy. So thyroid plays a huge role in just the ability to be motivated or have the energy to actually move forward with that. And then there's also some hormones that are really never associated with sexual health. Those are more the neurotransmitters.

SPEAKER_01 6:51

So there's two neurotransmitters that I think of when I think of kind of killers or killers to libido, killers to sex drive, one being cortisol, and the other one being adrenaline or norepinephrine used interchangeably. So cortisol, the stress hormone, definitely can suppress your testosterone, as we know, and estrogen and progesterone. So that can be a real killer of libido, as well as elevated adrenaline can reduce interest in sex as well. Chronic stress is going to lead to elevated cortisol and adrenaline release. So if you're under chronic stress, this can affect all facets of sexual health, libido desire, and the physical performance.

SPEAKER_03 7:39

Yeah, I can see that. And then we have a lot of patients that are on different types of psychotropics. I can see how that would uh that would how that would that would impact a lot of this stuff.

SPEAKER_01 7:48

Aaron Powell So other neurotransmitters or hormones in kind of impacted by sexual or that can impact sexual health would be oxytocin, dopamine, and serotonin as neurotransmitters, as chemical messengers. Dopamine in the brain is responsible for that reward center, that feel-good, the reward center, pleasure center. So this can be implicated in sexual health as well as oxytocin, which can be responsible for that feel-good, that bonding, release during orgasm, release during breastfeeding. Oxytocin is that emoji with the heart eyes, whether you're looking at your baby or your partner. So those two are incredibly important to think of in the context of hormonal sexual health. Serotonin is another one that can actually be considered inhibitory as it inhibits the dopamine and the oxytocin, which is why a lot of patients on SSRIs can experience changes in libido and desire.

SPEAKER_03 8:50

Yeah, I can see that. So it's that the huge, huge play between a physiological and a psychological piece because it's like without the hormones, you're not going to have the physiological, biochemical foundation to have any type of sexual health. At the same time, there could be a totally separate psychological component going on with emotions, relationship issues, past trauma, anything like that. And uh you can kind of see like if you put those two things together, that could be a wicked storm, you know, like a very difficult, very, very difficult to manage. Why do you think this is an under why do you think this is such an underserved area?

SPEAKER_01 9:28

Well, just like we said, it's hard to pinpoint the cause of the sexual health concern. Is it physical, is it psychological, is it emotional, um, is it on a biochemical level? A lot of times we normalize it in our culture as just being something that both men and women experience or anybody may experience. Sometimes we normalize it as a part of aging, which it is not a normal part of aging. Decreased libido should not be normalized. Women are commonly underserved in this sexual health huge category. Sometimes patients are uncomfortable talking about it. Sometimes providers are not equipped to talk about it, sometimes they don't feel equipped to test for it or screen for it. And it falls by the wayside, but sexual health is health, and I want to encourage our listeners to bring it up with their providers as a part of their overall health and wellness.

SPEAKER_03 10:21

I was thinking back in the days of me you know in primary care and uh thinking about all the patients. I mean, I think you're right. I mean, a a lot of patients don't even want to come, they think it's a normal part of aging. They don't look at it as a symptom of a bigger problem. They're embarrassed to bring it up to their provider or what have you. But if they do, I can see how it's often dismissed that, oh, you must be depressed.

SPEAKER_01 10:45

Oh, absolutely.

SPEAKER_03 10:46

Here. Right? And we know that when patients most patients if they do have a hormonal issue and they have low libido or a sexual dysfunction and they're given an SSRI, that's only going to make their sexual dysfunction worse.

SPEAKER_01 11:00

Yeah. Absolutely. It's another reason that sexual health is minimized or in or underserved or not always treated. A lot of times it's relegated to just the performance aspect. And we kind of jump to that, especially, you know, with men, the performance piece, and we don't look at the precursors to that. So we're we're kind of jumping to conclusions. One way that it's easy for me to bring up in a comfortable, more conversational way to inquire about my patient's sexual health or any underlying sexual concerns is when I ask about contraception. And unfortunately, a lot of times I get an eye roll, or it's not, it doesn't matter, it's not important, it's not a concern. And if the patient is comfortable, and I'll always make sure that this is something they're willing to talk about, I do want to dig a little deeper and say, why would you say that, or why is it not a concern, or do you wish it was a concern? Um, with men as well, I'd like to ask about their stress levels and kind of lead into that, getting into that social aspect. But it is something that may be uncomfortable to bring up for providers and patients alike, but it's so important. More often than not, I'll have a woman in her 40s or 50s and I'll say, How's how's your sex life? What sex life? And it's it's not a form, it's not a source of embarrassment or discomfort, but it's I can see the disappointment and the frustration. But I want to know, is the drive not there? Is the interest not there? Are there other barriers, physiological barriers? These are things that we can address if only we can talk about them.

SPEAKER_03 12:33

I mean, there's a normal chronological type change of hormones as an individual ages. I mean, we we all know that in uh a a woman with perimenopause, progesterone is the first hormone to go in women. Men slowly lose testosterone from 30 on, it starts to come down. And then, you know, with obviously with menopause, estrogen goes. So there's a normal fall-off of hormones as an individual ages. But it strikes me of how you're describing this, and you're completely right. Men are immediately thrown into the performance category. Women are almost women are often thrown into the psychological component. There's something wrong with you. And and you you you see it. You absolutely do see it. And and I can't tell you the number of male patients that I've seen that were prescribed Viagra from their primary care provider, but the male's testosterone level was 180. It wasn't the viague, it's that's not the problem, you know. But it wasn't even it wasn't even thought that that needs to be checked. And the and the l and the same would go, you know, how do you expect a man to feel normal if they don't have hormones? How do you expect a woman to feel normal if they don't have hormones? That's absolutely right. And and so it's it's a much bigger, bigger story when you think about the whole thing. And then also I don't think that we should um discount the need and requirement for all four things when it comes to sexual health. It's not just hormones, it's not just biochemicals. It's also, and we've talked about this on other episodes, you still have to be eating right, you have to be exercising, right? You have to be sleeping, because if you are not doing those three things, there is no way that your body can make the adequate biochemicals or the have the physiological response that it needs to have, whatever normal hormones you can make. Right. So you still there's a normal, right? And then yes, and it is perhaps we age out of hormones. It's normal that as we get older we don't have as much hormones, but you still have to do your piece about being healthy and doing your physio, your your physical part or your lifestyle components that you have to be doing.

SPEAKER_01 14:29

Absolutely. Just think about the connection between honestly performance and exercise, eating good and feeling good, sleeping and sex. I mean, this is vitality unfiltered. Some nights taking care of a baby, I have to choose between do I want to get a little bit more sleep or do I want to have sex? So you have to think of these really basic fundamental points.

SPEAKER_03 14:49

Maybe sex should be in one of the, you know, we said the four life the four lifestyle things are eating right, exercise, hydration, and um sleep, right? That was a four, right? Yeah. Well, I think the fifth should be sex. I mean, it's like that's a good that's a huge quality of life in virtual. Absolutely.

SPEAKER_01 15:06

And I think that our listeners are learning a lot about me this episode. I'm not- I just thought of something else. I want so we have a newborn at home. And a little okay, he's a little older now, but he doesn't sleep. He sleeps like a newborn. So sometimes I have to remind my husband that I'm still very much attracted to him, even though that category of performance might be lacking. I'm still very attracted to you. I'm just much too tired tonight.

SPEAKER_03 15:29

Aaron Powell There needs to be a bit of energy to follow through on all of that.

SPEAKER_00 15:32

But I want you to know that the other components are still there. We've got the desire and the libido. So just it's it's kind of it really is multi-faceted. Aaron Powell Correct. Absolutely. Trevor Burrus, Jr. That's my point that I'm trying to make.

SPEAKER_03 15:44

When you when you think about a patient and they're gonna they're contemplating, it's like, well, let's let's say all of a sudden somebody's listening and they're like, wait a minute, you know, like my libido's gone or the desire is completely gone. I need to get checked out. What would be a what would be what should that patient look for for a comprehensive evaluation on making sure they're taken care of?

SPEAKER_01 16:03

Good question. So, like I say in every episode, comprehensive evaluation includes a very detailed intake of the patient's overall health and wellness. I love to do my labs. I'm definitely gonna inquire about the hierarchy of needs, sleep, exercise, diet, first and foremost, sleep being number one probably, stress. We talked about how stress can be a killer of libido. I want to ask how they what their life stressors are and how they're managing them. I want to look at their medications. I'd like to review medications they are on, as we know some can decrease libido as on that biochemical level. Um, but just looking at the invi at the individual holistically and making an individualized care plan to address which aspect or which aspects of their sexual health concern.

SPEAKER_03 16:57

You know, and I I think you you hit it, um, talking about the medication aspect. But we also, you know, earlier you talked about the hormones that are the killer of sex drive. Cortisol, epinephrine, norepinephrine. Yeah. Well, what stimulates cortisol, epinephrine, and norepinephrine? All ADD meds. ADD meds work directly through the adrenal glands. They make your body stimulate epinephrine, norepinephrine, and dopamine. So those are the immediate hormones. And then if you're taking ADD meds, generally that is assimilar to a stress response. So your adrenal glands push out hormones, cortisol. So it's like, you know, and then all of the psychotropics. So that's a tough one to get around because those patients could very well be using these medications because they have a bona fide reason to take these medications. But that's a tough one to get through.

SPEAKER_01 17:48

Yeah. It's just like the SSRIs. You know, they might really impact another aspect of your life for the better, but decrease libido, another very important aspect of health. Like we said, sexual health is health.

SPEAKER_03 18:02

It is health. It is health. It's relationship health, it's uh healthy marriages, it's all of the relationships out there. And if you don't have if that's not a healthy component of your life, then your quality of life is down, then the stress is up, and it just is a downward spiral overall. So very good discussion, interesting discussion. All right. I think where that's gonna close this out. I want to thank each and every one of you for listening to us today. If you enjoyed the show, make sure you click or subscribe on the button below so you don't miss the next episode. Thank you for joining us on Vitality Unfiltered.

SPEAKER_02 18:32

Thanks for joining us on Vitality Unfiltered with David Bowder. Addressing norms, busting myths, and uncovering health realities for a more vibrant life today. For more expert insights and real talk, make sure to subscribe and join us next time.