Question: Since having Cushing’s, my sex drive is next to nothing. Is this common, will this problem remain forever or get better? Is there anything that can help?

Answer: A decrease in libido or sex drive is common in patients with Cushing’s. Several factors influence a person’s sex drive. In women, regular menstrual periods or adequate estrogen and progesterone replacement is important. In men, if the testosterone level is low, this indicates the need for testosterone replacement. In pituitary dependent Cushing’s, once the normal pituitary gland has recovered, the adrenal glands should be producing an adequate amount of both cortisol and male hormones (important in women for sex drive). If a woman has had 1 adrenal gland removed, the other adrenal should make an adequate amount of male hormones once the entire pituitary adrenal axis has recovered (this may take several months as well). In the situation of bilateral adrenalectomy, there is loss of adrenal male hormone production. If the ovaries are functioning normally, male hormones are also produced and this should provide an adequate amount for normal libido. If a woman does not have normal menstrual function and requires estrogen and progesterone replacement, sometimes a small dose of testosterone is added to improve libido. A common preparation is Estratest.

By Dr. Mary Lee Vance MD, Professor of Medicine and Neurosurgery, University of Virginia, Spring, 2017