A Guide to Maintaining a Healthy Sex Drive

Everyone ready for the holiday weekend yet? It’s a good time, I think, to cover a relaxing, if not inspiring, topic I’ve been meaning to get to. In all seriousness, I get a couple emails every week from folks who are wondering about their waxing or waning sexual drive and how it relates to their lifestyle. Some are folks celebrating the return of their mojo after losing weight and and gaining energy on the Primal Blueprint. Others are from readers concerned about their partners’ unhealthy habits and what they see as the coital repercussions. Still more are from folks transitioning to Primal living and going through a period of energy “adjustment” as they find the right balance in their workout regimens, calorie intakes, and overall lifestyle picture. In all, the questions revolve around a central point: what lifestyle measures support optimum sexual drive?

Truth be told, modern life isn’t friendly to the human libido. Contemporary challenges to a healthy sex drive are many: obesity, diabetes, high blood pressure, thyroid dysfunction, adrenal exhaustion, poor nutrition, prescription medications, hormonal birth control, too much stress, and too little sleep. You’re undoubtedly getting the picture. It’s a somewhat cruel irony, too. On the one hand, we’re increasingly living with these impediments, but on the other hand we’re bombarded with the marketing messages and cultural fallout of the Viagra age: we should all be happy, randy people up for an erotic rendezvous at all and any given moment. It’s simply a matter of will – and a pill if you need it.

Let’s put this aside for a few minutes – all the cultural hype and pseudo-medical baggage. Instead, let’s gather around the metaphorical fire circle and reclaim evolutionary reality. In other words, let’s get back to the fundamentals. What makes for a healthy sex drive? What are the real biological facts when it comes to the human libido? What health related choices can cultivate sexual verve and vitality over a lifetime?

Sex drive, as it were, involves a constellation of complex hormonal and psychological factors that are influenced by everything from health to lifestyle, personality to relationship status, gender to genetics. It’s a tricky, shifting, sticky wicket at times. It’s personal, emotional, nuanced, but there are some things we know.

Sex hormones, not surprisingly, play the central role in libido as well as fertility. For women, estrogen and testosterone both appear to positively impact sex drive. A pre-menopausal woman’s libido, for instance, is influenced by changing hormonal levels throughout her menstrual cycle, rising during the first half of the cycle to then peak at ovulation, the pinnacle of a woman’s fertility. In clinical research studies, women responded more to sexual stimuli and reported more subsequent interest in sexual activity when they first viewed said stimuli during times of peak endogenous estrogen levels.

In men, testosterone likewise holds a positive sway over sexual drive. Men with clinically defined low libido are often diagnosed with low testosterone, and men more than women respond better and more safely to testosterone supplementation. Metabolic syndrome, diabetes, and obesity also can contribute to low testosterone by impairing production of testosterone. Estrogen also figures into the hormonal equation for men although in a more inverse relationship. (Yup, guys have it, too.) If estrogen levels creep up too high in relation to testosterone, you might as well call it a night.

Likewise, prolactin tends to decrease libido in both sexes. Prolactin levels rise throughout pregnancy and remain elevated during breastfeeding. In both sexes, low thyroid function causes the pituitary gland to increase the release of both thyroid-stimulating hormone and prolactin. Anti-depressant and anti-psychotic medications are known to increase prolactin release as well.

The steroid hormone DHEA also figures into the libido picture for both men and women. DHEA is converted by the body into sex hormones, particularly testosterone and estrogen. Some research points to the importance of DHEA more than testosterone in pre-menopausal women’s experience of low libido.

Of course, there’s much more to libido than the physical. We’ve all heard the adage, “the biggest erogenous zone is the brain.” Although I’ll leave most of that part to other, better suited blogs (sorry), let’s roll up our sleeves now and look at some simple, entirely do-able practices for cultivating a healthy drive.


First, let’s talk about the supposed aphrodisiacs – those edibles credited with mysterious, erotic powers… I hate to disappoint, but any impact on one’s sexual feeling is probably more the placebo of ambiance and expectation than anything. (But if that works for you, by all means go for it.)

There are points of intersection between diet and drive, however. In some cases, they even suggest some sense behind a few of the aphrodisiac associations. Certain nutrients are key to the production of sex hormones. Zinc, for example, appears to play a role in testosterone production. Oysters are – guess what – chock full of zinc. (Ain’t that a kick in the head?) Nevertheless, a single serving an hour before the big event isn’t going to make any discernible difference. A well-garnished oyster platter might look appealing and exotic, but a diet with consistently ample zinc and other minerals is the real ticket.

Other foods contain nutrients and compounds that promote various elements of successful sexual functioning – like good circulation, hormonal balance, nerve ending sensitivity, and even emotional well-being. (We all know why those are important, yes?) Fish and nuts offer a healthy dose of fatty acids, which foster hormonal balance and help thin the blood. Much has been made of chocolate’s phenylethylamine compound that triggers the brain’s release of dopamine. Likewise, hot peppers’ capsaicin burns so good because it prompts the body to release natural endorphin pain killers. The list goes on. Amino acids like L-arginine (in shellfish and figs) figure into the production of sex hormones. B-vitamins counteract stress. (More on stress in a minute…)

Despite all the focus on these few nutrient “stars,” your best bet is – you guessed it – a nutrient dense diet high in antioxidants and minerals, generous in both essential fatty acids and (gasp!) healthy, clean saturated fat. The fact is, fats are critical for regulating the body’s production of sex hormones. It’s why fertility is enhanced by full-fat dairy, for example. Yet another reason to love fat…as if you needed one.


This should be obvious to everyone by now, but exercise is about the smartest thing you can do for your libido. There’s the boost to physical self-confidence (i.e. LGN – looking good naked) and the impressive increase in overall energy and stamina. But, of course, there’s more.

Let’s see here. There’s the pleasurable surge in endorphins, which research suggests leaves us happily in the mood. Then there’s the increased blood flow and the hormonal effects. How about lower stress hormones and a healthy boost in testosterone? Good, hearty resistance training is the the ticket here.

On the other hand, there’s the flipside of too much exercise – and the resulting physical exhaustion and hormonal alterations that can accompany it. Women who regularly work out to the point of exhaustion frequently experience adrenal fatigue and even infertility as a result of drastic hormonal changes. In men, the effects of exhaustion exercise can include “reduced resting levels of testosterone, altered pituitary release of luteinizing hormone and prolactin, and altered sperm characteristics.” (Not sexy.) It goes to show that you can have too much of a good thing – at least when it comes to working out.


There’s the short-term distraction of stress – the incessant bad mood, the nagging thoughts and reminders during what should be intimate, focused moments. Then there’s the longer term physical toll. As I say again and again, stress sets in motion a whole cascade of negative hormonal challenges. An unwarranted rise in adrenal corticosteriods is enough to diminish sex drive. One study, for example, demonstrates the, uh, undesirable impact of cortisol levels on arousal and erection.

Over time, chronic stress can leave us with little physical energy and even adrenal exhaustion. The losers here are the sex hormones. Researchers at Berkeley University have found that long-term stress and the corresponding surge of glucocorticoids suppresses not only the production of key reproductive hormones like GnRH but increases GnIH, which acts to further squash the production of aforementioned GnRH and the resulting sex hormone products, testosterone and estradiol. In other words, stress effectively throws a major wrench in the whole reproductive system – from start to finish.


Hormonal contraception alters the biochemical landscape to fool the body into thinking its pregnant, but it can also put a damper on libido. Because the Pill generally prevents ovulation, women on the Pill generally forgo the hormonal experience surrounding ovulation – an experience which usually includes a midcycle surge in sex drive. The surge can be subtle or dramatic depending on the individual woman, but the evolutionary sense is obvious: a female should want to have sex when she’s most fertile.

Other medications that can put the kibosh on your sex drive include most anti-depressant and anti-anxiety meds, high blood pressure medication, anti-psychotic prescriptions, and some stomach acid and ulcer meds. I’m not saying people shouldn’t take their prescribed medication or use a high efficacy form of contraception in order to enhance their sex drive. Knowledge is power. If you think your medication might be lowering your libido, you have the choice to talk to your doctor about alternative versions of your medications – or if healthy lifestyle changes can make enough impact on your condition that a dose reduction might be possible.


Finally, let’s talk age. What people in our culture too often assume is a dramatic, age-induced downward spiral is instead usually a health or medication related issue, a relationship strain, a crisis of self-confidence, or just an excuse to give up. As we all know, a lot more goes into a healthy, satisfying sex life than hormones.

Although our hormones will gradually, naturally shift with age, our sexual drive is like every other aspect of our physical selves: its function depends largely on our own efforts – and attitudes – throughout life. Research has demonstrated, for instance, that social and psychological factors are more influential in sexual satisfaction/dissatisfaction after menopause than biological causes. In fact, researchers have shown that post-menopausal women respond as strongly to sexual desire “cues” (“erotic/explicit cues”, “visual/proximity cues”, and “implicit/romantic cues”) as pre-menopausal women and even more strongly in the final fourth area of “love/emotional cues.” With changing social attitudes toward sex throughout one’s lifetime, surveyed men and women are reporting more frequent sex and more satisfaction with their sexual lives. How’s that for progress?

If you or your significant other has an ongoing, unexplained, precipitous decline in drive, I’d suggest two things. First, do an emotional and physical inventory. Are you over-doing (or under-doing) on the exercise? Are you eating poorly, getting too few calories, or not getting enough sleep? Are you under more stress or going through your own kind of personal funk? Has your confidence (physical or otherwise) been waning for some reason?

Does your relationship need some work, some space, or a romantic reboot? There’s some research behind the importance of fantasy and imagination in sexual desire. Although that’s probably subject for another blog than this, let’s just say that stagnancy never did anyone any favors. As one study shows, even a simple placebo and the associated belief that subjects were receiving “help” for their lack of desire was enough to boost many subjects’ sexual satisfaction and likely their attitude toward and communication with their partners.

If everything here seems in order, check in with your doctor and be vigilant about your interests. Ask for tests rather than a prescription. For men, this can entail testosterone, DHEA, other androgens, thyroid function (full panel), glucose/A1C1, and blood pressure. (Your doctor might order more knowing your particular medical history or any additional symptoms.) For women, all the above would be relevant as well as estrogen, progesterone, and adrenal function. (The adrenal tests might be appropriate for men as well, but problems are more common in women.) Work with your doctor and ask plenty of questions with the interpretation of the results, and don’t ever, ever hesitate to get a second (or third) opinion.

Folks, thanks for reading today. Share your own insights into maintaining – or recovering – a healthy sex drive. Have a great week, everyone!

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending more than three decades educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates flavorful and delicious kitchen staples crafted with premium ingredients like avocado oil. With over 70 condiments, sauces, oils, and dressings in their lineup, Primal Kitchen makes it easy to prep mouthwatering meals that fit into your lifestyle.

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