Sexual Health and Hormones: A Clinical Overview

Sexual dysfunction is common and often multifactorial. Hormonal changes can contribute, but so can cardiovascular disease, diabetes, medications, mental health, relationship factors, and sleep. A structured evaluation helps providers identify the most appropriate treatment.

Comprehensive Evaluation

• Sexual, medical, and medication history, including antidepressants, antihypertensives, and opioids
• Screening for depression, anxiety, and relationship or psychosocial stressors
• Assessment of cardiovascular risk and metabolic status, since erectile dysfunction can be an early marker of vascular disease
• Physical examination and laboratory testing guided by the presentation

Hormonal Contributors

In Women:

• Genitourinary syndrome of menopause, including vaginal dryness and dyspareunia, which may respond to local estrogen or other therapies
• Hypoactive sexual desire disorder, which requires careful diagnosis and consideration of FDA-approved options
• Systemic menopausal hormone therapy for appropriate candidates with bothersome menopausal symptoms

In Men:

• Testosterone deficiency, diagnosed only with consistent symptoms and confirmed low serum testosterone
• Thyroid disorders and hyperprolactinemia as other endocrine causes
• Phosphodiesterase-5 inhibitors and other therapies for erectile dysfunction, in addition to or instead of testosterone therapy as appropriate

Treatment Principles

• Address modifiable factors first or in parallel: weight, activity, sleep, alcohol, tobacco, and medication effects
• Use hormone therapy only when a clinical indication is established
• Discuss expected benefits and limits of evidence; hormone therapy does not improve sexual function in all patients
• Monitor response and safety, and reassess regularly

Provider Support

Providers who offer hormone therapy can work with Purepell through Halo Health Advisors. All evaluation and prescribing decisions remain with the licensed provider.