Metabolic health is sexy. Not just because it’s endlessly fascinating and getting a lot of (well-deserved) attention right now, but because it literally determines how people function and feel before and during sex—and even how a person feels about sex.
Why does this matter? About 40 percent of women of reproductive age globally experience some type of sexual dysfunction, with desire or orgasm. The prevalence increases to as much as 85 percent for those who’ve reached menopause. More than half (52 percent) of men over 40 also have concerns, often with erectile dysfunction (ED). But ED also affects up to a quarter of guys under 40.
Researchers argue that sexual well-being is key to overall health. But our sexual health also has ramifications for fertility. (Spoiler alert: next month’s newsletter is about metabolic health and fertility.)
What’s the metabolic connection? The way the body produces and manages energy (aka, our metabolism) impacts blood flow (key to an erection and clitoral and vaginal arousal), sex hormone levels (like testosterone and estrogen), and our psychology (mood, motivation, and reward), all of which impact sexual function and the experience of sex. So if you happen to care about sex, sexual pleasure, or fertility … it’s time to learn about metabolism.
88% of American adults are metabolically dysfunctional, meaning that our diets, lifestyles, and exposures lead our cells to struggle with the basic process of making energy from food to power our bodies and minds. And what goes largely unrecognized is that this rampant metabolic dysfunction affects our ability to become aroused, experience an orgasm, and make a baby. And it makes sense—when the body’s core physiology is hijacked by the constellation of factors that lead to metabolic dysfunction (e.g., micronutrient depleted ultra-processed diets, inadequate sleep, sedentary behavior, chronic low-grade stress and unprocessed trauma, microbiome issues, lack of adequate sunlight exposure, and environmental toxin overload), it feeds into widespread problems in all parts of the body.
Here are three main ways metabolic health can impact sexual function.
1. Blood Flow
High blood sugar and insulin resistance can significantly contribute to sex hormone imbalances in both men and women, and insulin has a direct effect on many of the enzymes involved in the production and conversion of sex hormones in the body, as well as impacting the levels of sex hormone-binding globulin, which transports sex hormones in the bloodstream.
Both testosterone and estrogen decrease for women after menopause, compounding issues with sexual function. For men, sex hormones also naturally decline with age and appear to be falling more rapidly over the past several decades than historically expected, possibly due to environmental factors like increased toxin exposure, as well as excess fat tissue. “Fat tissue in men is uniquely capable of behaving like ovaries, turning testosterone into estrogens,” notes Levels advisor Dr. Ben Bikman, author of Why We Get Sick. For all genders, low testosterone levels are associated with lower libido. In men, weight loss, resistance and aerobic exercise, and optimal sleep and stress management have been show to positively impact testosterone levels.
Levels advisor Dr. Sara Gottfried notes: “The American College of Physicians (ACP) defines low testosterone as <320 ng/dL combined with signs and symptoms, including sexual dysfunction, decreases in energy and muscle mass, mood disturbances, changes in bone mineral density, cardiovascular disease, and loss of body hair. While there is still debate about the appropriate cut-off, serum levels of 200-400 ng/dL are considered borderline. The ACP and the American Urological Association recommend that clinicians inform testosterone-deficient patients that it is an independent risk factor for cardiovascular disease. Treatment can improve measures of diabetes, energy, fatigue, lipid profiles, and quality of life.” Simply put, low testosterone appears to be closely related to cardiometabolic disease and insulin resistance, and these processes also feed back into further disrupting testosterone.
Indeed, insulin resistance impacts sex hormones by disrupting the hypothalamic-pituitary-gonadal (HPG) axis. More research is needed on the exact mechanisms, but higher levels of leptin and proinflammatory cytokines are likely culprits. The hypothalamus produces and secretes gonadotropin-releasing hormone (GnRH). GnRH then stimulates the pituitary gland to produce and secrete luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In men, LH activates testosterone production in the testicles. In women, FSH stimulates aromatization of androgens in the ovaries’ theca cells to produce estradiol (a type of estrogen). If the HPA axis is disturbed by insulin resistance, it can throw everything off.
Hormones are complex, but one crucial point to remember: hormone balance is a function of many different systems of the body working in concert, and much of what keeps the hormone symphony in harmony are similar to factors that lead to metabolic health. Hormone health—and specific sex hormone balance—involves:
At all levels, insulin sensitivity helps with the proper functioning of these processes in the hormone’s life cycle. For instance, to have optimally balanced estrogen levels, estrogen must be routinely metabolized by the liver (via two phases of hormone detoxification) and then excreted in the stool. Therefore, diet and lifestyle habits that support liver health and optimal gut and bowel function are critical for estrogen balance and essential for optimal metabolic health.
What helps with both hormone balance and insulin sensitivity? Nutrient-dense whole foods (to support enzymatic processes, hormone synthesis, cell membrane integrity, and endothelial function); fiber and probiotic foods to support gut function; optimal liver functioning (meaning avoid fatty liver disease, of which fructose and alcohol consumption is a major culprit); and avoidance of environmental toxins that disrupt both hormone activity and metabolism.
3. Mood and Motivation
Hormones and metabolism can also impact our mood and energy, changing our fundamental desire to engage in sexual activity.
The Bottom Line
Our metabolic health has massive implications for our sexual health. High blood sugar and insulin resistance can contribute to sexual dysfunction, disinterest, or a lack of enjoyment, yet few doctors will clue you into this link. Yet, sexual health is a crucial component of overall health and well-being.
You can gain a snapshot of your metabolic health status by looking at your metabolic blood tests. We have a guide to interpreting your cholesterol panel and one on understanding glucose levels that will help.
These tests will also be informative if you are concerned about fertility. Keep an eye out for my next newsletter, which tackles the important topic of how fertility intersects with metabolic health.
3 Ways metabolic health affects sexual function
Poor metabolic health can impact several aspects of sexual function, from arousal to erection.