Q&A 1: "What's Up With My Sex Drive?"

Let's talk sex drive, period loss at a 'healthy weight', Atypical Anorexia, metabolism with ageing, and more.

Welcome to the Let’s Recover bi-weekly (or tri-weekly, or monthly, we’ll see) Q&A! This is offered as a ‘thank you’ to subscribers who supports my work with a paid subscription (my senior dog’s medical bills are building up and my student debt is 6 figures, so it’s much needed). For paid subscribers, I have a Q&A thread in the inbox for submission - you also get access to a library of bonus podcast episodes. Please note that this Q&A (and my Substack and podcast) is not intended as medical advice nor does it replace medical treatment for an eating disorder! Instead, it is meant as a psycho-educative tool and supplement to learn more. I’ve added a preview for free subscribers too (I appreciate you guys as well!). If you want to upgrade, it is 5$ per month and you can cancel anytime + I offer a free trial if you’re not sure it’s your jam.

So let’s get started👇

(Mandatory suggestive imagery for the topic at hand)

Q: “Is there a connection between amenorrhoea and a total lack of sexual interest (even if at a ‘healthy weight’)?” & “(As a male) when could I expect my libido being back?”
A: There is! In the context of eating disorders, hypothalamic amenorrhea aka HA (lack of menstrual periods due to an energetic deficit) and low libido (low sexual desire) are actually rooted in the same thing: hormonal suppression. Due to the constant energetic deficit, the body detects that resources are scarce (‘famine mode’), thus now is not a safe time and place to reproduce. As a result, hormones (and sex drive) take a hit. It makes perfect sense from an evolutionary point of view, and it is actually a protective mechanism.

In people assigned female at birth (AFAB) this often means a drop in hormones such as oestrogen, often accompanied by a low LH to FSH ratio alongside polycystic ovaries (this is NOT the same as Polycystic Ovary Syndrome (PCOS) - unfortunately HA and PCOS are often mixed up by treatment professionals who lack competence in the hormonal impact of eating disorders). This can cause absent or irregular periods, fertility problems and lack of sex drive, alongside significant bone loss.

Not every person assigned female at birth will lose their period, and sometimes periods come back prematurely in recovery. This does not automatically mean that that they are now ‘fine’ or weight restored. It just means that different bodies prioritise differently, similar to how hair loss is common in eating disorders yet there’s always going to be that one person who is deathly ill yet has thick, or how digestive problems are common yet there’s always going to be that one person who has healthy regular bowel movements. More on periods in this podcast episode.

In people assigned male at birth (AMAB), who do not menstruate, an eating disorder still causes significant hormonal impact. Testosterone will tend to drop, which can cause low libido and erectile dysfunction. Just because you do not menstruate, does not mean your bones are ‘safe’ from an eating disorder. Low bone density, alongside hormonal/sexual problems, is seen in both males and females.

(Transgender individuals who are undergoing hormonal replacement therapy (HRT) will have some unique challenges reg. bone health and sex drive that are a bit outside of my scope. It is important to discuss with your medical team, and to take the eating disorder an its physical complications into consideration.)

Being at a clinically ‘healthy’ weight does not really matter if that weight is not A: healthy for your body, and B: has a sufficient amount of body fat (males and females alike need body fat!). Someone can have a ‘healthy’ weight yet have a low body fat percentage causing issues (reason 1000 why ‘weight criteria’ for eating disorders are BS, and why target weights must be seen in a bigger context). Set point refers not just to an arbitrary number, but more so what your body’s preferred body fat range is. This is also why ‘recovering through only gaining muscle’ is counterproductive. Until your body detects that it has enough body fat and energy coming in (without this being burned off through excessive movement), you’ll probably continue to have issues.