[00:00:01] Welcome to Anti Aging Unraveled, the podcast where we redefine aging and empower you to age your way. [00:00:08] I'm Dr. Laurie and this show is rooted in the lifeevity philosophy. Living life the way you want to with energy, clarity, purpose and longevity. Here we break down integrative functional medicine, bioidentical hormones, peptides, metabolic and brain health, gut immune connection, and cutting edge longevity therapies. So you're not just living long, longer, you're living better. [00:00:34] If you believe aging should be intentional, personalized and on your terms, you're in the right place. Welcome to Anti Aging Unraveled. Let's unlock longevity and help you age your way. [00:00:47] Welcome back, everybody. And we are here for another episode of Anti Aging Unraveled. And as usual, you guys know I love to say how much I love my topics. And, and this one is actually a little bit of an interesting one that I think we don't talk about it enough. [00:01:02] And also honestly, we don't talk about alternatives and ways to fix these problems enough. And that is really what helps libido, right? As libido starts to go and change and feel different and as our body changes, we really don't discuss this enough. And I feel like it's one of those topics that especially for women is no one talks, no one airs it out. And it is an interesting one because there are things that we can do for it. So we're going to talk about peptides, herbals and hormones for libido. And we're going to talk about products like PT141, oxytocin, kisspeptin, some herbs, and really the new science of desire and how we can make that into a real topic of conversation for people and bring that to the forefront. So if you've ever been told that, like I said with libido, that your labs are normal, that it's just stress, that it's just aging, that you have to deal with it, you should be grateful you can still function. Then this episode is really for you. Because libido is not one hormone, it's not one pill, one peptide. Libido is layered and same thing with free female or male. Erectile dysfunction is multifactorial for women as well. Neurologic, vascular, hormonal, inflammatory and emotional. They all come into play when it talks about libido. So today we're going to walk through the full spectrum of options, from the most foundational to the most advanced and really talk about real world clinical examples and some cases. Actually, I'm going to Put some cases in here about how we fix libido and how we don't just treat one aspect of libido. So let's briefly break down what libido is. Libido really lives at the intersection of the brain, the nervous system, the hormones, blood flow, vascularity, inflammation and really brain and emotional safety. Right. Especially for women. [00:02:56] So this is why two people with identical labs can feel completely different and those treatments options can be completely different. For example, we can have a patient, these are real examples by the way, just without names, obviously. 44 year old high performing fitness instructor, optimal estrogen, progesterone, testosterone, ate clean exercise daily, but yet her libido was zero. [00:03:22] And obviously you saw that hormones are not our option. [00:03:26] So what it was was chronically basically sympathetic nervous system activation. Once we downregulate that sympathetic nervous system, get the cortisol and adrenal dysfunction addressed, remove the over training desire, slowly return without adding hormones or peptides. Sometimes we'll add supplements to help this, especially with the adrenal, but it's starting to come back on its own. Another example is 52 year old male, strong desire, inconsistent erections, just could was there was no consistency and wasn't able to to consistently have an erection. But his libido is there. So in this case we can talk about a more common problem which is vascular responsiveness and the dilation of the blood vessels to give blood flow. So we have to treat these cases very differently and that really comes into some of these new products on the market for treating libido and for treating desire and for treating the brain and from treating it from other aspects other than just hormone, which we will address today and blood vessels because they're the two most common things that are talked about. So let's start with some of the herbals where they help. There's a variety of them. I'm just going to touch on some of the more common ones that I like to use especially for women. One is called maca. And MACA doesn't significantly raise estrogen or testosterone. It actually appears to modulate the hypothalamus signaling and mood. So it actually will give a little bit of that brain hypothalamus signaling to into the erogenous zone. Right. So for example, patient who was 39 postpartum, normal labs, had a complete loss of interest of sex. We did 12 weeks of maca, some magnesium for improved sleep and desire started to return after getting the cortisol and the sleep and the rest and doing some MACA just again to get that hypothalamus working in post pregnancy and desire returned. I'm going to put it as curiosity, not urgency. And that really distinctively matters because you know, people expect it to come back to the level that it was previously. And sometimes that urgency isn't possible to achieve, but at least we can get that curiosity and that simplicity back. Another example would be a 47 year old perimenopausal woman with normal hormones, high stress. Again, it's that adrenal overdrive, cortisol irregularity and MACA helped smooth those libido fluctuations. [00:05:56] But it doesn't always improve orgasm in her case, which is expected because this isn't going to actually give you increased stimulation to the area. This is just going to help with helping with libido and actually the mood, not necessarily sensation. Another one is ashwagandha. Ashwagandha again has to do with cortisol and improving stress and resiliency and it helps indirectly by lowering cortisol levels, improving that stress resilience, improving that adrenal overdrive. So it's great for adrenal burnout, high anxiety driven libido loss, but it's not a primary drug by itself. I do find it helpful again in combination with maca, but also in combination with some magnesium for nighttime sleep. It's a great as an adjunct or a combination of herbs. An example for, for something like Ashwagandha with Maca, 45 year old high stress environment executive and just has no libido. Ashwagandha plus getting that sleep back help to calm that nervous system and start that reset. Okay, so again these herbs are good as an adjunct and sometimes even an early kind of stimulator of bringing back that desire or curiosity. We could talk a little bit about peppermint oil. Peppermint oil is used as a sensory and neurologic modulator. [00:07:14] So we don't use it a lot but it's sometimes discussed in libido conversation because it actually does increase sensory awareness. [00:07:22] So it increased the perception of enhanced blood flow and alertness. And it can be used in combined with some of these other vasodilator creams that will actually start for stimulation so doesn't raise hormones, not directly increases, doesn't increase desire, but it will increase sensation. [00:07:39] So we use it very diluted and I would say it's more of like a temporary or an add on to some of our herbs. One that I think got a lot of press relatively recently in the last year or so would be Tongkat Ali and where does this fit in? So, typically speaking, it was for male libido, virility, and I have more recently been using it for my women because it actually does reduce what we call binding globulin for testosterone. So it actually will increase some free testosterone in the body and actually will work on that hypothalamus axis, that HPA axis, again lowering cortisol. So again, it does a little bit of both. It'll decrease that cortisol, it'll free up some testosterone, and it does have data to support the dopamine, dopamine, that pleasure center, motivation center of the brain. So it actually makes more sense as like a stress hormone modulator than a direct hormone booster. But it works really well in combination with some of these other herbs to free up hormone, to get your body to actually lower some of that cortisol and stress response and get that libido stimulated. So tongadali, I would say it's dose dependent. Women need less than men. [00:08:52] Men, it does work really well if they have significant low testosterone to give a little bit of a bump to that testosterone level. Women, I would say not as much. So I actually stay at lower levels and I don't push the doses on the tangodale. All right, so this is kind of where most of us are familiar, the bread and butter of the hormones of libido. And I'm going to touch on these hormones and then I'm going to jump to some of the newer arousal peptides that are on the market and hormones that are on the market. [00:09:20] So I think first and foremost, we need to understand that estradiol, which is E2, which is the more traditional estrogen, really is what supports vaginal tissue health, blood flow and sensation. So when we start to put back estrogen, if we're not putting back E2 and someone complains of low libido, we're not going to get that enhanced sensation and the enhanced orgasm without testosterone and or estrogen. So especially in light of painful sex, painful intercourse and loss of sensation. So for this example, this patient, 52 years old, loss of most of her vaginal mucosa, painful intercourse, estradiol restored comfort and sensation. [00:10:05] Desire didn't always come back, which is a distinct difference, Right? So feels good, doesn't hurt anymore. But now we need to work on that brain component. [00:10:16] Okay, so we got good blood flow and sensation, and maybe we need to work on one of those other herbs or what we're going to talk about in a few minutes. And I want to point that out because we don't need to push the dose of estrogen in those cases. [00:10:28] And that's a key distinction. We don't want to over treat just to try to get libido back. Estradiol is going to enhance orgasm and sensation and decrease pain. Estriol helps with tissue as well, so vaginal tissue, but it doesn't have much of a systemic effect. So as far as like the other menopausal symptoms and even for some vaginal comfort, I do find that you really need a little bit of extra dial estradiol with it and then there's testosterone. So I mean testosterone is huge. We can talk about testosterone probably till we're blue in the face. With libido supports motivation, confidence, sexual thoughts. It actually will help with libido in I would say about 40% of patients in all honesty. So maybe a 5050 shot. Testosterone obviously does not work in everyone. So for example, we have a 48 year old female who had low desire. Testosterone helped with motivation but not orgasm. The connection was still missing. Okay, so that's when we knew that hormones were only part of her story. [00:11:35] Right. [00:11:36] So you know, I think that when we think about testosterone, we think about it's going to enhance sensitivity, it's going to enhance blood flow, it's going to enhance male and female penile erection and the clitoris taurus. It's going to enhance all of these things and it's going to give you that desire and kind of some of that brain help that you need. But it's only about a 50, 50 shot on that with most women. I will tell you. Right, so what else can we do besides put testosterone back? And this is really some of the conversation gets really good. [00:12:09] There's One thing called PT141 and PT141 is really interesting. So it's Bremelanotide and it's a peptide. It activates our melanocortin receptors which are in basically in our brain. And just think about them as stimulating desire. They work on men and women, they actually help with mood, they help with energy, they help with evening you out. Actually I've heard all of this, but primarily what you're doing is you're actually working centrally in the brain to stimulate the pleasure center. So you can use it in people that you can't use hormones on. You can use it in male prostate cancer patients, you can use it in women that don't, that can't or don't want to do hormones for some reason. And it doesn't increase estrogen, progesterone, or testosterone and it does not rely on any blood flow. So it's going to just restore that central sexual motivation and arousal signaling. Sometimes you still need to work on the estrogen and other things around it, but if we're just talking libido, PT141 does a really nice job and like I said, it, it does have some effect on that emotional connection. So what I do find is that people feel a little bit more stable, maybe a little bit more, even a little more loving. [00:13:24] That rewarded motivation center is definitely activated and you get that dopaminergic signaling that actually will help you to anticipate pleasure and motivate to engage more arousal. So again I, and I like, I say this a lot in some of my podcasts. It's kind of like that Pavlov's dog phenomenon where it's self fulfilling, but this actually helps to keep that going. Okay, so what I do want to say is that PT141 can come in a lot of different ways. And I actually did just do a couple of posts on this because it is now FDA approved for men. It does not obviously, like we said, directly improve erections, but it does enhance sexual performance and confidence and drive. So it is an injectable that does come also as a nasal spray. And I find that, like I said, it's not an antidepressant. But I do see secondary mood effects related to this motivational signaling. It will get. It can give some flushing reaction as well, just FYI, but and it can be taken about 15 to 30 minutes prior to intercourse. I do know people that will take this daily at lower doses, especially as a nasal spray or even they do make it as a lozenge or as well. There are a couple companies that do that. So injectable is the most studied and the most predictable. Typically like I said, on demand use nasal spray. Again, is a little bit more of a compounded product, but I do prefer it because they combine it with a lot of other products that we're going to talk about in a few minutes. Side effects, flushing, nausea, headache, some little bit of temporary blood pressure increases at low doses. I have not seen this too much. [00:15:05] It helps to go slow and start with lower doses. [00:15:09] And we don't like to do it with the alcohol because it will create kind of a flushing reaction as well and enhance that response. [00:15:17] So, you know, this is emerging. I find it to be extremely helpful. I feel like it's one that I've definitely become more of a proponent of prescribing this for and just a couple examples of patients that I've used this in. 41 year old female, where we had all her hormones optimized, including testosterone. [00:15:37] Still can't get that libido back. Low dose PT141 nasal spray, especially 15 to 30 minutes before sex. She described it as kind of like the signaling came back online, she was able to actually want to have sex. In another case, 55 year old male, post cardiac event. So a vascular patient, anxiety around intimacy, specifically PT141, helped restore the desire without affecting blood pressure, without creating vasodilation. Again, we're in a post cardiac patient and we can even obviously adjust hormones as well with this patient, which we did a little bit later on. [00:16:14] A great combo with this product is oxytocin. And oxytocin is done really well with PDE5 inhibitors. We're going to talk about both. PDE5 inhibitors are kind of your dilation, your Viagras of the world. We're going to talk about blood flow and oxytocin, how they can work with, with PT141. [00:16:33] So how does oxytocin work? Again, it goes back to that brain, the hypothalamus, the pituitary. It's a neuropeptide hormone. It's produced in the hypothalamus, it's released by the posterior pituitary and it acts as a neurotransmitter in the central part of the brain. Peripherally in the body, it actually acts as a hormone. So it's actually best understood as a social bonding and safety and parasympathetic activating signaler. So to shut down that overactive sympathetic response, it will help to balance that. So again, for that calming effect, that loving effect, that mood benefit, all right, that sexual desire and like kind of the arousal quality and receptiveness to arousal when, especially when desire already exists. [00:17:23] So PT141 and oxytocin as a combination are extremely synergistic and work very, very well together. [00:17:32] Again, most commonly dose is a nose spray. Every once in a while I can see it as I found it as a cream. But for us, nasal sprays tend to be the most efficient and effective. [00:17:41] And you know, I think what you need to realize is that it actually reduces that fight or flight response. So we're kind of going back to that cortisol overdrive we talked about in the beginning with these herbs and calming herbs. [00:17:55] So you can use the calming herbs in conjunction with the oxytocin, the PT141 to rest and connect instead of fight or flight. So it shifts away from a stress and a high anxiety ridden response to a healthy sexual response. [00:18:14] So I think if you think about how oxytocin works, it's actually naturally released during sexual arousal and at orgasm and physical touch and intimacy. So if that benefit can be given a little bit earlier, it's just going to perpetuate the act of wanting to have sex or the act of wanting to be aroused. You're actually enhancing smooth muscle contraction during orgasm, you're enhancing the intensity, you're improved post orgasmic bonding and satisfaction. So all of that goes into what oxytocin does for you. And in all honesty, I've had men respond just as well, if not better to oxytocin as women, and primarily with their mood and feeling a little bit more even and having a little bit more connectedness. [00:19:01] So estrogen, which we talked about a few minutes ago, increases oxytocin sensitivity, receptor sensitivity, which might explain why the effects are often stronger when you adequately replace the estrogen. So someone is, we're doing oxytocin and we can't do estrogen, that's one thing. But if we're doing it and we want to make sure that things are working on all cylinders and that they're working efficiently, putting back a little bit of estrogen to the tissues so that there's a stronger oxytocin receptor response will help with that one orgasmic response and to decrease the irritation as well. Right. Because you're getting back that you're eliminating the dryness. [00:19:42] So what is the science that supports putting all these together? Well, we kind of talked to some of this through already, but the whole goal is that we want to decrease cortisol, even out the stress response, we want to help with the parasympathetic response, we want to increase sensitivity locally. Right. We want to also increase the ability for the brain to take in and respond to this emotional or desire responses. [00:20:12] That's a lot. And that's without even talking about these blood vessel dilators. Right. Which is what's most commonly talked about with libido and sensation. [00:20:22] So for example, I would say probably about 90% of people, I can bring back some context of libido with just the products that we've discussed, some maca, maybe some ashwagandha and a PT141 and oxytocin nasal spray and maybe even a little bit of testosterone, depending if we're going to do hormone replacement or not. Okay. Obviously a post menopause a female, we want to at least talk about the estrogen and vaginal estrogen. But what if there is not good blood flow? What if we're older, we're hypertensive, we maybe have peripheral vascular disease. [00:21:00] That's where the tadalafil and the sildenafils come into play. And these actually enhance blood flow, they dilate and they give improved genital blood flow. And in these cases, I will keep these kind of on the back burner, if you will, for people that are really resistant or they can get libido back but not a strong orgasm because they can't get enough blood flow to the area or they can't do the hormones for some reason. [00:21:26] So I actually do find these to be extremely beneficial. They do make them as a topical as well. So they can be done topically, sometimes even with peppermint and other things for sensitivity, or obviously they can be taken as a capsule, which most of us are pretty familiar with for the erectile dysfunction states. Stereotypical 55 year old normal testosterone. Or maybe we already replaced it, still getting inconsistent erections. Using a low dose daily to dofil helped with erection and reliability and confidence. Right, that's kind of the stereotypical. But you can use it in women as well, especially with muted sensation. [00:22:02] All right. And I will say that it can be used topically, like I said, for muted sensation. They have creams and stuff to dilate the blood vessels to the area so that actually it's more sensitive and it doesn't have to be done just an oral. Okay, so another one. Let's talk a little bit about kisspeptin. Kisspeptin is emerging. It's a peptide. I do, I would say a mild amount of kisspeptin. I would like to do more kisspeptin, but human studies have shown that it sits upstream of estrogen testosterone. Okay. So it increases sexual desire, it increased the limbic system activation, and it doesn't have a major hormone effect. [00:22:47] So this is still kind of, I would say probably experimental. I mean, obviously all peptides are experimental, but a number of patients have described this as increasing attraction and desire. But I would say kisspeptin is, I don't use quite as much of this as I do the oxytocin, the PT141, but it can be used as a stack. So this can be used as part of the same peptide stack for arousal as the others. [00:23:15] And then one of the last things I want to talk about is something that's known as Trimix in the Industry. But I think, you know, what I want to really bring to light here is that you can use some Trimix type of creams or gels that actually are also vasodilators. They will bring blood flow to the area. [00:23:39] And these can be used for men or women. [00:23:43] They are, I would say they could be used for pain. I've seen it for pain syndromes as well. And what we're really looking at is ingredients that, like I said, dilate, so alprostadil, papaverine or other vasodilators and they put them into combination, especially when you fail tadalafil or sildenafil. Okay. So. And there are people that fail those products and they just, they regardless or they can't use those products. [00:24:13] So it requires a little bit of education, a little bit of technique because it doesn't address really the libido or desire piece. But if it's used about 15 to 20 minutes prior to intercourse, it is effective for creating an orgasmic response. [00:24:28] So we see this for primarily, like I said, resistant to PDE5. So if they're just not working for you, post prostate erectile dysfunction, severe vascular or neurogenic erectile dysfunction, diabetes related complications, like I said, it's not a first line drug for me. But in someone that really cannot gain sensitivity, it is definitely an option for us. I would say mostly in people that are. [00:24:57] That other dilators are not working is how I would use this Trimix itself, like I said, as a triple property. It will not increase desire. But that's why I like to combine these things. This is, it's a, it's part of a layered body of sexual health strategies. Right. It's not a standalone solution, but that particular product I feel like is almost like a last resort product. [00:25:22] So when you're thinking about, you know, what to do on someone that really you can't use anything on or nothing is working just to get the orgasmic response. That would be where I would go. And there are a lot of compounded companies that do variations of those. A lot of different trios, like I said, that are very, very effective. [00:25:41] So just some final thoughts on libido. And again, so just not a frank conversation. I want to make sure that this becomes the forefront of one, aging, because we should be discussing this. Successful aging should be healthy sexual aging. And two, libido is not broken, it's regulated. Herbals help when stress is the driver. Hormones can help when tissue and baseline signaling or deficient peptides can help when the brain and nervous system are blocked. So the key to treating libido is layering and not jumping on the strongest tool first, I. E. Some of these vasodilators. Right. I think it's important to understand that this is so multifactorial and you really need to look at the whole picture in order to understand and actually discuss it. It's one thing to just say, yes, we have sex. It's another thing to have desire. And then it's another thing to say it feels good. And that the. Obviously the tissues are intact and everything else and that. That you want it again. So again, repetitive action. [00:26:44] So, you know, I really do believe that the story and the conversation is almost as important as the treatment. [00:26:51] So again, I'm just to recap, we had some herbals like maca, ashwagandha, Tonga dali. We had PT141, oxytocin, two of my favorites, kisspeptin, as an outlier that might actually be in the forefront of many treatment protocols moving forward. And obviously some of the, what I would say more traditional erectile dysfunction drugs, your vasodilators, and obviously they're still in the armament of options, but they tend to be a little bit more difficult to use. And we know that they actually can't be used in everyone as well. So I think oxytocin and PT141 are far underutilized. And then last but not least, some of these, what I would consider trimixes, which are a little bit of the alternative vasodilators for people that just were the other dilators that are not working. The sildenafils of the world are just not functioning cell. I can never say this one. All prostate, papaverine, other vasodilators that might be compounded together to create local blood flow. We're all trying to create localized enhanced blood flow to the area. [00:27:58] So if you're wondering what layer applies to you, where to start, how to open this conversation? We open this conversation all the time in our practice. I would love for you to visit mydrlori.com all you have to do is click that. Get started now. Fill out your personalized intake or we will discuss it as part of your plan. And if it's top priority for you, and that is top priority for us. So we think that this is an important part of aging your way. And many women and men, that is one of the first things they say to us when they come into our practice is we need help getting on the same page. And that's what we're here for. So make it topic of conversation with your primary make it a topic of conversation with us and let us get you the help that you need to age successfully. And for me, and for a lot of you, lifeevity is about a healthy sexual relationship and it should be addressed mentally, physically, inflammatory, vascularly in all the ways. [00:28:51] So don't forget to subscribe guys, to Anti Aging Unraveled, where as always, we separate hype from physiology and help you define aging naturally and aging your way. And until the next episode, I would love to have you guys keep sharing and commenting for anyone that you think might enjoy this and I'll see you soon. [00:29:11] Thanks for joining me on this episode of Anti Aging Unraveled, where longevity is personal and you're empowered to age your way. If you found today's episode helpful, be sure to subscribe to the podcast or our YouTube channel, Anti AgingUnraveled. And of course, follow us on Social for more tools, insights and conversations rooted in lifeevity philosophy, living life the way you want to take your next step, visit mydrlori.com, click get started now and fill out your wellness or weight loss intake to begin your personalized longevity journey. Until next time, keep living with intention, vitality and purpose. Here's to longevity, lifeevity and aging your way.