Great Sex, Naturally

“Our bodies act as incredibly accurate barometers that indicate
how closely we live our lives in-line with our true heart’s desires.”

Your magnificent hormones drift through your body, profoundly affecting who you are, how you feel, and your overall health and vitality. They constantly influence your thoughts, emotions, behavior, and spirit, often exerting a powerful pull on even your most subtle urges and inclinations. In fact, the word hormone derives from hormé, Greek for “impulse.”

Perhaps more than anything else, your hormones affect your sexuality, intimately shaping your experiences of love, attraction, and arousal. (Hormone is also related to the Greek ornynai, which means “to rouse.”) If there’s one thing you can do to enhance the quality of your sexuality, stay healthy, and keep your zest for life, it’s to create and maintain your hormonal balance.

Your hormones are not only an integral part of your personality, but also an extraordinary physiological phenomenon—tiny biologically active substances that are released by your glands, circulate in your body fluids, and have strong effects on parts of your anatomy far from their points of origin. Every day, a choreographed dance takes place within your physical self as these complex, multifaceted substances intermingle to create your unique sexual nature. The intricacies of this dance extend even beyond your body; your hormones ultimately connect you with your environment, inviting you to join with another who can share your passions and pleasures, bond with you, and join you in the dance.

As you go through your life, this choreography passes through many delicate transitions—hormones stimulate the changes of puberty, ovulation, menstruation, fertility, pregnancy, perimenopause, menopause, and postmenopause—and a new kind of hormonal harmony gradually emerges during every phase. Each new dance of your sexual health is as elaborate as anything you’ve previously experienced and perhaps even more extraordinary. Even as you pass through new transformations, your hormones continue to move in elegant synchronized patterns, your sexual nature gently re-creates itself, and the dance goes on.

In this chapter, you’ll learn about the important and remarkably resilient role your hormones play in your sexuality and health, and many ways you can nurture and preserve their equilibrium through all of your hormonal transitions. You’ll discover which of your hormones you most need to know about to support your sexuality, which are most likely to be out of balance during certain phases of your life, and the essential natural tools you need to correct those imbalances and enhance your libido—including herbal remedies, nutritional support, bioidentical hormones, and more.

In order to harmonize your hormones and enhance your sexuality, you would do well to become acquainted with the key players in the dance—the chemical messengers that moisten, relax, nourish, empower, energize, revitalize, and sensualize you on a daily basis. Their names are familiar: estrogen, progesterone, DHEA, testosterone, cortisol, and thyroid hormone. You have other hormones in your body as well, but we call these six the Great Sex Sextet because of the important roles they play in your sexuality. When they’re each in balance, you tend to feel like your healthiest self, capable of practically anything you put your mind to, and fully able to manifest your sexual energy; if they aren’t in balance, you feel robbed of your potential, both sexually and otherwise.

In the pages ahead, as we explore each of these hormones, we’ll focus primarily on how each affects your body, mind, and sexuality from the perspective of Western medicine. We’ll also touch on the nature of hormones from the standpoint of Chinese medicine—their “energetic” qualities, typically overlooked in the West. As you’ve discovered, Chinese medicine teaches that your chi consists of yin and yang energy: yin is inward, contractive, relaxing, moistening, and feminine; and yang is outward, expansive, stimulating, drying, and masculine. As a practitioner trained in both Western science and Chinese medicine, I’ve found that some hormones tend to be more yin, and others more yang, in their effects on your body.

Each hormone in your Great Sex Sextet has a unique place on the yin–yang continuum: Estrogen is the most yin, followed by progesterone, which is mainly yin but with some yang actions, and DHEA is less yin than progesterone. Continuing in ascending order of yang energy, you have testosterone, followed by cortisol, with thyroid hormone being the most yang.

The yin and yang properties of your hormones can also be illustrated with the familiar yin/yang symbol, although it’s important to note that some hormones—particularly progesterone and DHEA—can have both yin and yang effects on your body.

As long as all of these hormones work well together, you’ll have hormonal harmony and sexual health. To experience full sexual arousal, you need to be contractive and relaxed (yin), but you also need to be expansive and stimulated (yang). Let’s take a look at each of the hormones on your yin–yang continuum, and how they influence your sexuality.

Estrogen is your great connector; it enhances your feelings of intimacy and tenderness, and facilitates your ability to bond deeply with another person. Essential to your sexuality, it sustains and promotes your femininity, keeping your libido primed to flow in abundance. Estrogen is also life giving; when you were in your mother’s womb, you were bathed in a protective layer of uterine tissue that was stimulated to develop by estrogen.

From the Chinese medicine perspective, estrogen is important to your vitality, and very yin because it softens, moistens, nurtures, allows for greater flexibility, and accentuates your deepest feminine nature. As you’ll discover, it’s because of fluctuations in your estrogen level that your body releases your “Heavenly Water” during much of your life.

At puberty, a surge of estrogen fleshed out your hips, breasts, and curves, and developed body hair in your most intimate places, as you magically blossomed into a young woman. Each month during your menstruating years, estrogen enhances your fertility and forms the lining in your uterus—the endometrium—to cushion and support a potential embryo. If pregnancy doesn’t take place, as your estrogen level drops, the lining sloughs off and becomes your menstrual flow.

Through your menstrual cycles, estrogen connects you with the phases of the moon. For many women, the monthly rise and fall of estrogen creates cycles that closely correspond to the lunar calendar. Ancient cultures recognized this link between menstrual cycles and the natural world: the words month, moon, and menstrual all share a common ancestral root.

Estrogen, which is made in your ovaries and adrenal glands, is critical for your sexual energy and vitality in many ways. One of the most important is its ability to support your libido by interacting with testosterone in your brain. You need adequate amounts of both estrogen and testosterone to turn on your brain’s arousal circuits. When you have optimal estrogen, testosterone can effectively stimulate nerve receptors to create the sparks that kindle passion and pleasure.

Estrogen can help you feel good in other ways as well. It’s directly linked with your sense of well-being, because it works with serotonin (your “feel-good” brain chemical) to enhance your moods. Serotonin increases feelings of happiness and decreases feelings of anxiety, and research shows that estrogen and serotonin levels rise and fall in tandem. This is why many women have mood swings, feel depressed, and experience erratic food cravings before their periods, but not at other times in their cycles.

As you discovered in Chapter 3, estrogen plays a key role in your potential for sexual pleasure by maintaining the health and elasticity of your vaginal and vulvar tissues, including your clitoris, urethra, and inner and outer labia. These tissues are estrogen-dependent, which means they need adequate estrogen to stay flexible and moist. Without sufficient estrogen, they can lose much of their natural lubrication, making pleasurable sex difficult or impossible. (Estrogen also supports connective tissues throughout your body—it can serve as a natural moisturizer; improve collagen content; help prevent wrinkles; and give you soft, smooth, supple skin.) And as you’ve also seen, estrogen helps maintain the ideal pH of your vaginal tissues, thwarting vaginal infections due to bacteria or yeast, as well as urinary tract infections—either of which can obstruct your enjoyment of sex.

Estrogen not only played a major role in enlarging your breasts at puberty—like fertilizer to soil, it allowed them to bloom from tiny buds to the fuller breasts of a woman—but during each of your menstrual cycles, as your estrogen levels wax and wane, so does the volume of your breast tissue. Estrogen also heightens the touch-sensitivity of your breasts, which are important for your femininity, integral to your sensual arousal and response, and attractive to your partner.

Other benefits of estrogen include increasing your stress tolerance, preventing inflammation in your brain, potentially helping to maintain your memory, and supporting your blood-brain barrier—a thin cover that protects your brain from environmental insults and toxins. Researchers hypothesize that women may help preserve their brain cells and prevent age-related dementia if they begin taking estrogen in early menopause.¹

Your bones thrive in the presence of estrogen. This hormone stimulates cells that build new bone, and inhibits ones that pull calcium from your bones. Having adequate levels of estrogen from your teens to your 40s is important for maintaining healthy, strong bones; it helps you make deposits into your “bone bank”—which you need when your hormone levels and bone density drop at menopause.

Estrogen is your best friend when you have just the right amount, but a foe if you have too much or too little. An excess can lead to breast cysts, heavy menstrual cycles, exaggerated premenstrual symptoms, uterine fibroid tumors, and ovarian cysts, as well as increase your risk of estrogen-related cancers. Insufficient estrogen can cause you to feel irritable and overwhelmed; result in the discomforts some women experience postpartum; and lead to menopausal symptoms of insomnia, anxiety, hot flashes, and vaginal dryness. Later in this chapter, you’ll discover different kinds of estrogen, ways of enhancing your body’s ability to produce the friendliest forms, and how to use natural bioidentical estrogen replacement.

Taking Care of Your Breasts

The health of your breasts is a part of your sexual health, and reflective of your overall wellness. All of the lifestyle tips you’ve explored earlier in this book will help you maintain healthy breasts. To further preserve your breast health, be aware of your risk factors for breast cancer, examine your breasts often, and get screened regularly for cancer. Remember that your breasts are more highly hormone-sensitive than other parts of your body. Use hormone replacement therapy only if you have to, and take the lowest dose you can for the shortest time necessary. If you take estrogen or progesterone for menopausal symptoms, use only natural, bioidentical hormones.

Progesterone helps maintain your hormonal equilibrium and provide a strong, stable basis for your libido. In addition, it can ease anxiety, induce restful sleep, and “relax” your connective tissues. It has primarily yin qualities, but can also be yang in its support of your energy-building adrenal glands.

Made in your ovaries and adrenal glands, progesterone has a unique ability to enhance your sexuality because it can be a precursor to testosterone—as you’ll discover, your sexiest hormone—and promote your body’s production of cortisol, which can also affect your libido. In addition, progesterone influences your sexual energy by supporting your thyroid hormone (which regulates the metabolism of every cell in your body), and nurtures your libido by helping you sleep. Being able to sleep soundly can increase your ability to take pleasure in sex … to sleep, perchance to enhance.

When progesterone is released after you ovulate, it helps prevent estrogen from becoming too prolific, and your uterine lining from becoming too thick. It can also help settle down your nervous system and reduce heart palpitations associated with menopausal hormone changes.

If you’re in your middle or late 30s and you want to become pregnant, taking natural progesterone may improve your fertility by helping prepare your uterine lining for a fertilized egg to implant. Many patients in this age bracket who try unsuccessfully to become pregnant for many months, or years, easily conceive once they start taking natural progesterone.

If you become pregnant, your levels of progesterone soar in support of your pregnancy, with many effects and benefits. You may have a “pregnancy glow,” and the feelings of well-being and vibrant health that many women describe when pregnant; both can be due, in part, to progesterone. By relaxing your connective tissues, the surge of progesterone helps soften your ligaments and allow for the baby’s safe passage through your pelvis.

Progesterone can also come to your aid if you experience postpartum depression. After childbirth your hormone levels, including progesterone, decline sharply. Taking natural progesterone can mitigate feelings of despair during this otherwise special time.

Like many women, you may experience decreasing levels of progesterone in your late 30s or early 40s. This can be the result of a stressful lifestyle or simply because you’re entering a less fertile time in your life. Either way, you may tend to have an imbalance—not enough progesterone compared to estrogen—creating a condition called estrogen dominance. Symptoms include increased breast tenderness, breast swelling, water retention in your tissues, bloating (especially of the abdomen), increased premenstrual symptoms, exacerbated menstrual cramps, heavier periods, and more clotting in your menstrual flow.

A classic sign that you may have inadequate progesterone is insomnia in the second half of your menstrual cycle—particularly if you often awaken in the middle of the night and can’t get back to sleep. Another sign is anxiety that occurs only during the second half of your cycle; progesterone has the ability to activate GABA receptors in your brain that induce mental calmness. Both of these symptoms can compromise your libido, since adequate sleep and a calm mind are essential for your peak sexual energy.

Many symptoms of low progesterone can be alleviated with herbal support to enhance your body’s natural progesterone production or by taking natural bioidentical progesterone in the second half of your cycle. As you continue this chapter, you’ll discover more about both approaches.

Your Moon Cycle: The Ebb and Flow of Your “Heavenly Water”

If you’re the typical female, your “moon cycle” begins around age 12 and continues until about age 50, when you experience a gradual cessation of your cycles. Day one of your cycle is the first day of your period; the initial part of your 28-day cycle, typically the first 14 days, is known as the follicular phase. During this phase, estrogen predominates, reaching its highest level and stimulating the growth of your uterine lining. If you have regular menstrual cycles, you’re most likely to be fertile at midcycle, around day 14, when you ovulate (release a ripe egg) and your ovaries form a tissue mass called the corpus luteum, which releases progesterone. Your sexual appetite crests during the follicular phase, becoming especially yang at midcycle, when your urge to procreate is strongest.

During the second half of your cycle, known as the luteal phase, progesterone is abundant, and estrogen is also likely to be high. At the end of your cycle, estrogen and progesterone both plummet, allowing your body to release the endometrial lining as your menstrual flow, and your sexual energy wanes.

Traditional Chinese medicine provides a refreshing alternative to modern terms like menstrual flow or the generic period. As mentioned in the Introduction to this book, ancient Chinese practitioners didn’t refer to a woman’s menstrual flow as blood, but rather as her “Heavenly Water.” (It was sometimes also called her “Dew of Heaven.”) Like many women in the West, you may feel that the topic of menstruation is saturated with negative connotations. Imagine how differently you might feel about your monthly flow if you consistently described it with such a heavenly metaphor!

A hormone with far-reaching effects, DHEA (short for the tongue twister dehydroepiandrosterone) elevates your libido, induces a sense of well-being, enhances fertility, builds bones, and more. With both yin and yang qualities, it nourishes your brain and ovaries while also supporting your entire hormonal system, especially your adrenal glands, and building your overall health.

DHEA is produced primarily by your adrenal glands, but also by your ovaries and brain. It enhances your sexuality; and sex, in turn, can increase its release in your body. Some of the health benefits of sex that we outlined at the beginning of Chapter 1 are due, in part, to the release of DHEA during arousal and orgasm.

DHEA’s ability to boost your libido and your moods was demonstrated in a study published in 2005 in the Archives of General Psychiatry, which found that supplemental DHEA significantly improved sexual functioning and successfully treated depression in women and men aged 45 to 65. Although the dose was unusually high, it powerfully impacted the libido and mental state of those who took it. Another study, which showed that DHEA can enhance fertility and pregnancy rates in older women (by increasing the quality of their eggs), confirmed its beneficial effects on sex and mood; a number of the study’s participants reported “side effects” of increased libido and improved well-being.

The secret to DHEA’s ability to enhance your sexuality is biochemical: as a precursor to testosterone, it plays a pivotal role in your “hormone cascade.” The diagram below shows how pregnenolone, your “mother” hormone, is a precursor to many of your other important hormones, and how they all interact in your body.

As you can see, DHEA converts directly into testosterone, and via testosterone, into estrogen—which is why many women need only tiny amounts of DHEA to experience dramatic libido-enhancing effects, particularly during and after midlife. DHEA is most effective when other hormones, especially estrogen, are well balanced, and it seems especially beneficial for women who are overstressed and need to rejuvenate their bodies, minds, and spirits.

While DHEA is busy enhancing your sexuality, it’s also giving you other noteworthy benefits that indirectly support your libido-building lifestyle. Studies show it can improve memory and concentration, and by stimulating cells that lay down new bone tissue, improve female bone density—which can be especially important for menopausal women.

If your DHEA level is low, you’re likely to experience reduced libido, a diminished sense of well-being, and lower overall vitality. Other symptoms may include fatigue, decreased memory, reduced fertility, poorer bone and adrenal-gland health, and a general reduction in your hormonal health. As you move forward in this chapter, you’ll discover how to evaluate your DHEA level and, if it’s low, use natural bioidentical DHEA to correct your symptoms. DHEA is best used under the guidance of a skilled health-care professional; an excessive amount can have effects in your body similar to those induced by androgens (male sex hormones), such as acne, increased facial hair, balding, and anxiety.

You may think of testosterone as the male sex hormone, but it’s very much your hormone, too. Produced naturally by your ovaries and adrenal glands, it’s vital to your sexuality and health. Not only do you need it for a healthy libido, but it also energizes your entire being and helps keep you “jazzed” about your life. Testosterone is mostly yang—exciting; uplifting; and with qualities that allow for growth, outward motion, and creativity—and it can supercharge your sexual chi, which has powerful healing potential for your body, mind, and spirit.

As we touched on earlier in this chapter, testosterone, with the assistance of estrogen, stimulates nerve receptors in your brain, igniting your pleasure circuitry and setting sexual feelings and arousal in motion. At the same time, testosterone can give an added jolt to your sexuality by increasing your clitoris’s sensitivity to touch.

Testosterone can have wide-ranging effects on your personality, giving you an extra “edge” that may be felt in your sexual energy, or anywhere else in your life. For example, it may help you become more assertive, develop a take-charge attitude, maintain your dynamic creative drive, or summon the confidence to hold firm boundaries when you need to.

Like DHEA, testosterone can also increase your sense of well-being. Research has shown that testosterone plays a role in modulating the actions of dopamine—a brain chemical that allows you to feel joy and pleasure. When women have deficient dopamine, they’re subject not only to reduced sex drive but also feelings of hopelessness and decreased ability to handle stress.

Testosterone gives you additional benefits not directly connected to your sexuality: It helps build your bones and prevent bone loss, maintain a balanced ratio of fat to lean muscle mass, and improve your muscle strength. During midlife, it can help reduce hot flashes, night sweats, and headaches. Testosterone can also help protect your brain cells from injury, and research shows that it may help prevent the “tangled-up” neurons in the brain associated with Alzheimer’s disease.

You need a sufficient amount of testosterone in your body to make all of its benefits possible. If your level is too low, in addition to experiencing diminished libido and feeling lackluster about sex, you’re apt to be uninterested in trying new activities and feel “drab,” worn-out, and tired much of the time.

Many women who take natural testosterone find that it stimulates both their sensuality and their senses. Along with resurrected sexual desire, they often describe feeling as if they’re having flashbacks to how they felt at earlier times in their lives when healthy levels of hormones coursed through their bodies—more alert and alive than they’ve felt in years, more perceptive, and more attuned to new sensations and their environment. Some say they feel their awareness reawakening, after long slumber, to all the possibilities inherent in their bodies.

It appears that in some situations testosterone can reduce risk of breast cancer. A study reported in Breast Cancer Research in 2009 found that when women take bioidentical hormone therapy such as estrogen and progesterone, taking testosterone as part of the regimen may decrease breast-cancer risk. This may be due to several mechanisms of testosterone, including its abilities to increase cancer-cell death and to change receptors on estrogen-sensitive cells (which are otherwise more cancer-prone with estrogen therapy).

Later in this chapter, you’ll discover more about testosterone, including the natural bioidentical testosterone prescription that’s best for many women.

Your Hormones and Your Jing

Practitioners of ancient Chinese medicine couldn’t isolate hormones and examine them with microscopes, and they had no concept of hormones as we know them. But through careful observation they understood their energetic actions and effects on a woman’s sexuality during every phase of her life.

The traditional Chinese notion that perhaps comes closest to reflecting our modern Western understanding of hormones is jing—a form of your chi passed down to you by your ancestors, and a part of your life beginning with your conception. The effects of abundant jing in your body can be much like the effects of healthy, balanced hormones in Western medicine.

If you spend your jing carefully, you increase your chances of living to a healthy, ripe old age. You can preserve your jing with a life of moderation, eating good food, getting adequate sleep, and nourishing your body. You can also recycle your jing and strengthen it with certain techniques and sexual practices, some of which we’ll explore later in this book. In terms of your sexuality, if you have abundant jing, you have the energy and vitality to enjoy a robust sex life.

On the other hand, if you spend your jing quickly, you’re more prone to illness and low energy, including diminished sexual energy. You can exhaust your jing with a high-stress life; a poor diet; inadequate sleep; and excessive prescription or recreational drugs, smoking, or alcohol.

Produced in the small adrenal glands that sit atop your kidneys, cortisol is the “stress hormone” your body releases when you feel as if you’re running behind schedule, under pressure, and racing to catch up. Your adrenal glands are surprisingly important for your sexuality; cortisol is a stimulating, yang hormone that can make or break your libido. Let’s take a closer look at your critical cortisol-sex connection.

With cortisol, balance is everything. If you don’t have enough, your libido suffers, you tend to feel tired all the time, you lack your get-up-and-go, and your immune system doesn’t work optimally. But if your cortisol is consistently too high, day after day, as a result of chronic stress in your life, your libido is also likely to crash, in part because constant stress is exhausting and depletes the energy you need to be sexually responsive. Too much cortisol also results in feelings of fragility and agitation—not exactly what you need for great sex—and causes you to gain weight, especially around your waist.

Excessive cortisol can wreak hormonal havoc by throwing your other hormones out of balance and jeopardizing many of the benefits they offer for your sexuality and health. Instead of consistent menstrual cycles with balanced levels of estrogen, progesterone, DHEA, and testosterone, your body may experience a continuous “alarm” state. As a result, you may not ovulate, which lowers your progesterone level and in turn can cause much heavier menstrual flow and worsened PMS symptoms—again, hardly what you want to put you in the mood for pleasure. In addition, excessive cortisol can inhibit the function of your thyroid hormone, which, as you’ll discover, also contributes to your libido.

When you have the right level of cortisol, it benefits your health and sexual energy in myriad ways. It gives you the opportunity to fully experience your libido, supports the health of your immune system, and promotes normal blood-sugar regulation. If you have stress in your life, it helps you respond in an appropriate, healthy way.

Your body has a natural cortisol rhythm that also supports your health and sexuality. You feel best when your level is high in the morning and slowly subsides toward evening; you get out of bed bursting with energy, and at the end of the day you feel tired and readily able to fall asleep. Paradoxically, cortisol is a stress hormone that helps you sleep through the night. A healthy cortisol level provides energy you need by day, yet quiets your mind at night, allowing your body to rejuvenate, heal from illness, and maintain a healthy libido.

If your natural cycle of cortisol is out of kilter—as a result of unmitigated stress or low blood sugar—your cortisol level may be low in the morning and high at night. In this scenario, you can experience difficulty waking in the morning, and insomnia at night—a major libido killer.

When you’re asleep, cortisol is responsible for converting sugar into glucose to feed your sleeping brain. You need a steady supply of glucose, throughout the night, to get a full night’s rest, but if your cortisol is too low, you don’t convert enough glucose to let your brain stay asleep through the night. At some point your brain gets “starved” of glucose, and your adrenal glands start sending out adrenaline, another stress hormone, instead of cortisol. You may experience what amounts to an adrenaline rush in the middle of the night, waking suddenly, as if an alarm has gone off in your head, with your thoughts racing. It may be hours before you can fall back to sleep.

Many people are unaware that insufficient cortisol at night can be caused by past lifestyle issues. For instance, if in the past you’ve had chronically high cortisol that resulted from unrelenting stress, your adrenal glands can become “burned-out” and unable to release adequate cortisol when you need it. You can remain in that state long after the period of stress has passed.

Another cortisol imbalance that can deplete your sexual energy, also caused by chronic stress, is known as cortisol steal. This happens when a high demand for cortisol “steals” from your production of other hormones. As you saw in the “hormone cascade” diagram earlier in this chapter, your hormones are interrelated, and some can be converted into others. If you have a typical case of cortisol steal, your body responds to the cortisol demand by converting some of your progesterone into cortisol; as a result, your progesterone isn’t able to perform all of its important functions. Cortisol essentially pilfers progesterone, your progesterone gets shortchanged, and your health and libido suffer the consequences.

In an extreme case of cortisol steal, one of my patients survived a frightening near-death experience, after which she remained for years in a state of post-traumatic stress that exhausted her adrenal glands and caused acutely imbalanced hormone levels. Although only in her 30s, she stopped menstruating, her hair turned white, and she effectively went into early menopause. In an effort to meet the urgent demand for cortisol, her body had “stolen” from its production of estrogen, progesterone, DHEA, and testosterone. (Fortunately, she was able to recover, and eventually resumed having periods.) This shows what can happen in a woman’s body under unusual stress, but even low stress, on a daily basis, can gradually increase your body’s cortisol demand to the point that your overall hormone production becomes imbalanced. This can have far-reaching effects on your hormonal health, wear down your body, and deprive you of many of the joys of a healthy sex life.

If you’re chronically stressed as you approach midlife, and your cortisol is in high demand and your adrenal glands can’t keep up with your body’s other hormonal needs—particularly if you’re ovulating inconsistently, or not at all—you may experience an especially difficult menopausal transition. When your ovaries go through their natural midlife “career change” and stop producing hormones, your adrenal glands normally pick up where your ovaries leave off. But if chronic stress has compromised your adrenal glands, they have a hard time stepping up to the plate. This can result in exaggerated menopausal symptoms: excessive insomnia, dramatic night sweats and hot flashes, and erratic mood changes. Healthy adrenal-gland function and cortisol production are essential to a strong menopausal transition and a vigorous midlife libido.

As you continue with this chapter, you’ll discover how you can keep your cortisol-producing adrenal glands strong and vital, and also support your sexuality and health, with dietary tips, herbs, nutritional supplements, and natural bioidentical hormones.

You may have noticed that thyroid hormone isn’t on the “hormone cascade” diagram. Unlike the other hormones we’ve explored, it doesn’t come from pregnenolone. It’s made in your thyroid gland, a dynamic butterfly-shaped organ just below your Adam’s apple. A powerhouse for energy production in your body, your thyroid gland is essential for your libido, and the hormone it releases is very yang in its ability to generate your sexual energy.

Most people, although not all, naturally tend toward a healthy thyroid-hormone level. By following the lifestyle recommendations previously outlined in this book—and especially by managing stress—you increase your chances of maintaining one. You may not be aware of all the benefits that stem from having your thyroid hormone at a healthy level, but you’re apt to feel them everywhere in your life—including your sex life. Your thyroid hormone helps create the energy you need to forge through challenging situations, overcome barriers, achieve your dreams, maximize your health … and have great sex.

Your level of thyroid hormone is vital to your capacity for pleasure because too much or too little can send your sexuality and your health into a tailspin. If you have too much, a condition known as hyperthyroidism, you can have an increased heart rate, anxiety, or weight loss. If you have insufficient thyroid hormone, or hypothyroidism—a far more common condition among women—it can slow your entire metabolism and cause a host of symptoms, including decreased interest in sex, difficulty responding to sexual stimulation, and problems achieving orgasm. Restoring your thyroid hormone can be one of the most important steps you take to enhance your sexual responsiveness, orgasmic potential, and quality of life.

In addition to decreased sex drive, your symptoms if you have low thyroid hormone may include irregular or heavy menstrual cycles, PMS, excessive fatigue, sluggishness, depression, easy weight gain, insomnia, headaches, migraines, digestive problems, and constipation. Having low thyroid hormone reduces your body temperature, so the condition can also cause an aversion to cold weather, chronically cold hands and feet, and poor circulation. If you have low thyroid hormone in midlife, you’re prone to severe menopausal symptoms, including vaginal dryness that doesn’t fully respond to topical estrogen.

Since low thyroid hormone reduces the rate of your metabolism, it can cause other symptoms that affect organs and systems throughout your body. If you have the condition, you probably won’t have all of these symptoms, but you may recognize some of them: heart palpitations, an inability to lose weight, high cholesterol, low blood sugar, decreased immunity, difficulty getting up in the morning, puffiness in your face and eyelids when you wake, joint and muscle pain, dry skin and hair, hair loss (including a tendency to lose the outer third of your eyebrows), infertility, recurrent miscarriages, anxiety, hives, and allergies.

If you have low thyroid hormone, it can be difficult for a doctor to diagnose accurately. Laboratory tests aren’t always definitive, borderline cases are often overlooked, and you can have low thyroid hormone even if your test says you’re normal—a condition known as “subclinically low” thyroid. Yet if you have low thyroid hormone, you may suffer needlessly, for years, from many of the above symptoms.

Understanding how your thyroid hormone works can be helpful if you need to restore it to a healthy level. Although we refer to “thyroid hormone” in the singular, you actually have more than one thyroid hormone. One of them, known as thyroid stimulating hormone, or TSH, is what’s usually tested to find out whether you have low thyroid hormone. (In the pages ahead, and in Appendix E, we’ll look more closely at thyroid-hormone evaluation and testing.) TSH stimulates your thyroid gland to release an inactive thyroid hormone called T4, which your liver converts into an active thyroid hormone known as T3. You want to have a healthy level of active T3, because it stimulates all of your cells to make energy, both sexual and otherwise.

One cause of low thyroid hormone is stress that won’t go away. If you’re under incessant stress, imbalanced cortisol can impede your ability to convert T4 into active T3; instead, it’s converted into an inactive form called Reverse T3. Without enough T3, you may stop ovulating, which in turn can cause many hormone imbalances, including estrogen dominance—too much estrogen compared to progesterone. In a vicious cycle, this can be detrimental to your thyroid-hormone function. (On the other hand, when you have a healthy thyroid-hormone level and you ovulate regularly, you release progesterone on schedule, and, in a virtuous cycle, this supports your thyroid-hormone function.)

As we move forward, you’ll discover natural remedies you can use to treat thyroid imbalances and help keep your thyroid hormone at a healthy, libido-supporting level.

Now that we’ve delved into the nature of each of the six hormones that make up your Great Sex Sextet, let’s look at the most useful tests you can use to gauge their status in your body. As you’ve seen, you need adequate levels of each of these hormones to experience peak sexual arousal and optimal health.

Evaluating the key players in your hormonal dance can be a revelation—especially if you’ve been suffering from the effects of imbalanced hormones without realizing it. The more you know about your hormones, the more empowered you are to make healthy choices that nurture and support their equilibrium. If you discover that any are low or imbalanced, it may be a breakthrough on your way to maximizing your hormonal health and enhancing your sexuality.

You can evaluate your hormones with a variety of approaches; the first is simply through your own general observation. The preceding descriptions of the roles your hormones play in your body—their benefits when you have healthy levels, and the symptoms if you don’t—can help to give you an overall sense of whether or not you have an imbalance of any of them. If you have symptoms, you can use the following chart to help ascertain which of your hormones may be low. The check marks give you a profile of the typical symptom pattern for deficiencies of each hormone.

Although this chart may help identify whether you have hormone imbalances, some imbalances can be difficult to detect and their symptoms subtle. To more definitively determine if your hormones are imbalanced, you can have a doctor order laboratory tests. These tests aren’t recommended for every woman, but if the preceding chart indicates that you have hormone imbalances, you may benefit from them—especially if you experience exaggerated PMS, abnormal menstrual cycles, or menopausal symptoms. There are a number of ways to test your hormones; see Appendix E to learn more about the most comprehensive and accurate methods available.

As you’ve explored, your hormones play enormously influential roles in your body, mind, and spirit, and can affect every facet of how you feel. If your hormones aren’t in harmony, you won’t be either; imbalances can take a huge toll on your sexuality, health, and quality of life, and in some cases transform your hormones from libido-boosters to libido-busters.

If you continually experience adrenal-gland fatigue, for example, you’re not apt to feel especially sexy or vital. Your body may lack the extra reserves it needs to nourish vibrant health and sexual vigor. Many women live in a perpetual state of hormonal mayhem, and have no idea what’s causing their discomforts. Common hormone-related conditions that can noticeably interfere with your sex life include PMS, heavy menstrual flow, and adrenal and thyroid disorders. Later in the chapter we’ll also consider the special class of hormonal swings associated with midlife.

There’s a lot you can do to prevent or treat all of these conditions. Many can be resolved with simple lifestyle shifts and nutritional, herbal, or hormonal supplementation. Some women need additional support because of their unique situations, but regardless of what condition you may need to solve, you can improve your hormonal harmony and sexual energy by strengthening your foundation of health with the plan laid out in Chapters 1 and 2.

This is vividly reflected in the view of traditional Chinese medicine. As touched on earlier in this book, when you have abundant chi, you’re more likely to enjoy balanced hormones and healthy sexuality. Deficient chi leads to diminished libido, lethargy, depression, heavy periods, infertility, postpartum depression, and symptoms of adrenal-gland fatigue and low thyroid hormone. Chi can be restored through a more restful lifestyle and a healthy balance of yin and yang energy.

In Chapter 3, we looked at another common chi imbalance known as “stuck chi”—an inefficient flow of chi—which can also reduce the quality of your sex life. In addition, it can cause pain, masses such as cysts and fibroids, heavy menstrual flow (especially with clotting), irritability and frustration associated with PMS, and erratic emotions during menopausal changes. If you have stuck chi, exercise can be a highly effective way to get it flowing again.

In the following pages you’ll discover many ways you can enhance your sexual health and nourish your libido by solving common hormone imbalances, and resolve deficient or stuck chi, with herbs, flower essences, or acupressure. In addition to solutions for PMS, heavy menstrual flow, adrenal issues, and thyroid imbalances, special attention will be given to menopausal hormone changes, since they’re the most likely cause of low libido during many women’s lives. The tools and medicines we’ll explore are both modern and ancient, but all are natural solutions designed to harmonize, not harm, your hormones and your health.

Many women think of PMS as the classic libido bane, and have no idea that it can often be prevented or successfully treated. They simply resign themselves to the belief that as long as they menstruate, they’ll have to spend part of every month dealing with unpleasant physical and emotional symptoms.

If you share this view, it’s understandable. Conventional medicine sees PMS largely as unavoidable and unpreventable. This erroneous idea can be especially unfortunate if you’re one of the many women who have sought professional help for symptoms of PMS. You may have been prescribed birth-control pills or an antidepressant like Prozac, with unsatisfactory results—and serious side effects.

If you’re the typical woman who experiences PMS, your symptoms may last for a week—although for some women PMS can last up to two weeks—and subside when your menstrual flow begins. The symptoms can hamper your sex life for good reason: they may include fatigue, headaches, insomnia, acne, food cravings, weight gain, water retention and bloating, breast swelling and tenderness, mood swings, depression, irritability, impatience, frustration, weepiness, and hypersensitivity. You may feel unable to deal with your normal responsibilities and experience increasing anxiety as you approach the end of your menstrual cycle. The emotional symptoms, which can vary in severity, are notorious for making sex unlikely; you may find your partner’s idiosyncrasies not only unattractive but irritating (and he may naturally find you equally exasperating at this time of month).

The libido-limiting potential of PMS makes preventing or treating it all the more important. If you experience PMS for a week each month during your menstruating years, you could spend a combined total of about seven years of your life coping with its symptoms. Solving PMS can open many doors, allowing you to experience the time before you menstruate as positive and pleasurable, rather than condemned to inevitable negativity and pain. You may be surprised to discover that during this part of your cycle you can be not only symptom-free but sexually fulfilled—and find that your partner’s idiosyncrasies are really quite lovable after all.

PMS is largely preventable or treatable because it isn’t the problem; it’s a constellation of symptoms that reflects underlying imbalances in your body. These can be due to your stress levels, neurotransmitters, and other factors, but the most frequent causes are hormone imbalances. Numerous studies show that balancing your hormones can be essential to resolving symptoms of PMS. Imbalances in estrogen and progesterone are among the common culprits; as this chapter has pointed out, estrogen dominance—too much estrogen relative to progesterone—can increase PMS symptoms. Cortisol and thyroid-hormone imbalances can also cause the symptoms, as well as hormone imbalances in the years leading up to menopause, when women typically experience drops in hormone levels.

You can use the hormone-evaluation and hormone-testing techniques outlined earlier (and in Appendix E) to determine if hormone imbalances are implicated in your PMS symptoms. If you have estrogen dominance, you can treat PMS by boosting your progesterone level with methods we’ll explore in the following pages. With estrogen dominance, your PMS symptoms are likely to include breast swelling and tenderness, bloating, headaches, and heavy menstrual flow. Estrogen dominance can be the result of your liver not breaking down this hormone efficiently, so you can also treat your symptoms by enhancing your estrogen metabolism. Later in this chapter, you’ll discover how to accomplish this with dietary choices and supplementation.

Cortisol and thyroid-hormone imbalances can contribute to PMS because they’re important in the functioning of all your hormones—especially those pertaining to ovulation and the release of progesterone. If your PMS is due to imbalances of either cortisol or thyroid hormone, you can treat your symptoms by following the recommendations you’ll find later in this chapter for addressing adrenal and thyroid imbalances.

You don’t have to live with untreated PMS. There’s a lot you can do to tackle the underlying causes and prevent its decidedly unsexy symptoms. Let’s look at several steps you can take to treat PMS—some that are well-known approaches, and a few that are “secrets.” The first two are applicable if low progesterone is contributing to your symptoms; the others can help if your symptoms are due to other causes.

—Chaste-tree berry. If you’re low in progesterone but would rather not take hormones, chaste-tree berry can be particularly beneficial for treating PMS. This herb is known as a phyto-progesterone because of its ability to promote your body’s progesterone production. (Despite its name, it won’t make you chaste; to the contrary, it can enhance your sex life by helping you treat PMS.) The recommend daily dose is 40 drops of liquid extract, or 175 mg of standardized powdered extract.

—Natural bioidentical progesterone. Many women respond well to taking natural bioidentical progesterone for symptoms of PMS due to low progesterone. It should be taken from midcycle (approximately day 14) until your menstrual flow begins (usually around day 28). It’s best applied to your skin as a transdermal oil or cream (later in this chapter, you’ll find a description of these, and Appendix F contains detailed information on using them). Typical doses of natural bioidentical progesterone for PMS are between 25 and 100 mg taken each night before bed, although a dose as low as 12 mg may be all you need to mitigate your symptoms and enhance your sexuality.

—Lifestyle therapy. Following the Great Sex Lifestyle mapped out earlier in this book helps keep your hormones in balance and PMS under control. Make sure you take your daily supplements, especially your multivitamin, and avoid caffeine; research shows that excessive caffeine makes PMS symptoms more likely. Regular exercise can reduce symptoms by lowering your estrogen level, increasing your circulation, elevating your endorphin production, and helping you fight depression. Minimize your stress level; if stress is unavoidable, manage it wisely. The Great Sex Detox in Chapter 2 further promotes your body’s ability to keep PMS at bay.

—Extra supplement support. Whatever multivitamin or other supplements you take, make sure you get 50 mg of vitamin B₆, 1,000 mg of calcium, and 500 mg of magnesium daily. If one of your PMS symptoms is depression, take 1,000 mg of the amino acid tyrosine daily. (Tyrosine should be taken in the morning.)

—Saint-John’s-wort. If you have PMS symptoms of weepiness, depression, and major mood shifts, an underlying cause may be a low level of your “feel-good” neurotransmitter serotonin. As you discovered previously in this chapter, your estrogen and serotonin levels rise and fall together. When your estrogen level subsides toward the end of your cycle, your serotonin level also drops, making you much more prone to mood swings and depression before your periods. The herb Saint-John’s-wort can help alleviate these PMS symptoms—ample research has shown its effectiveness in treating depression—which in turn can allow you greater opportunities to experience pleasure. The recommended daily dose is 900 mg standardized to contain 0.3 percent hypericin. (Note: Saint-John’s-wort may affect the actions of certain prescription medications.)

—Xiao Yao Wan. In Chinese medicine, symptoms of PMS are often accompanied by a diagnosis of “liver chi stagnation,” which means your chi isn’t circulating freely through your liver and throughout your body. If you have this condition, your PMS symptoms typically include a high level of irritability, frustration, and anger, as well as swollen, painful breasts. The Chinese herbal formula known as Xiao Yao Wan, or Free and Easy Wanderer, which was mentioned in the preceding chapter as a treatment for menstrual cramps, can effectively move your chi and boost your libido at the same time. It can reduce irritability and anger before your periods, and help you feel relaxed, content, and as its name suggests, free and easy. It’s made by many companies, and dosages vary; follow the recommendations on the product label. (see Appendix C for supplier information.)

—Aromatherapy. The essential oil bergamot, a lovely musky-smelling citrus oil, can help you relax, balance your emotions, and gently relieve PMS symptoms. Bergamot is recommended if you’ve been under excessive stress or have trouble expressing your emotions, and it’s also used to stimulate libido blocked by depression and frustration. You can apply it with a spray dispenser to your chest and abdomen twice a day to help allay symptoms. (Bergamot can increase your skin’s photosensitivity, so refrain from using it before you’re exposed to sunlight.)

—Acupressure. As you’ve discovered, “stuck chi” can lead to pain and emotional irritability, and lower the quality of your sex life. The acupressure point Liver 3 can be especially helpful for PMS because it gets your chi moving again; it’s also known in Chinese medicine as Great Thoroughfare, due to its importance as a conduit for the flow of chi. To relieve symptoms of PMS and support your sexual energy as well, you or your partner can press firmly on this point for one to three minutes, at least twice daily as needed. For added impact, bergamot can be applied to the point; this may stimulate the point and help keep your chi moving. (To locate the Liver 3 point, see Appendix A.)

—Flower essences. By helping create subtle emotional shifts and engender calm, peaceful feelings, flower essences can be a soothing way of supporting other approaches to preventing and relieving PMS. The flower essence known as impatiens can help you stabilize your emotions if you’re feeling impatient, agitated, burned-out, hurried, and harried. It nurtures your ability to slow down, relax, be centered in the moment, and get in touch with your feelings—including feelings of sensuality. Another flower essence, cayenne, can help you move past feelings of being emotionally blocked, and gain a sense of new, forward-moving growth and energy in your life. Flower essences can be taken every few hours until symptoms subside (usually within 12 hours); the typical dose is a few pellets or drops under your tongue.

If you have heavy “moon flow,” it can drain your energy and libido, even if it’s not accompanied by painful cramping. Alleviating heavy menstrual flow can make a big difference in how you experience your periods, and create new possibilities for your sexual energy (which doesn’t necessarily have to involve sex). A segment of your cycle you once thought doomed to the discomforts of “bad moons” can instead become a positive time in your life.

Heavy menstrual bleeding has the potential to dramatically decrease your libido because it can lead to anemia due to iron deficiency. Iron, a mineral incorporated into your red blood cells, allows oxygen to be carried to every cell in your body. You need iron and oxygen not only to sustain your life and perform your body’s functions, but also to convert the amino acid tyrosine into dopamine, a brain chemical that enables you to feel pleasure. If you’re chronically anemic because of heavy menstrual bleeding, inadequate dopamine can make you susceptible to lower libido and diminished sexual response, along with feelings of worthlessness and hopelessness.

As you explored earlier in this chapter, ancient practitioners of Chinese medicine referred to a woman’s menstrual flow as her Heavenly Water. From a traditional Chinese medical perspective, if you have heavy Heavenly Water, it’s due to a chi deficiency, and if you have blood clotting as well, it’s the result of stuck chi. From a modern Western perspective, the underlying causes of heavy menstrual bleeding and clotting are often hormone imbalances. By addressing the underlying causes of the condition, from both an Eastern and Western standpoint, you can lift the heaviness from your Heavenly Water and transform your periods.

The most common hormone imbalances that can cause heavy menstrual bleeding involve your estrogen and progesterone levels. As you’ve discovered, progesterone plays a key role in preventing the estrogen in your body from being too prolific, and helps keep the endometrial lining that builds up in your uterus every month from becoming too thick. Since the endometrial lining sloughs off and becomes your menstrual flow, having adequate progesterone can keep your Heavenly Water light.

Heavy menstrual flow can be due to another common hormone imbalance—a low thyroid-hormone level. As you’ve seen, you can have low thyroid hormone even if laboratory blood testing says you’re normal—a condition known as “subclinically low” thyroid hormone. (see Appendix E for more information on thyroid-hormone testing.) If you have heavy menstrual flow and low thyroid hormone, you may benefit from nutritional support for your thyroid gland and natural thyroid-hormone medication. Some women with low thyroid hormone, including some who are subclinically low, have less menstrual bleeding—as well as more regular cycles, improved ability to lose weight, and increased libido—when taking nutritional supplements and natural thyroid-hormone medication.

Hormone imbalances can lead to other conditions that can cause you to have heavy menstrual flow, including uterine polyps, uterine fibroids, and ovarian cysts. If you have heavy menstrual flow, it’s recommended that you see a gynecologist for a thorough evaluation to rule out these and other conditions.

Let’s look at ways you can help restore your sexual response throughout your cycle by lightening your Heavenly Water:

—Natural bioidentical progesterone. If you have heavy bleeding due to low progesterone, you may stand to gain from taking natural bioidentical progesterone, applied to your skin as a transdermal oil or cream. The recommended dose is between 25 and 100 mg, taken each night at bedtime during the second half of your cycle. (You’ll find guidelines for applying transdermal progesterone later in this chapter and in Appendix F.)

—Thyroid support. As mentioned above, in the event that you have heavy bleeding along with low thyroid hormone—and this applies whether you’re subclinically low or not—you can gain from taking nutritional support for your thyroid gland, as well as from natural thyroid medication. Nutritional support consists of supplementation with tyrosine, iodine, and selenium; and natural thyroid medication may include a product such as Armour Thyroid or Naturthroid. Descriptions of all of these appear in the following pages in our discussion of thyroid imbalances; the dose amounts and other recommendations suggested there are appropriate for treating heavy menstrual flow associated with low thyroid hormone.

—Tips from Chinese medicine. According to Chinese medicine, you can treat heavy menstrual flow by correcting the chi deficiency that causes it. You can strengthen your chi through the Great Sex Lifestyle recommended earlier in this book and by balancing your hormones. Healthy lifestyle choices also keep the chi circulating in your pelvis, which can make a big difference in the quality of your menstrual flow by alleviating the stuck chi that causes clotting. You can also treat heavy menstrual bleeding by taking Chinese herbal formulas before your Heavenly Water begins flowing each month. To have a formula made specifically for you, see a qualified practitioner of Chinese herbal medicine. (see Appendix B.) One standard formula, known as Myomin, available from Chinese herbalists and online, combines four herbs to treat heavy bleeding due to excess estrogen by lowering your estrogen level. The recommended dose is two pills twice daily.

Acupressure can also treat heavy menstrual flow by strengthening your chi; press on your Spleen 6 point for one to three minutes each day. To move your chi and treat clotting with heavy menstrual bleeding, press on your Liver 3 point for one to three minutes each day. (see Appendix A to locate both points.)

If you have heavy menstrual flow that leads to anemia due to iron deficiency, two other useful options should be mentioned here. While these don’t directly address the causes of heavy menstrual bleeding, they can play a supportive role by helping you overcome related issues that can get in the way of your sexuality.

—Ba Zhen Wan. Chinese medicine holds that chronic anemia leads to a chi deficiency, and many herbal formulas can help you recover from anemia and restore your chi. One of the best, called Ba Zhen Wan, or “Women’s Precious Pills,” is available through Chinese herbalists and online. (For supplier information, see Appendix C.) The formula is made by many companies; take the recommended dose on the product label, and continue taking it for at least six months to rebuild your chi.

To reinforce the effects of Women’s Precious Pills, you can do acupressure for anemia and chi deficiency. Press the following points for one to three minutes each day: Ren 6, Ren 12, Spleen 6, Liver 8, Stomach 36, and Large Intestine 11. (To locate these points, see Appendix A.)

—Additional supplement support. If your heavy menstrual flow results in anemia due to iron deficiency, in addition to taking 40 mg of iron daily, you may benefit from taking the amino acid tyrosine. Although tyrosine doesn’t address anemia itself, as a precursor to dopamine it assists with your dopamine level and supports your ability to experience pleasure. (Note: To properly convert tyrosine into dopamine, you need to have adequate iron and oxygen in your body.) The recommended daily dose is 1,000 mg taken in the morning. Some women feel revved up when they begin taking tyrosine, so it’s best to start with a low dose and increase it gradually. If you’re already taking tyrosine as outlined above for symptoms of depression with PMS or for heavy menstrual bleeding associated with low thyroid hormone, you won’t need to take more.

Your adrenal glands are essential for your health and libido; they give you energy you need for everything in your life, including sex. In addition, they improve your tolerance for stress, especially during challenging phases of your life, and help sustain you through the hormonal transitions of midlife.

If your sex life is waning as a result of long-term unrelenting stress, you may suffer from adrenal fatigue—a condition in which your adrenal glands become exhausted and unable to function properly. This is often due to a prolonged experience of excessive work without sufficient time to rest and recuperate, and not enough time spent simply enjoying life. If you have this condition, you may feel completely “spent,” devoid of sexual energy, and as if you simply have nothing left to give. Because adrenal fatigue can have so many undesirable effects on desire, solving it can vastly improve your potential for pleasure.

As we’ve elaborated on in this chapter, your adrenal glands produce cortisol, a key player in your hormonal dance and a vital factor for your libido. One of the most important aspects of maintaining your sexual energy is supporting your adrenal glands in their day-to-day cortisol production. Steady, balanced cortisol provides many benefits for your health and allows you to fully enjoy your sexuality, but too much or too little can drain your libido and leave you feeling burned-out. Chronically high cortisol production can eventually cause your adrenal glands to become fatigued because they simply can’t sustain that level of stress-hormone output; this can ultimately lead to adrenal-gland exhaustion and, paradoxically, low cortisol production, resulting in chronic fatigue and lack of energy. This is why continuously elevated cortisol production is linked with many other health issues, including suppressed immunity, irregular menstrual cycles, weight gain, anxiety, and low sexual response.

If you have adrenal fatigue, you may need adrenal support to balance your cortisol, restore your energy, and stimulate your libido. It can be especially beneficial if your life is demanding, you’re under a high level of stress, and you need that extra “push,” day after day. You can support your adrenal health on a short-term basis—it can help you weather the storm of finals week, or a period of stressful travel—but in order to increase your sex drive, adrenal support should be undertaken long-term. By nurturing your adrenal health over time, you can gradually replenish your depleted sexual energy.

You can begin supporting your adrenal glands by making the right lifestyle choices. First and foremost, manage stress wisely. Some is unavoidable, but you can choose how you respond to it and whether to take on new stressful projects in your life. Create a lifestyle that gives you plenty of time to relax and rejuvenate. Remember to stop and smell the roses, and incorporate gentle, yin exercises into your daily routines. You can accomplish your goals, but not without adequate downtime. Pushing yourself every day eventually becomes counterproductive by triggering the high cortisol production that can result in adrenal fatigue, chronic exhaustion, low sexual energy, insomnia, and other symptoms.

Your dietary choices can also bolster your sex drive by supporting your adrenal function. Make sure you eat three meals and at least two snacks a day to keep your blood sugar even; if you skip meals, your cortisol may rise to an unhealthy level to compensate for a lack of sugar to “feed” your brain. As you discovered in Chapter 2, it’s best to eat foods with a low glycemic index. High-glycemic foods like sugary doughnuts cause your body to release excessive insulin, resulting in a subsequent drop in blood sugar that leaves you feeling hungry, tired, and craving more sugar. Your body then releases more cortisol, in a vicious cycle that keeps you in a perpetual state of adrenal fatigue.

You can further enhance your adrenal function by avoiding foods that cause allergic reactions. When you consume a food allergen, the effects can be similar to those of eating high-glycemic sugary foods: an insulin surge results in low blood sugar, then a spike in your cortisol level, and you may wind up feeling fatigued, shaky, and craving sweets.

Herbs, supplements, and natural bioidentical hormones can also help to buoy your adrenal glands and support your libido. Let’s look at the most effective options, beginning with two adrenal-supportive herbs. In the next chapter, you’ll discover more herbal remedies (including Chinese “sexual tonics”) that have the ability to further boost your adrenal function.

—Siberian ginseng. For centuries, this herb has been used to strengthen the body, boost health, and increase longevity. Modern science has confirmed its benefits: Siberian ginseng contains compounds that can help you overcome stress by supporting your adrenal glands’ hormone production, as well as stimulate your immune system to help fight off infections. (One study found it effective in reducing herpes outbreaks.) Siberian ginseng may also increase your mental alertness, energy, sense of well-being, and sex drive.

For supporting your adrenal glands to enhance your libido, the recommended dose is 100 to 200 mg, containing a standardized extract of 0.5 percent eleutheroside, taken two to three times daily. Siberian ginseng has very few unfavorable side effects and is safe for lactating women. Some people experience slight diarrhea if they take an excessive amount or insomnia if they take it near bedtime. Those who have uncontrolled high blood pressure or are taking barbiturates or the drug digoxin shouldn’t use it.

—Rhodiola rosea. This potent herb has long been used in folk medicine to foster fertility, physical endurance, energy, and longevity, and to alleviate maladies of the nervous system. A large body of scientific research has validated its health-enhancing effects; for example, it can improve your capacity for mental and physical exertion, and reduce your recovery time after intense exercise. Rhodiola is known as an adaptogen because it assists you in adapting to stress—which is why it’s so beneficial in fighting adrenal fatigue and diminished libido. It helps you beat stress by affecting levels of hormones and neurotransmitters your body releases in response to stressful situations. It can also inhibit the breakdown of neurotransmitters such as dopamine, serotonin, and norepinephrine—all of which can enhance your sex drive.

Studies suggest that rhodiola can have other beneficial effects on your hormonal system as well—for instance, by supporting your thyroid-gland function (which in turn further protects your adrenal glands from being overburdened), and enhancing your immunity through its actions on your thymus gland. Research also indicates that rhodiola may boost fertility by improving egg maturation and increasing the number of follicles (vesicles that contain developing eggs) growing in the ovaries.

Many people who take rhodiola find that it elevates their energy, moods, mental clarity, and sexuality. For adrenal and libido support, the recommended daily dose is 100 to 170 mg in a standardized form containing 2.6 percent rosavin. Rhodiola is considered a very safe herb, but its rare side effects include insomnia and anxiety. It shouldn’t be used by anyone taking antidepressants or stimulants, or those with bipolar disorders.

—Vitamin C. When you go through acute or chronic stress, you can lose a lot of vitamin C through your urine; if you experience stress-induced adrenal fatigue, be sure you’re getting an adequate amount of this vital supplement. In addition, vitamin C is important in your body’s production of adrenal hormones. If you’re under stress and have low adrenal function, take a minimum of 1,000 mg of vitamin C twice daily to support your adrenal health.

—Pantothenic acid. Also known as vitamin B₅, pantothenic acid plays a key role in your body’s production of adrenal hormones. If you have adrenal fatigue due to stress, the recommended dose is 250 mg twice daily.

—Phosphatidylserine. This supplement derived from soy can improve your body’s ability to handle the symptoms of anxiety or insomnia often linked with excessive stress, a high cortisol level, and adrenal fatigue. If your cortisol level is too high during the day, you may be subject to anxiety; if it’s too high at night, you may be prone to insomnia. You can reduce anxiety associated with stress-induced high cortisol by taking phosphatidylserine during the day. To prevent insomnia associated with stress-induced high cortisol, take it before bedtime. The recommended dose is 90 to 180 mg daily. Phosphatidylserine is well tolerated by most people, and should be taken along with a high-protein snack.

—Progesterone. If you experience the libido-restricting effects of adrenal fatigue due to stress, you may benefit appreciably from taking natural bioidentical progesterone. As you saw in the “hormone cascade” diagram, progesterone acts as a precursor to cortisol. Because of this, it supports your adrenal glands in their daily cortisol production, enhancing your health and sexual energy.

Taking natural bioidentical progesterone can also increase progesterone’s other benefits in your body. For example, it can help in midlife when your ovaries significantly reduce their hormone production and start looking for a new “career.” At this point, as we’ve touched on previously, your adrenal glands suddenly find themselves promoted to the job of taking over where your ovaries left off—one more reason why you’ll gain from having strong adrenal health.

The amount of progesterone you need, and how long you should take it, depends on your individual requirements and situation. Natural progesterone creams are found at health-food stores, but for best results, see a licensed naturopathic doctor or other qualified holistic practitioner for guidance; taking natural progesterone without first getting an assessment of your entire hormonal system can create more imbalance. It’s most effective when used as a transdermal (applied to your skin) oil or cream each night before you go to bed. You should take natural progesterone only if you need it and begin with a low dose, then slowly build up to the dose that works best for you. Recommended daily doses for adrenal and libido support typically range from 25 to 100 mg. (Later in this chapter, you’ll find guidelines for using transdermal progesterone, and additional information in Appendix F.)

—DHEA. You can also use natural bioidentical DHEA to address the effects of stress-induced adrenal fatigue and low sexual energy. The “hormone cascade” diagram earlier in this chapter shows how DHEA, like progesterone, is a precursor to cortisol, which means that it, too, supports your adrenal glands in producing cortisol and enhancing your health and libido. In addition, taking natural DHEA can promote the other benefits of DHEA that we explored earlier—whether you’re in midlife, or at any other time. To take DHEA for adrenal support, apply 4 to 8 mg daily to your skin (preferably to your labia) as a transdermal oil or cream. Start with a low dose and increase the amount only if needed; too much DHEA in your body can have undesirable effects. You can purchase DHEA at health-food stores, but for best results, seek the guidance of a licensed naturopathic doctor or other appropriate practitioner.

As you’ve discovered, your thyroid gland is a powerhouse for your libido; your thyroid hormone helps generate the energy you need for everything you do, sexually and otherwise. But although the benefits of a balanced thyroid-hormone level are multifaceted, if you have too much or too little, it can throw off your capacity for sexual pleasure and pervade your health with a wide range of adverse repercussions.

Identifying and correcting low thyroid hormone can be crucial not only to your sexuality and overall quality of life, but also for keeping the rest of your hormonal system in balance and working well. If you experience many of the symptoms that show check marks for low thyroid hormone on the “hormone symptom chart” that appeared earlier in this chapter, it’s a good idea to begin your own therapy by supporting your thyroid health with nutritional supplements. You can take the following supplements to help rectify a low thyroid level and revitalize your sex life:

—Tyrosine. This amino acid gives your thyroid gland the nutrition it needs to manufacture your thyroid hormones T4 and T3. The recommended daily dose is 1,000 mg taken in the morning. Tyrosine can have a stimulating effect when you first begin taking it, so you should start with a lower amount and gradually work up to this dose.

—Iodine. A mineral critical to your body’s ability to produce thyroid hormones, iodine is plentiful in many seafoods, seaweeds, and iodized salt. (If you don’t have sufficient iodine, you’re prone to developing a benign thyroid tumor known as a goiter.) As a supplement, the recommended daily dose is 150 mcg for females age 11 or older, 175 mcg for pregnant women, and 200 mcg for breast-feeding mothers. (Note: People with Hashimoto’s thyroiditis or Graves’ disease should refrain from taking iodine.)

—Selenium. An important mineral for your thyroid health, selenium supports the conversion of the inactive thyroid hormone (T4) into the active thyroid hormone (T3). The recommended daily dose is 200 mcg.

Supporting your thyroid health with these supplements may be enough to remedy a low thyroid-hormone level (they can all be taken at the same time), and you may not need additional treatment. But if your symptoms persist, you should find professional guidance to further gauge your thyroid-hormone status. You can gather useful information by having a physician order the tests described earlier in this chapter and delineated in Appendix E—although, as we mentioned, you may have low thyroid hormone even if testing indicates you’re normal. If test results are normal but your symptoms continue, see a naturopathic physician for a more complete assessment and to help ascertain if you have subclinically low thyroid hormone. Either way—whether your low thyroid level is revealed by testing, or you’re subclinically low—taking thyroid-hormone medication can give your body the ideal thyroid support it may need. Let’s look at the keys to using thyroid-hormone medication to elevate your thyroid level and your libido:

—Thyroid-hormone medication … what you need to know. If a doctor diagnoses you as having low thyroid hormone (hypothyroidism), there’s a good chance that you’ll benefit from taking thyroid hormones. They’re available by prescription only, but conventionally trained medical doctors are unlikely to tell you about all of your options.

There are two types of thyroid-hormone replacement: natural and synthetic. Patients diagnosed by medical doctors as being low-thyroid are typically prescribed only synthetic thyroid hormone, such as Synthroid or Levothyroxine. Some people respond well to these products, but others continue to experience fatigue and other symptoms of low thyroid hormone.

In addition to the philosophical issue—you probably prefer a natural to a synthetic treatment—there’s a real practical difference between natural and synthetic thyroid-hormone medication. The natural option contains both the inactive form of thyroid hormone (T4) and the active form (T3), but the synthetic option contains only T4. So if you take natural instead of synthetic thyroid hormone, it can make a huge difference in how you feel and the results you get. As previously mentioned, T3 stimulates your cells to produce energy, so the natural option may more effectively help restore your energy level and libido, especially if you don’t convert your T4 to T3 very well.

A licensed naturopathic physician or other qualified holistically oriented practitioner can thoroughly evaluate your thyroid-hormone needs and help you determine if you should be on natural thyroid-hormone medication. If you’ve been prescribed synthetic thyroid medication by a conventional practitioner, but you still often feel tired or experience other symptoms of low thyroid hormone that we outlined earlier in this chapter, you may benefit from natural thyroid-hormone medication such as Armour Thyroid or Naturthroid. It could be just what you’ve been waiting for to revitalize your energy level and sex drive.

The amount of natural thyroid medication you take, and how long you take it, will be determined by your doctor to suit your unique needs. With any type of thyroid-hormone medication, the lowest dose needed is generally best. Armour Thyroid and Naturthroid are typically taken daily in pill form, about 20 minutes before breakfast.

If your thyroid-hormone level is too high, you should be guided in your treatment options by a licensed naturopathic doctor or other holistic practitioner. High-thyroid conditions, which include Hashimoto’s thyroiditis and Graves’ disease, can be complex and are beyond the scope of this book.

Hormones and Infertility: The Sex Connection

If you’ve been diagnosed with infertility, you may be surprised to discover that many of the steps you can take to address infertility also enhance your sexuality. For conception to happen, you need the healthy, harmonious hormones that promote a strong libido. If you have any of the hormone-related imbalances we’ve explored in this chapter—including estrogen dominance (which may be associated with abnormal or absent ovulation), adrenal fatigue, or a low thyroid-hormone level—solving them can be crucial to successful conception. For example, if your progesterone or DHEA levels are low, taking natural progesterone or DHEA may help you conceive.

About 20 percent of couples unable to conceive are diagnosed with “unexplained infertility.” In some of these cases, it may be because the woman has a subclinically low thyroid-hormone level (low thyroid hormone that doesn’t show up on tests), and she may conceive when her thyroid imbalance has been addressed.

All of the lifestyle factors you explored earlier in this book for enhancing your sexuality also help to address infertility by supporting balanced hormones. Your Great Sex Detox, as spelled out in Chapter 2, could be particularly relevant here. The hormone-mimicking chemicals ubiquitous in the environment, also known as hormone-disrupters, may play an especially important role for many would-be parents. (They affect some couples more than others because each person can react differently to them—depending in part on genetic makeup—but decreasing exposure to these chemicals can help create hormonal balance and enhance fertility.)

Intrauterine insemination and in vitro fertilization can help increase the likelihood of conception, but any couple seeking help for unexplained infertility should first restore great health and vitality in their bodies. This echoes ancient Chinese medicine, which teaches that infertility can be caused by chi imbalances; a lifestyle that supports chi, and allows sexual chi to flourish, is essential for conception to happen. No amount of hormonal manipulation with fertility drugs can correct underlying chi imbalances.

The transition you experience in midlife marks the beginning of a period of great potential creativity and rebirth. Your changing hormones not only affect you physically, but also influence your thoughts and feelings, so your menopausal metamorphosis can be a time of renewal for your body, mind, and spirit—and a time of sexual discovery.

You don’t have to accept the negative connotations that the word menopause may have for some people—as if it’s only a time of uncontrollable hormone shifts, difficult symptoms, and loss of libido. You can embrace midlife as an opportunity to fulfill new expectations about your body, your sexuality, and your well-being. One postmenopausal patient described her midlife experience as “giving birth to my older, wiser self, and being set free from the old me … along with some of the most gratifying sexual experiences of my lifetime, and sensations of sexual ‘newness’ and well-being that I haven’t felt since my teenage years.”

The notion that menopause is a time of regeneration and spiritual rebirth may seem unfathomable to some practitioners of conventional Western medicine, but it has been widely held for thousands of years in Chinese medicine. In fact, in the traditional Chinese view, your midlife transition is known as your “Second Spring.” According to this outlook, every month between puberty and menopause your chi flows downward toward the earth, from your heart to your uterus, to produce menstrual blood (your Heavenly Water) and give you the potential to bear and nourish children. If this downward flow of chi and blood continued past midlife, your chi would become depleted and you would age prematurely. Instead, at midlife your body conserves your chi by reversing the flow; it begins flowing upward, from your uterus to your heart, away from the earth and toward your spirit. No longer devoted to the possibility of bearing and nourishing children, your chi can be used to bear and nourish your spirit. Menopause is seen as a time of liberated energy and joy, when your upward-flowing chi lifts your spirit to new heights, giving you vast opportunities for self-development and expanding your spiritual potential. One Chinese medical authority describes it as the time when you become a wellspring of wisdom and a mother figure in your community. Your Second Spring is the passage of your energy from Heavenly Water to heavenly wisdom.

By challenging the conventional Western view of menopause, you can not only experience it as a time of heightened consciousness and spiritual awakening, but you can also open up an entire phase of your life—which some medical “experts” may have written off as destined for discomfort and diminished libido—to new possibilities for sexual pleasure instead. And like many women, you may find that menopause brings a newfound sense of sexual freedom, not only because you no longer have to be concerned about birth control, but because without the hormonal ups and downs of menstrual cycles, you may have more sustained, steady sexual energy.

Menopause can also provide you with opportunities for profound psychological and spiritual growth because it’s the other end of the menstrual spectrum that began in adolescence with your first period. Like adolescence, menopause is a dramatic hormonal transition that enables you to become more aware of your inner rhythms—another window of time that opens up to allow your consciousness to expand.

You may have been living on “autopilot” for much of your adult life, not fully aware of what you really want, or who you actually are. Perhaps your nervous system has been operating within a framework laid down decades ago during your formative years—a framework you once needed to deal with family and social dynamics, but which no longer serves you well. Your menopausal transition gives you the chance to examine this framework and make conscious changes in order to live more in accord with your authentic self—vital for a healthy sex life because it boosts your self-esteem and allows you to claim your own natural sexual needs and make better choices. You can expedite your personal midlife renaissance by keeping a journal, reading self-empowering books, or working with a therapist.

It’s important to realize that your experience of menopause is unique; the physical and spiritual changes you go through leading up to and through midlife may be accompanied by a variety of symptoms—or by none at all. If you experience symptoms, they tend to begin in your mid-40s, well before you reach menopause, although some women experience them earlier or later. Menopausal symptoms stem from hormonal imbalances, and not all women are created equally when it comes to midlife hormonal harmony. Some have a tumultuous transition, filled with physical challenges that require much time and attention, while others seem to sail through midlife effortlessly, with little or no difficulty, hardly needing to pause for menopause.

If you experience sexual challenges at menopause, it may be due to decreases in your levels of the hormones that nourish the tissues of your pelvis and sex organs; some tissues once well hydrated by your hormones may become drier, and your connective tissues and musculature may become softer. Menopausal symptoms can also compromise your sexuality because, in addition to well-known symptoms such as hot flashes, night sweats, and insomnia, they may resemble exaggerated PMS symptoms—fatigue; headaches; breast tenderness; bloating; mood swings; irritability; depression; and heightened feelings of sensitivity, weepiness, and insecurity. Your periods are apt to become less frequent as you approach menopause, and they may become either much lighter or much heavier. If your hormones fluctuate erratically, you may sometimes feel as if your emotions are riding a crazy roller coaster, and your exaggerated mood swings may be disruptive to your personal relationships, sex life, or career.

The hormone shifts that women experience at midlife can also cause another common symptom—reduced libido. It’s not unusual for a menopausal woman to experience little or no interest in sex or intimacy, even though she still loves her partner, and for some couples this can be a source of conflict in their sexual relationship.

If menopausal symptoms pose challenges to your sexuality and health, overcoming them can transform your sex life. There’s a tremendous amount that you can do, without synthetic hormones or pharmaceutical drugs, to effectively treat your symptoms, correct hormone imbalances, keep your sex organs healthy, and strengthen your capacity for midlife passion. Let’s explore your many options for making your journey through menopause smooth and pleasurable:

If you’re seeking relief from menopausal symptoms, including low libido, you want to begin with the gentlest, weakest, and most conservative measures you can, and gradually move to stronger treatments only if needed. Like some women, you may have low libido but sufficient or borderline hormone levels. These gentle approaches may effectively reduce or eliminate your symptoms, and you may never need any other treatment.

Conventional doctors often jump to the conclusion that if you have menopausal symptoms and a lowered sex drive, you need hormone replacement therapy, largely because their training doesn’t adequately prepare them to explore your other options. Hormone replacement therapy has far more potential side effects than other approaches, and it’s preferable for your overall health and sexuality if you can avoid them. The following are your best “first line of defense” options for treating menopausal symptoms naturally and gently:

—Black cohosh. The herb black cohosh has long been used to alleviate symptoms associated with menopause, including hot flashes, night sweats, depression, and (as you saw earlier in this book) vaginal atrophy and dryness. Research shows that black cohosh is safe and can be taken for an extended period of time, or until it’s no longer necessary for controlling midlife symptoms. It reduces hot flashes by affecting your estrogen receptors, but doesn’t actually increase your estrogen level; this makes it a good choice if you have a family history, or personal history, of estrogen-related cancer. A study published in the journal Gynecological Endocrinology in 2011 found that black cohosh can also help menopausal women who take the drug tamoxifen (often prescribed after breast-cancer diagnoses to prevent future recurrences). Tamoxifen can aggravate menopausal symptoms, but women who took black cohosh in addition had fewer hot flashes, less anxiety, and improved sleep. The recommended dose of black cohosh for reducing symptoms of menopause is 80 mg taken twice daily.

—Maca. A powerful Peruvian herb, maca contains plant sterols that have the ability to strengthen your entire hormonal system. Maca is effective in treating menopausal symptoms of hot flashes, night sweats, and insomnia because it can stimulate your glands to increase their production of estrogen and other hormones—which makes it a valuable alternative to hormone replacement therapy. Maca has other benefits as well: it supports your adrenal glands, helps lower your stress-hormone level, and increases your sex drive. (It also increases male libido, as you’ll discover later in this book.) The recommended dose for menopausal symptoms is 1,000 mg twice daily.

—Da Bu Yin. Da Bu Yin is one of the best Chinese herbal formulas for treating menopausal symptoms related to a deficiency of yin, which typically include night sweats, insomnia, hot flashes, anxiety, and increased thirst. The herbs in Da Bu Yin have been used for thousands of years and have no known side effects. The recommended dose of one Da Bu Yin product, called Great Yin (see Appendix C), is two to three pills three times daily.

—Two Immortals. Also known as Er Xian Tang, Two Immortals is another traditional Chinese herbal formula for treating menopausal symptoms. It helps to boost libido, balance hormones, relieve hot flashes, and reduce irregular menstrual bleeding and cramping during the years leading up to menopause. It’s made by many companies; dosages vary, so follow the recommendation on the product label. (see Appendix C for supplier information.)

—Vitamin E. You can help reduce hot flashes by taking vitamin E; the recommended dose is 400 to 800 IU daily. (Take with caution if you’re on blood-thinning medication.)

—Soy. As a food high in plant hormones, or phytoestrogens, soy can have certain hormone-like effects on your body. Ample research shows that women who consume higher amounts of soy foods experience milder midlife symptoms.

If you’ve exhausted the possibilities for treatment with herbs, nutritional support, and foods, and still experience menopausal symptoms that compromise your health and sexuality, you may benefit from hormone replacement therapy. Supplementing your body with the right hormones can help restore your hormonal balance, libido, and sexual enthusiasm, and keep your vulva and vagina hydrated. It can also support your immune system, bones, and connective tissues, and by improving your moods, increase your sense of well-being and receptiveness to pleasure.

Whenever possible, you want to use natural bioidentical hormones rather than conventional synthetic hormones, and use the smallest amounts necessary to achieve the desired effects. Natural bioidentical hormones are considered safer than conventional synthetic hormones because they’re derived from plant sources and have a chemical structure that’s the same as the hormones your body produces over the course of your lifetime (hence the term bioidentical). Synthetic hormones can lead to health problems because they rely on forms of hormones structurally very different from those your body naturally makes.

Natural bioidentical hormones are becoming more widely available to help women with menopausal symptoms and low libido—thanks in large part to the alarming results of the 2002 Women’s Health Initiative, a long-term study sponsored by the National Institutes of Health that focused on strategies for preventing heart disease, breast cancer, osteoporosis, and colorectal cancer in postmenopausal women. The study showed that conventional hormone replacement therapy can increase your risk for heart disease, stroke, and breast cancer. When these findings were released, many women chose to throw out their conventional hormone prescriptions and suffer the consequences of abrupt mood changes, reduced sex drive, hot flashes, night sweats, insomnia, and other symptoms.

Since then, increasing numbers of women have turned to herbal remedies to ease their symptoms, or sought out natural bioidentical hormone replacement therapy. Research on natural bioidentical hormones has surged, and the growing consensus among experts is that they may be safer for many women. According to a 2009 article in the journal Postgraduate Medicine, “data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts.” But even though natural bioidentical hormones have become holistically minded doctors’ preferred method of hormone replacement therapy, conventional physicians may still encourage you to use synthetic hormones for menopausal symptoms, and especially for decreased libido.

The Women’s Health Initiative found that it was women who took Provera and Premarin—at the time the most popular conventional progesterone and estrogen prescriptions for menopausal symptoms—who were at increased risk for dire health consequences. Provera is synthetic and not bioidentical. Premarin, the most well-studied hormone used in conventional hormone replacement therapy, is considered by some to be seminatural—a questionable claim, because it contains 4 to 8 percent horse hormones—and it’s certainly not bioidentical. (It may be natural and bioidentical for a horse, but not for you. Even though Premarin is derived from another mammal, it contains more than 200 different compounds foreign to your cells. Plant-derived hormones, by contrast, contain natural hormone-like substances that are chemically altered in a laboratory to yield compounds identical to the hormones a woman produces in her body.)

Perhaps it was inevitable that trying to trick Mother Nature with synthetic forms of such powerful substances as hormones would eventually backfire. Many women have similarly put their health on the line by taking synthetic hormones in another form—as birth-control pills. Some take them for their entire reproductive lives, even though it has never been clearly established if their long-term use is safe. Birth-control pills, which contain estrogen and progesterone, interfere with a woman’s natural hormone production, suppress ovulation, and can have many other undesirable effects. Some women experience strokes or high blood pressure while taking them, and others develop liver tumors. They may also change the viscosity of your bile, which can lead to the formation of gallstones or have other adverse affects on your gallbladder, resulting in sporadic episodes of painful nausea and vomiting. (For information on natural birth-control methods, see Appendix H.)

The hidden risks of synthetic hormones make natural alternatives all the more attractive. Your options for using natural bioidentical hormones to treat menopausal symptoms and enhance your sexuality have improved considerably since 2002. Today you have many effective choices at your fingertips for taking natural bioidentical estrogen, progesterone, DHEA, and testosterone. You may benefit from using one of them separately, or a combination of several of them. Let’s explore your options for therapy with each one:

—Natural bioidentical estrogen. The two primary estrogens in your body, as outlined in Appendix E, are estradiol and estrone, which converts into estriol. Estradiol is the strongest-acting estrogen, and predominant in young women; estrone is weaker than estradiol, and predominant in postmenopausal women. Estriol, which is much weaker than either estradiol or estrone, is the predominant estrogen for supporting and hydrating your vulva and vagina.

As you’ve discovered, estrogen can have a wealth of benefits for your sexuality and health. At the same time, researchers have found that estrogen can increase your risk of certain cancers, especially in the breasts and uterus. How could something normally so beneficial play a role in such health-compromising conditions? To help answer this question, and understand more about the role of estrogen in your health, it’s worth looking at why cancer happens.

Although the ultimate causes may be mysterious, many researchers agree that a person who gets cancer has an immune system that isn’t working as well as it should. Your body produces cancer cells every day, but the powerful surveillance system of your immune cells renders them harmless and unable to multiply and turn into cancerous conditions. This is why you can help prevent cancer with everything you discovered earlier in this book about keeping your immune system in peak form.

Some authorities on the subject of hormones and cancer—including Jonathan Wright, M.D., who helped popularize bioidentical hormones—believe that estrogen doesn’t cause cancer but can act as fuel to a fire if the cancer is estrogen-sensitive. On the other hand, if taking hormones makes you healthier by improving your sleep and your ability to cope with stress, it may help keep your immune system strong, resilient, and able to ward off any type of cancer. And in recent years research has shown that estriol, which is safer than estradiol and estrone, has protective effects against breast cancer.

Your decision as to whether to use bioidentical estrogen, and how much to use, should depend on your individual situation and needs; it’s best to see a doctor who specializes in prescribing it. For some patients with menopausal symptoms, I prescribe only estriol, in doses that may vary, depending on symptoms, from 1.0 to 2.5 mg applied transdermally a few times a week. For others, bi-est (a standard hormone prescription consisting of 80 percent estriol and 20 percent estradiol) is recommended, with daily doses that typically vary from 1.25 to 2.5 mg, also applied transdermally. (see Appendix F for information on transdermal hormone applications.)

—Natural bioidentical progesterone. In this chapter we’ve enumerated the many sexual and health benefits you derive from your body’s natural progesterone production. As you approach midlife, with a decrease in your natural progesterone production, you may experience fewer of these benefits, and you may gain from taking natural bioidentical progesterone. And at midlife, when your ovaries stop producing hormones and your adrenal glands take over the job, it can give your adrenal glands much-needed support.

Inadequate progesterone can exacerbate many symptoms associated with menopause. In addition to diminished libido, you may experience aggravated breast tenderness and swelling, and increased water retention and bloating. In the years leading up to menopause, your symptoms may include increased PMS and menstrual cramps, heavier periods, and insomnia and anxiety during the second half of your menstrual cycles.

If you take natural bioidentical progesterone, you want to begin with a very low dose and gradually build up to the level that works well for you. Taking too much progesterone can have side effects that include nausea, headaches, dizziness, and sleepiness the morning after you take it. As with estrogen, the amount you need, and how long you should take it, depends on many factors and your individual situation. For best results, see a qualified health professional experienced in prescribing natural bioidentical hormones.

For treating exaggerated PMS symptoms in the years leading up to menopause, the recommended dose of natural progesterone is generally between 25 and 100 mg, applied transdermally each night before bed during the second half of your cycle. But if you’re also taking estrogen, make sure you take at least 50 mg of progesterone a day—important to help protect you from abnormal cell changes in the endometrial tissue in your uterus. Back in the 1970s, women who took estrogen without also taking progesterone had a much higher incidence of endometrial cancer. Subsequent research found that when estrogen is taken with progesterone—more in alignment with the balance nature intended—this risk is appreciably reduced. There’s no clinical justification for using estrogen without progesterone, unless for some reason a woman doesn’t tolerate progesterone.

If your uterus has been removed, taking progesterone can still markedly improve your quality of life by providing you with its many libido- and health-enhancing effects. Many medical doctors tend to think that if you’ve had a hysterectomy, you simply no longer need progesterone—as if its sole purpose is to prevent endometrial buildup in the uterus. Again, if you need to take hormones, it’s important to find a physician who specializes in prescribing them.

—Natural bioidentical DHEA. The libido-boosting, health-enhancing effects of DHEA make it seem all the more precious when your body’s natural production decreases at midlife. As explored previously in this chapter, in addition to improving your sexual functioning and supporting your entire hormonal system, it can elevate your moods, help you overcome depression, benefit your brain, and improve your bone density—a key issue for many menopausal women.

Not every woman who takes natural bioidentical hormones for midlife symptoms needs to take DHEA. For some, the right amounts of estrogen and progesterone sufficiently ease their symptoms. But for others, taking DHEA can be essential for restoring health and bolstering libido. If you have midlife symptoms and think you may need to take DHEA, your test results (from hormone testing, as described in Appendix E) and your symptoms should direct your treatment. The symptoms you’re likely to experience if your body isn’t making adequate DHEA are decreased sex drive, poor memory, reduced ability to tolerate stress, and low adrenal-gland function. You may also have a diminished sense of well-being, lower overall hormonal health and vitality, fatigue, and reduced bone health.

Before taking DHEA, make sure your estrogen and progesterone levels are stabilized. If you’re also taking estrogen and progesterone, I recommend waiting a month after you start doing so before you begin taking DHEA. During and after midlife, many women need to take only very small doses of DHEA to experience notable libido-enhancing effects, increased energy, and better stress tolerance—for example, a daily dose of no more than 8 mg of DHEA applied to your skin as a transdermal oil or cream. (DHEA should be taken cautiously; excessive intake can have undesirable effects.) A holistically oriented practitioner can help find your ideal dose.

—Natural bioidentical testosterone. Some women in midlife become acutely aware of testosterone’s myriad health and libido benefits when their natural levels subside. As you’ve seen, testosterone is indispensable to your ability to feel excited about your life—and sexually excited as well. It can also help reduce hot flashes, night sweats, and other menopausal symptoms.

If your testosterone is low in midlife, your most noticeable symptoms are apt to be diminished libido, disinterest in sex, a lack of creativity and motivation, an inability to build and maintain muscle, and frequent fatigue. As with DHEA, treating your menopausal symptoms with estrogen and progesterone may be enough, and you may never need to take testosterone. But if you have persistent symptoms that point to low testosterone and your test results (from testing as outlined in Appendix E) bear it out, you’re a good candidate for testosterone treatment. For some women, taking testosterone not only helps restore their sex drive and eliminate menopausal symptoms, but also stimulates a heightened awareness of their bodies reminiscent of the hormonal awakenings of adolescence.

If you take natural bioidentical testosterone, you can expect to achieve the desired effects with a very low dose—no more than 4 mg daily, applied to your skin as a transdermal oil or cream. A qualified health professional who specializes in natural bioidentical hormone therapy can help you determine the amount you need. As you discovered earlier in this chapter, there may be benefits to taking testosterone in conjunction with other hormones; research suggests that when taken along with bioidentical estrogen and progesterone, it may decrease your breast-cancer risk. (If you’re also taking estrogen and progesterone, it’s best to start doing so about a month before you begin taking testosterone.)

If you use bioidentical hormones, you need to know the substantial and surprising differences between methods of taking them. Hormones, as mentioned before, can be applied as transdermal (absorbed through the skin) oils or creams, or they can be taken orally in pill form. Many conventional doctors—as well as some who claim to practice alternative medicine—prescribe only oral pills, perhaps because other methods weren’t part of their education. But transdermal application is more effective and healthier because it allows hormones to be absorbed immediately into your bloodstream. If you use oral pills, after you swallow them, they’re taken to your liver, where much of their hormone content is broken down before the remaining amount—only about 20 percent—reaches your target tissue. In addition to reducing your efficiency of hormone absorption, this puts undue stress on your liver, and if you’re taking estrogen, increases clotting factors that can lead to strokes. Research has shown that applying estrogen transdermally is safer than taking it as an oral pill.

(To continue your exploration of how you should take bioidentical hormones, including how to best apply them to your body and other important considerations, see Appendix F.)

Foods and Supplements to Support Your Midlife Libido by Enhancing Friendly Estrogen

The extent of your menopausal symptoms, and the degree to which they affect your sexuality, can be closely related to how efficiently your body metabolizes, or breaks down, estrogen. During the years leading up to menopause, you may ovulate less regularly, which can bring about estrogen dominance. Although your overall estrogen level naturally tends to be lower at midlife than in previous years, promoting healthy estrogen metabolism is still of utmost importance in helping prevent serious conditions like breast and uterine cancer. Your estrogen metabolism is critical because it can result in either “friendly” or “unfriendly” estrogen. (For more information on how your body can convert estrogen into either friendly or unfriendly forms, see the diagram in Appendix E.)

The following foods and nutritional supplements can noticeably improve your body’s ability to make friendly estrogen and eliminate unfriendly estrogen. They can help reduce menopausal symptoms if you have estrogen dominance, or experience difficult PMS, in the years leading up to midlife. For some women, these foods and supplements provide an especially valuable means of supporting hormone replacement therapy. If you’re taking estrogen for menopausal symptoms, they can help decrease your risk of breast cancer—the single biggest concern for women taking estrogen at midlife. And even if you never take it, you still stand to benefit from these foods and supplements; they can help reduce your risk of breast cancer at any time in your life.

—Seaweed. The rich iodine content in seaweed makes it one of the best foods for boosting your friendly estrogen metabolism and supporting your breast health.

—Cruciferous vegetables. You can significantly improve your estrogen metabolism by choosing plenty of helpings from the cruciferous family of vegetables (for example, broccoli), because they’re high in indole-3-carbinol—a potent anticancer agent that supports your body’s ability to make friendly estrogen. Include the cruciferous clan at your dinner table often, preferably lightly steamed or raw (high temperatures can destroy indole-3-carbinol). As you discovered in Chapter 2, broccoli sprouts are exceptionally powerful for their cancer-fighting potential. They’re also great for your friendly estrogen metabolism.

—DIM. Short for diindolylmethane, DIM is a cruciferous vegetable extract derived from indole-3-carbinol. It may have even stronger effects than eating cruciferous vegetables because of its unique ability to promote friendly estrogen metabolism, and by helping prevent estrogen from binding to your breast cells, reduce your risk of breast cancer. To give your estrogen metabolism an extra jolt of support, take 300 mg of DIM daily.

—Calcium d-glucarate. This compound occurs naturally in your body, and is found in many fruits and vegetables. Particularly helpful if you’ve had breast cancer, or are at high risk of developing breast cancer, it promotes your friendly estrogen metabolism, supports your breast health, and may inhibit growth of breast-cancer cells. Calcium d-glucarate has a strong safety record; no side effects have been reported from taking it. The recommended dose for enhancing estrogen metabolism is 1,500 mg daily.

—Liver lipotropic formula. Your sex-boosting cleanse outlined in Chapter 2 includes a liver lipotropic formula—a blend of herbs and nutrients that helps your liver break down toxins more effectively and also supports your friendly estrogen metabolism. To enhance your estrogen metabolism, take two capsules of liver lipotropic formula (see Appendix C) twice daily.

You began this chapter by exploring your six key sex-enhancing hormones, and the many benefits each provides for your body, mind, and spirit—everything from moistening your vaginal tissues to kindling your capacity for compassion. As you’ve seen, every day of your life your magnificent hormones nourish, stabilize, stimulate, harmonize, empower, and energize your health and your libido. Since hormonal disharmony can be harmful to your health and sexual energy, this chapter has also provided you with many effective natural methods for enhancing your sexuality by restoring equilibrium if your hormones are imbalanced.

With your hormones harmonized, you’re equipped to use all of the other sex-enhancing secrets you find in this book to more fully fan the flames of passion. We now turn to Part II of our journey—our in-depth investigation of a wide range of natural means you can use for additional sexual self-empowerment. In the next chapter, you’ll discover a treasure trove of tools for enriching your sex life. There are many gems still to unearth; the excitement has only just begun!

1 A note on our use of the term menopause: Although menopause is typically defined as the year that begins with your last period, for the purposes of this chapter we often use the term to include perimenopause, the period of time leading up to menopause, during which you begin to experience midlife hormonal changes like irregular menstrual cycles.