May 26, 2005
Oral Contraceptives Permanently Reduce Libido?
Oral contraceptives for women cause the female body to overproduce sex hormone binding globulin (SHBG) which is a protein that binds to testosterone. Testosterone enhances sexual desire in women just as it does in men. Researchers led by Irwin Goldstein and Claudia Panzer at Boston University have found that SHBG levels remain elevated even a year after women stop taking the pill and women may suffer sexual dysfunction as a result. (same article here)
Hormonal changes induced by oral contraceptives (OC) are not immediately reversible after discontinuation of use, according to new research issued today at the American Association of Clinical Endocrinologists (AACE) Fourteenth Annual Meeting and Clinical Congress.
Despite the benefits of OC, their use has been associated with sexual dysfunction and androgen insufficiency. OC are known to decrease serum testosterone levels by decreasing ovarian production of testosterone and by increasing production of sex hormone-binding globulin (SHBG) from the liver. It has been assumed that these changes are reversible after discontinuation of OC use.
In the study of 102 pre-menopausal women with female sexual dysfunction, SHBG values in the OC group were seven times higher than those in the never-user group. OC lowers the free androgen index, in part, by substantially increasing SHBG levels. Despite a decrease in SHBG values after discontinuation of OC use, SHBG levels remained continuously elevated for up to one year in comparison with those in the control group. The free androgen index may remain low for a prolonged period.
Decreased libido, problems havng orgasms, painful intercourse, and other side effects of the Pill may be long lasting and perhaps even permanent for some women. Dr. Panzer warns:
"It is important that when doctors advise women to take oral contraception that potential side-effects, including loss of sexual appetite and arousal, are pointed out.
"If, as our study suggests, the Pill can cause a long-term or permanent loss of libido, that is something women need to be made aware of."
Parenthetical aside: The Pill has been in use for 45 years and yet a major side effect from its use is only being discovered now. Keep that in mind the next time a fairly new drug is found to have an unexpected side effect and the US Food and Drug Administration comes under a chorus of criticism for failing to foresee some problem. Discovery of drug side effects is hard to do even when a drug has been studied for decades.
Will women who have suffered a decreased desire for sex from taking oral contraceptives have to resign themselves to permanently reduced libidos? Maybe not. Drugs exist which suppress SHBG production.
The picture following treatment with tibolone was quite different. There was only a minor influence on circulating estrogens, and SHBG levels were reduced by 50%. Androgens are known to suppress SHBG production at the hepatic level [9,10,26,27]. After oral intake, tibolone is rapidly converted into 3α- and 3β- hydroxy tibolone, both having estrogenic properties, and the Δ4 isomer, which is known to possess progestogenic as well as androgenic activity. In fact, the receptor affinity for this isomer is about 40% of that of the potent androgen dihydrotestosterone [3,4]. The marked reduction in SHBG levels and as a consequence increased concentrations of free testosterone implies an enhanced circulating androgenic activity. This may be important as regards some clinical effects of tibolone.
A drug to suppress SHBG production would need to be either safe to take for the long term or capable of resetting liver SHBG production in a way that sticks once the drug is stopped. It is time to start looking in earnest for such a drug.
Well, the purpose of "the pill" IS to avoid pregnancy...and diminished desire for sex DOES help avoid pregnancy....
Then could the Pill also depress ambition and the drive to succeed?
Is Blue trying to blame the pill for his/her own depressed ambition and lack of drive to succeed?
It just seems ridiculous that first we give women oral contraceptives that end up causing dysfunction then dose them up with something else that probably has undesirable side effects as well. Guess life's not perfect.
I think the important question for all guys is, "Can we find a pill that has the opposite effect, at least on libido?"
Over the years I've noticed that women not on the pill seem more passionate, more compulsive in their ardor. This might seem odd given the chance of pregnancy and the damping effect you might expect on sexual energy. This androgen suppression idea does mesh with my sexperience. Another less quantifiable effect is a certain change in body odor that occurs in women on the pill. Pheromones might be altered or diminished by the foreign hormonal effect.
If some of the hormonal changes are permanent, would this make it more difficult for the affected women to become pregnant? Clearly, being disfunctional sexually would decrease the amount of sex a woman would have. hehe Perhaps this marginally impacts the birth rate as well as the divorce rate?
Also, I'm interested in the implications of the hormonal change would have on any children conceived after OC use. Could this impact aggressiveness, sexual identity of the child, etc?
Annectdotally, I've seen libido return after a year or two off of oral contraceptives. With a vengence!
Jody -- the first man -- and I am certain it will be a man -- to discover and market such a thing will not only be stupefyingly rich, he will never again pay for a drink in his life. Frat houses will buy the stuff in Mexico and pour it into the libations. Hell, add it to the water supply... now, if only we could get sex-segregated drinking fountains ...
It definitely depends on which progesterone is used in the pills. For a while my woman shifted over to a "cheaper" variant. Boy was it cheaper. :-(
Luckily that's been fixed.
This is very disheartening, especially considering the long term effects that can't be reversed immediately by a woman choosing to no longer use oral contraceptives...as I'm going to. Think of the ill effects on relationships in general...all those women opting for the pill in long-term relationships and both partners involved never realizing they're actually promoting the decline of their sexual relationship and intimacy, one of the cornerstones of a romantic relationship. It's downright frightening to think of the whole cultural effect that widespread use may be inducing.
I would like to know more about the effect of the contraceptive pill on sexual drive. Can you point me in the right direction?
Actually, this is a poorly designed study that proves nothing. First, it's a retrospective study. All the women in the study were at a clinic to be treated for "sexual dysfunction". They were already either on the pill or not on the pill. So they all already had "sexual dysfunction", whether or not they were on the pill. Then they measured their SHBG levels. Then they compared the women who were on the pill to the women who were not on the pill. They never measured anyone's levels before they started taking the pill! They claimed the women who were on the pill and then stopped, had SHBG levels that were "elevated", but their levels were only compared the other women who weren't on the pill. This is ridiculous. How do they know that their levels weren't higher to begin with? Not only that, but they claim 30% of women on the pill have sexual dysfunction. But 30% of ALL women have sexual dysfunction! I just think this is a silly study that was published in a low-level journal. This article would never be accepted for publication in a highly respected journal. They need to do a PLACEBO-controlled prospective study (measure levels and sexual function before the pill, during the pill, and after the pill) to show anything meaningful.
Given that the risks of not taking the pill are unintended pregnancy (and possible abortion) I don't think that anyone could ethically do a double-blind study where some women think they are getting the Pill but are actually getting placebo.
Actually, I'm wrong -- there has been at least one; I wrote about it in 2003:
Doctor Cynthia Graham recently conducted one of the first double-blind placebo-controlled studies of oral contaceptives effects on women's sexuality (involving women who had already been sterlized, so there was no pregnancy risk). Quoting from the abstract: "The [combined oral contraceptive] adversely affected sexuality in the Edinburgh women, with 12 of the 25 women in this group also reporting the side effect of reduced sexual interest. There were modest negative effects of the combined pill on mood, more noticeable in the Edinburgh women. The [progestogen-only pill] was associated with no adverse effects on sexuality and some improvement in well-being in both centres." [Graham, C.A., Ramos, R., Bancroft, J., Maglaya, C., & Farley, T.M.M. (1995). The effects of steroidal contraceptives on the well-being and sexuality of women: A double-blind, placebo-controlled, two centre study of combined and progestogen-only methods. Contraception, 52, 363-369.] Someone in the audience said that since issuing this and other articles attributing adverse sexual effects to contraceptives, Dr. Graham has lost some funding and the pharmeceutical industry has been trying to suppress these studies and shut down new research in the area. I have no evidence of this one way or the other, but it sounds sadly plausible.
I don't feel like recopying all the formatting and links, they're on my blog.
BTW, while I wasn't part of this study (that I know of) the Pill has caused me a permanent loss of libido (measurable in blood hormone levels besides just lack of desire,lubrication or orgasm) and have been off the pill for over 8 years. my sexual/medical history and a bunch more links on FSD
Having been off the pill now for 6 months; I do feel an improvement (placebo effect maybe?) and would probably never use it again for fear of irriversible problems. I think doctors need to be better informed, as when I discussed it with mine he wasnt v helpful im sorry to say. I would agree with Sanford that this study itself is fairly unreliable for the reasons stated, however due to my own experience and from speaking to other women, I believe there really is a link between the pill and sexual dysfunction and more info is needed so girls/women can be warned. Oh and hurry up with the male pill please boffins!
I went off the Pill mid-cycle a few weeks ago because I was afraid it was causing my moodiness and depression, and I'm seeing an immediate change in libido. Ay caramba. If I had a lover right now I wouldn't get any work done.
I found this site after searching for ways to decrease SHBG. I am one such woman who has suffered these effects. I never wanted to take the pill as my GP had advised me against taking it because there was a significant risk of stroke in my case because of severe migraine with aura. After I moved to a different area I changed GP and every time I visited the nurses pressured me to get put on the pill. My new boyfriend was constantly complaining that sex was no good for him without a condom and that I was just being selfish by not taking the pill (all his previous girlfriends had been on it). Eventually I went to my new GP who contradicted my old one and urged me to take the pill. I feel like this was the point I lost my life. I was 21, had been blessed with a fast metabolism, very good muscle tone, IQ of 180 which led me to work in science, I felt full of life and enthusiasm, the world was my oyster. When I started taking the pill I immediately became depressed, fatigued, I constantly had breakthrough bleeding, I lost my muscle-tone and became podgy, I could no longer have sex without artificial lubrication, I had constant thrush and felt disgusting, my immune system suffered, I caught one infection after another, my mind was fogged and I couldn't keep up with my work, I had no energy to do anything. After developing DVT and nearly losing my life I came off the pill. That was 6 years ago and I am still not the person I once was. I have absolutely no interest in sex, intercourse is painful and I need artificial lubrication, I don't have the drive I used to have and I am tired all the time. I am able to do my scientific work once more but it is not as easy as it once was. My body has regained some muscle-tone but I feel old and like I threw away my youth. I have found that this is due to lack of free-testosterone and by all accounts it is permanent damage. I have the hormones of a much older woman. I am now worried that it will have some impact on my children's health. Please do not give in to the pressure of going on the pill it will damage your body permanently and you will not be the woman you were meant to be, let men wear condoms and lump it.
I'm not sure if it is the same chemical but I had very similar syptoms come up after taking Noroplant. I had a tremendously high libido as a teenager with heavy periods lasting 7 days. After going to college decided I wanted my degree more then anything and was worried that I'd get pregnant along the way. I decided since I forgot to comb my hair or rush my teeth on rushed morning s what would stop me from remembering to take the pill so I opted for Noroplant which in the long run was less expensive ten that length of duration of pill anyway. Within a few days of having the Noroplant implanted, my libido tanked. I thought this is funny you don't get pregnant becasue you absolutely don;t want to have sex! I figured it was an intial reaction and it would regulate, but it did not. I became very depressed in less then a semester loosing the "freshman 15 instead of gaining" it. I lost ambition, drive, energy, and outlook for happiness too. I suffered from yeast infections and dyrness of the vagina as the woman above did but also drier tear ducts. It gave me security of not having to evn question that I'd have an unwanted pregnancy but very little else.
I did question if it was just depression becasue it didn't go away after I got them taken out 5 years later but I immediately went on the pill (which Initially gave me morning sickness) and tried an other pill set and an other with a myriad of additional side effects untill I said no more and thought things would bounce back but really they didn't.
I saw a specialist later who simply said that if I was having regular periods, which technically they are, my hormone levels were probably not my problem and I just needed a guy who cuddled more ...as if I made this up. I had some winners and losers as far as men go so i don't think its got much to do with that even if snuggling is really awful nice.
A few years later I had a OB gyn suggest I try the pill again and I said no way- but gave in after he said this time it will be different. Unremarkably, a few days after trying the stuff, my libido which was still low, lowered further (perhaps it has raised slightly over time but I just never noticed -this was a clear indication to me that there was something definately up with birth controll meds themselves) I quit and never went back to the GYN and will no longer use chemical bith controll.
My periods to this day (I'm 32 now not 19) are shorter and lighter with about 1-2 heavy days as opposed to the 5 of my teenage years and I feel the longer I am off the pill the heavier they are getting though very slowly. I Imagine some change would occur with age but that they are increasing in length and heaviness now makes me feel like much of that change was chemically induced and I'm finally starting to detox a little. I have not tired to have kids yet but hope I might in hte future.
As a side note, I have good insurance now so have been investigating my cronic fatigue and lack of libido- I've ruled out Libido, all but very mild depression (took a long written test that basically siaid I was 1-2% more depressed then the nornal popultion on a 100% scale with slightly more anxiety- you would have anxiety too if you felt like jusnk all the time but had to preform on a par with everyone else). I'm going for a sleep test next to check into possible narcolepsy- explaining the fatigue but not missing libido. I just can't think of anything else except an undiscovered sleeping disorder except maybe digestion or the origional culprit, birth controll meds!
What can I do to get tested to see if it really may have something to do with taking Noroplant or taking the pill?
Consider going to an endocrinologist and get your free testosterone (as distinct from bound testosterone) and other hormones tested. It is possible that low dose testosterone might boost your libido.
Were there any success stories? Did ANYBODY actually get back to being normal self after taking the pills? I suffer the same effects of the pills too and reading this page doesn't give a lot of hope.
I didn't realise that the pill was causing my problems until I stopped taking it to have children. Then I think my sex drive was still low but I wanted to have a baby so had added motivation to have sex. Since the birth however (5 months ago now) I've found that my sex drive has been much higher, except for the one month when I tried going back on the pill! Having a baby is a rather extreme cure though! I was taking a combined pill, containing 30 micrograms ethinyl etsradiol and 150 micrograms levonorgestrel. Have been doing a lot of reading on the subject recently to try to find one which won't have this effect so would be interested to know which other pills people have tried. According to my GP it is the estrogen component which causes the problem, but my reading so far suggests that he is wrong and that the progestogen component is having an effect. This would explain the problems with Norplant mentioned above (Norplant is a progestogen only implant containing levonorgestrel).
in menopause I have finally learned oral estrogens suppress SBGH. You need transdermal estrogen to avoid this. Unfortunately this is not routine in the U.S. although more common in Europe. I have warned my daughter. I now use transdermal estrogen for menopausal symptoms and hope my SBGH will fall given time. (it is elevated)
I'm back after some months...I went to an obgyn who also seems to specialize in endocrine related matters. I went for the fatigue and low libido and severe reactions to cold. he first gave me cortab (cortizone?) saying my adrenals were deficient and needed to heal. this did make e a bit warmer and slightly more ease getting up but gave me a slue of other side effects ( weight gain nausia, headaches, pressure) so I'm off this now and feeling extra tired. Libido never changed....so he took blood and gave me some thyroid meds to try. and progesterone creme and now testosterone creme saying my levels were fine but he didn't knw what else to try....why I'm on progesterone if that is what gave me trouble in the first place (noroplant) is beyond me. seeing a few points mentioned above I'm going to talk to him about it. I do oft feel like I have the flu right before my period but in the first half of menstrual cycle I'm actually often slightly blissful especially during my period. I'll admit to not knowing enough about the actual chemical process through the month to understand what I actually feel through the month.
My values for those interested: I was taking dhea and it came up high so i stopped taking it... it was 347. ( normal range is 23-266), T4 1.2 (normal saying 0.7-1.9), tsh 3.70 (normal range .32-5.0) but this is circled on my labs as a problem so maybe doc isn't going by lab values, t3 118 ( normal range: 72-170), free testosterone 1.6 (Normal ranges seems to be between .4 and 3.2), total testosterone is 67 (normal range being 6-82) so weather it is normal because of the higher dhea or just normal... I'm not certain but taking the creme (inner labia) doesn't seem to do anything but cause slight irritation.
I'm wondering should I be demanding a shbg level? Ask for a trial of tibolone?