A Pill for Libido. Really?

As an internist who sees hundreds of women in the second half of life, I am all too familiar with women’s waning libidos.  Having gone through menopause myself, I have personally experienced the power that changing hormones have on many psychological and bodily functions that the younger me took for granted.  As an integrative physician, I am always searching for causes of symptoms and for natural and integrative ways to treat and heal them.  Our society sees a waning libido as a pathological symptom.  Viewing our aging bodies as pathological is where our problem truly lies.

Our collective maturity level in America can truly be seen as ‘adolescent’.  We are a society with many compulsions.  We seek fast ways to manipulate the body, to manage symptoms, and to regain youth. We want pills as substitutes for inner work, diets for rapid weight loss, and shots to stop menstruation considered inconvenient by many.  We are addicted to an ideology that has proven not to work over the past three decades.  Somehow, we are unable to make the shift to a more mature way of thinking.  Industries that support these compulsions make a lot of money.  The money itself becomes an incentive to keep the compulsions in place.

We have promoted the ‘anti-aging’ ideology for nearly 3 decades. We have yet to find a way to turn back the clock.  We are fearful of aging because we lack respect for process, and have not created a way to mark and consecrate our life stages from a place of reverence. Our society normalizes this. Mother Nature, in all of Her wisdom, marches on in time.  It is about time we find a way to gracefully honor the rhythms of the natural order of life and learn how not to resist aging due to our adolescent fear.

A woman’s libido has many facets that influence it – hormonal, psychological, emotional, and spiritual. Hormones have powerful effects on the biological nature of sexual desire.  When we are young and fertile, our hormone surges are aligned with the zeal to procreate.  In other words, the desire for sex is aligned with Nature. This is a powerful force that underlies our libidos when we are young.  As we age our hormones change, and we are less able to procreate - and Nature is less supportive of our libidos.  Women in their mid-40s complain about their waning libido, their changing body, and mostly their newly discovered need for balance.  They feel depleted after half a life of caring for others.  Energetic depletion, alongside changing biology creates less desire for sex. There is a greater desire for more intimacy, spiritual and emotional fulfillment, and the restoration of balance in both a woman’s body and life.

By our 50’s, most of us have experienced enough pain and difficulties to last us a lifetime.  These experiences are meant to serve as catalysts for inner growth and self-discovery. In midlife we must move out of the compulsion to ‘please the world’ and into an inner place of authentic connection.  We must learn how to be true to ourselves.  For us to find meaning and not feel victimized by our past requires hard work and a desire to seek.  The process of seeking itself deepens our ability to be intimate and fulfilled. In my medical practice, I find that women, who are committed to ‘seeking’ as they age, feel more fulfilled with intimacy, rather than the sex act alone. They are able to more readily accept their changing bodies. Sexual pleasure to them feels different, in some ways more fulfilling, even though their libidos may not be as heightened as in youth. The irony is that they are the ones who feel more sexual fulfillment than those who continue on the treadmill defined by the collective, with expectations of eternal youth.

Because our society has glorified youth and the sex act in favor of aging and intimacy, as we age, society expects us to perform both physically and sexually similar to when we were young, but with limited success.  Our aging bodies have different needs: the need for a pure diet, exercise, work/life balance, attention to inner process, and - one that we have not yet normalized in our society - a search for meaning. The spiritual aspects of ourselves call to us more powerfully and with greater zeal as we age.  Our physical bodies also require more attention.  Continuing the unhealthy diet of our younger years, does not nourish our changing bodies, and many of the lifestyle choices that have gained traction do not support our emotional or physical bodies.  This level of self-awareness needs to be paramount as we age if we desire to achieve a state of true health, which should no longer be defined by a ‘hard body’ or a ‘boundless sex life’.

For men, Viagra and Cialis do not fulfill these needs.  The ability to hold an erection for a longer time is not an adequate substitute for health, meaning, or intimacy.

Our society is struggling with the choices it has collectively made.  Frankly, our collective ideology is in contrast to the laws of Nature.  In other words, it goes against the laws of Nature.  Due to the decades of traction behind our unnatural ways of life, we continue to pump out pills as substitutes for what is missing at deeper levels of our being. The woman’s libido pill Addyi will not be able to offer what women consider as sexual fulfillment – namely:  intimacy, meaning, and a renewed relationship with themselves and their partners. The risk of life-threatening side effects alone is not worth taking a libido pill.

As we age and seek deeper levels of meaning, biology (not surprisingly) follows suit.  Not necessarily with the same intensity as it did during youth, but our aging physical bodies respond to emotional and spiritual depth differently than when we were young.  The zeal to live from depth is what Nature supports as we age, in favor of the zeal to procreate as in youth.

At this time we do not need yet another pill with more side effect casualties left at the altar of our flawed ideology.  We need to reframe our collective consciousness and normalize the necessity for healthy aging as defined by physical, emotional, and spiritual health.  This is a much more powerful way for us to live and will go much further in our level of fulfillment, both sexually and spiritually, than any pill can ever offer.

Why Are We Depressed?

• An 80 year old woman who just lost her husband to cancer

• A 55 year old man who just lost his job

• A 22 year old who just broke up with his girlfriend

• A 70 year old woman whose dog just died

• A 42 year old in the midst of a divorce

• A 51 year old man 2 weeks after his heart attack

• A 45 year old woman whose hormones are out of balance

In all of these examples, grief or depression would be a normal and healthy result of these losses. Would any of these examples fit the criteria of mental illness, requiring medication, or would their grief and sadness be seen as a normal response to what they had just experienced?

A few days after 9/11/2001, many patients came to see me when they realized they did not feel the emotions others did upon witnessing the devastation surrounding the Twin Towers. They felt numb from being medicated with anti-depressants previously prescribed by their physicians for circumstantial grief and depression that surfaced years ago after experiencing similar life events as those described in the list above. Although the situation that catalyzed their feelings had long passed, they had not received any support or help to process their emotions at that time, nor was it suggested that they wean off their anti-depressants. Their response to the 9/11 devastation made them realize they had unknowingly been emotionally numb for years due to the anti-depressants they were still taking.

This was a powerful sign for me to evaluate how we diagnose and treat depression. I also became acutely aware of the surprising amount of complacency that is normalized in the medical system when prescribing pharmaceuticals for symptoms of depression, anxiety, grief, or sadness. In fact, grief and sadness have been so pathologized in our society that people feel the need for medication if they experience either emotion. For many, feeling numb is preferred over experiencing intense emotions, which are actually a normal part of being human.

Our mental and emotional well-being is intrinsically related to how isolated and alone we feel during times of loss and transition, and whether or not we are a part of a larger community. People who feel their lives do not matter, are more vulnerable to depression and anxiety. People who are emotionally sensitive are vulnerable as well. Never before in the history of the human race have people felt so alone and isolated as they do today. Our connection with one another has been contaminated with technology and the mechanization of our systems. Before cell phones and computers were the norm, we actually spoke with one another. This has been replaced with texting and emailing, a method of communication that lacks heart or emotion. We have sacrificed our emotional and energetic connections with one another for convenience. Feelings of isolation, loneliness, and grief are the consequence of these choices.

When feelings of isolation, loneliness, or sadness arise, neurotransmitter levels (that regulate our moods) fall. Some important ones are serotonin, gamma-amino-butyric acid, L-Dopa, acetylcholine, and norepinephrine. Neurotransmitter levels are also directly affected by diet and exercise, our perceptions, and attitudes. It has also been well established that one of the most effective anti-depressants is regular exercise, as it affects neurotransmitter levels that regulate our mood. These levels are also affected by a sense of belonging. In fact, several studies have shown that women with breast cancer who were part of a support group lived twice as long as women who were not.

A diet high in Omega-3 and antioxidants and low in sugar and grains supports our nervous system and neurotransmitter levels. A diet high in refined sugar, processed food products, carbohydrates, chemical additives, and food colorings has a negative effect on neurotransmitter levels. When people use addictive substances such as recreational drugs and alcohol to ‘medicate’ their feelings, these can amplify depression and cause a rollercoaster of emotions. Unfortunately, this form of self-medication is normalized and present in epidemic proportions in our society today. In fact, it is a part of how we mark ‘the coming of age’ in our society.

An additional cause for mood disturbances is hormonal shifts in midlife. Between their late thirties and fifties, women experience a drop in levels of the hormone, progesterone, which causes their neurotransmitter levels to decline, intensifying feelings, and amplifying depression and anxiety. Both diet and exercise support the nervous system, as previously mentioned and, along with natural hormone balancing, are extremely effective in healing these symptoms.

Synthetic hormones, both prescribed and those present in non-organic food have the opposite effect, causing serotonin levels to fall, making everyone more vulnerable to depression and anxiety. A lack of sleep can also have this effect on mood and emotional health. Diet, exercise, and hormone balance are highly effective and restorative for sleep disturbance as well.

Processing our emotions and supporting each other during life’s transitions and losses (in addition to a healthy lifestyle) are the most powerful antidotes for depression and anxiety. Compensating for and normalizing our mood to appear unwavering (as expected by society) results in the denial of our very human experience of joy and sorrow. Having our feelings validated can do more for our sense of well-being than any anti-depressant ever can. If we require an anti-depressant for a brief period of time to help move through a window of difficulty, it is important to process our pain and wean off it, under a physician’s guidance, once we are stable enough to do so. When dealing with organic or familial depression or anxiety, prescription medication may be an important intervention. Normalizing the need to medicate our very human feelings is both dangerous and unfulfilling.

Traditional medical thinking is still archaic in its approach to our emotional and mental health. Physicians rarely make the correlations described above or take the time to understand why their patients feel what they do. They are quick to prescribe anti-depressants, the majority of which are unnecessary. It requires discernment to bring awareness to what is a normal emotion and what requires treatment. The medical system has still not normalized the impact that lifestyle can have on mood, despite the strong evidence showing a direct correlation. We must widen the context from which we understand mental and emotional health, and practice courage in exercising our choices for self-care that support it.

In the long run, nurturing, authentic relationships, acknowledging and accepting our emotional sensitivity, and living a lifestyle that optimally supports and optimizes our biology are some of the most effective ways to heal depression, anxiety, and other mood disorders that plague our society.

Ultimately, how we love and treat each other is the most powerful medicine of all.

This article was written in memory of Robin Williams, who brought joy and laughter to so many. He compensated for his depression with his gift of comedy. In death, he awakened us to the importance of honest, self-awareness of our emotional world.

May he find peace as he returns to the Light.

Midlife as a Gateway to Authenticity

Are you a midlife woman who doesn't understand what is happening to your body and your mind?
Have you told your doctor how you’re feeling and were dismissed with medications or hormone replacement therapy?

Do you feel overwhelmed by the volume of information available about managing midlife and peri-menopause?

I am not only a practicing internist but a midlife woman.  I have been helping midlife women for over two decades with their menopausal symptoms and have gained significant personal insight about how little support is currently available for us.

During my forties I noticed my body and energy level change. I began to feel tired and heavy.  I also felt restless and had trouble sleeping through the night.  I looked for answers to these symptoms in my medical books and journal articles. I even went to my gynecologist to understand why I was feeling this way.  All she had for me were prescription drugs and hormone replacement therapy.  She told me that this is peri-menopause and that I have entered this category in midlife.  “It’s downhill from here” she said.  My visit was a huge disappointment.  As a scientist and a problem solver, I was determined to understand why I was having these symptoms and what I could do to restore my sense of health and well-being.

I found a lot written on this subject.  What I read though was theoretical but not practical and it did not address the deeper aspects of what I was looking for.  Why did my soul feel restless?  Why did I feel emotional ‘heaviness’?  Why was my body changing in this way and why were issues resurfacing that I thought were solved?  I was forty-two when I began to feel this way. I was an intelligent and a dynamic woman who had lived a very healthy lifestyle.  I had also created a successful medical practice and on the surface,  appeared to be at the top of my game.  Deep inside, I felt empty and disconnected.  My marriage felt deeply unsupportive and I found myself less able to tolerate the disrespectful ways I was being treated.  It was as if I was not able to compromise myself in order to adapt anymore.   My tolerance for the superficial was receding.  I found myself being more reactive and angry.

What I discovered was that hormonal shifts in my body that were normal during this stage of life brought with them emotional and soul shifts that were offering me an opportunity to take a look at my life from a deeper perspective.  Since I was conditioned to pathologize this, it engendered a deep fear of aging and degeneration. It was anything but.

This time in a woman’s life holds immense transformational power.  When a woman arrives at this gateway, her hormones shift, recalibrating her identity.  She is meant to question who she has pretended to be and move her deep into her soul and her authentic self.  Our society deems this a ‘midlife crisis’.  I like to think of this as the alchemical process of becoming real.   Women need to learn how to take care of themselves through this gateway and beyond.  They need to learn how to use the framework of transformation to connect with their intrinsic power and truth.  At this juncture, women are in need of balance at all levels of their body, mind, emotions and soul.  Many have lived unbalanced lives up to this point, neglecting to take care of ourselves.  As their bodies change they are called to heal their self-neglect.

I would like to offer some simple solutions to support your midlife transformation:

1. Work with a physician who can help you balance your hormones, not replace them.  Bio-identical hormones are much safer alternatives to synthetic ones.  They can quickly restore your feeling of well-being when used correctly in small doses.  Most women are in need only of natural progesterone to balance the estrogen to progesterone ratio.  Taking estrogen in even natural form can aggravate many symptoms of the menopausal transition.  This needs to be customized by your physician to suit your biology and your sense of well-being.  There is no "cookie cutter" way to balance hormones.

2. Acupuncture can make a significant difference in your well-being particularly if you are having a difficult time with menopausal symptoms such as hot flashes and night sweats.

3. Have your thyroid levels checked.  Make sure your physician orders a thyroid panel to give her/him a better understanding of the status of your thyroid as it can become sluggish during midlife.  Make sure you have free T3 levels checked.  These commonly decrease in midlife resulting in weight gain, fatigue and foggy thinking.  Replacing your free T3 and normalizing your TSH to a value between 1 and 2 will make a big difference in your sense of well-being.  Moreover, low free T3 levels have been correlated to an increase in all cause mortality.

4. Clean up your diet.  Change your diet to one that is mostly organic and plant based.  A plant based Mediterranean diet has been shown to significantly lower the risk of heart disease, diabetes and cancer, three of the most common diseases in the U.S. that present in midlife and beyond.

5. Begin taking a therapeutic grade omega-3 supplement and vitamin D.  These will decrease inflammation and strengthen your immune system, reducing the risk of disease.

6. Make aerobic exercise a priority.  At least 20 minutes of exercise, 6 days a week is needed to decrease the impact of physiological stress and restore cardiac health.

7. Incorporate massage therapy, yoga and meditation in your life as ways to heal stress and bring you closer in contact with your authentic self.

8. Work with a psychotherapist to gain a better understanding of your real needs and desires and to dismantle the parts of you that no longer serve your life.  Many feel that they can do this alone and with the help of friends, but it is much more effective and efficient to engage a professional who is objective and can clearly mirror what you need to work on to connect to your authenticity.

9. Make a commitment to be true to yourself and seek for a deeper sense of meaning every day.  Stop compromising your real needs to be liked or accepted.  This is one of the hardest patterns for women to break.  Garner the courage to be true to yourself.  You will earn the respect of many around you.

I invite you to reframe midlife from a time of crisis to one of transformation.  The best years of your life are yet to come.  Grace them as a seeker with deeper meaning and understanding  so you can experience the power and sacredness of your authentic self and most of all experience a deeper sense of meaning now and for the rest of your life.

The Power of Bearing Witness

I have been seeing a patient, who I will call Ann, for 10 years.  She is a therapist who is a gentle and sensitive soul.  I can only imagine the gentle yet powerful space she is able to hold for her clients.  As she bears witness to the many facets of their lives, they have a powerful witness to their process.  They have her love, guidance, expertise and strong arms that hold them through their journeys. They are fortunate to have her in their lives.  With the space she holds they know they are not alone.

I saw Ann the other day when she needed me to bear witness to her process.  She had to hold space for a mother who had lost her daughter.  She was not sure what to say to this mother to help her pain.  It rattled her to her core.

As I sat with her and held space for her, all I could do is bear witness to her process. I told her that the most powerful gift she could give the grieving mother was her presence.  Bearing witness is a gift we can offer each other at any time.  In a world that is moving at warp speed, it is easy to forget that we matter.  Since we don’t live in communities like we once did that marked our passages and witnessed our lives, it is common to spend our milestones alone.  Once they pass, people get occupied again with their busyness and forget that we are in process.  When a person experiences a loss, the process through grief takes time.  It is important for them to be supported through its different stages.

Bearing witness is a sacred act.  It even changes the one who bears witness.  It deepens and fortifies one's soul.  It makes one trustworthy.

As a person’s grief transforms and shifts through its various stages, one gains access to the inner endurance that lives within.  The vacuum that is left in one's life is somehow filled with memories and a deeper level of wisdom.  This is an alchemical process.  The pain of loss never goes away, but it changes  form and also changes the greiver in profound ways. Without bearing witness, one could never experience the power of  Soul in process.

Many of us feel alone in our process.  This is not good for our health. We feel isolated. We may feel that our process is a burden on others.  Isolation is one of the most profound stressors on Earth.  Being witnessed, on the other hand, makes us feel like we matter.  Mattering is good for our health.  It makes our life worth living.

Mattering is a form of LOVE.

As a physician, I feel that bearing witness is the most sacred part of what I do each day.  Holding space and bearing witness to sometimes unbearable suffering deepens my heart and fortifies my soul.  It makes my patients feel that they matter, that their pain and suffering matters.  To be asked to bear witness for another is a profound honor.  Life presents us with so many ways to bear witness to each other every day. We must embrace these opportunities for loving.

Like Ann who will be changed forever by her witnessing, we must hold our strong arms around each other with open hearts. As Ann bears witness to a grieving mother, I bear witness to Ann.  Somehow, I feel that my arms are around her and this mother, all at the same time.  My heart is open to holding space for all of this.  For me it is a great honor and a blessing.

Making another feel like they matter also makes my life matter.  Isn't this ultimately what we are on Earth to experience? For me, this is one of the greatest forms of LOVE.

The Need to Transform the Existing System of Healthcare

There is a movement underfoot in our country that is provocative and exposing. Our shadow is up and it is unraveling itself in all of our institutions. When I left the medical system at age 36, I did so because the corporate intent that I was expected to enable – sick care, felt ‘unethical’ to me. Sick care was not what I was trained to serve. It was not what my heart and soul went into medicine for. But it was required of me by the medical system to generate profit. I was required to keep people sick in order to keep my job.

Deep inside, I knew I was a problem solver. This is what I loved about Internal Medicine. I wanted to uncover the causes of symptoms and ease suffering by working with people to figure out the causes for their illness and how to tap into it to find solutions with them. If our premise is that life is full of precision, then we should be able to figure out the purpose and meaning behind our symptoms and suffering. Our suffering can also help us become real. It has an alchemical effect on our ego that strips it from being ‘all knowing’ to becoming a student of life.

I love medicine. It excites me and it stimulates my thinking at many levels. As physicians, we need to use our knowledge from a context that serves the vocation of medicine.  We also need to use it responsibly and humanistically. This is what we have lost and must regain in health care today. We must open the currently closed system of medicine while maintaining a high standard-of-care. An open system grows and evolves.  A closed system stays stagnant and is based in fear.  Today’s health care system uses fear to keep patients coming.  Its revenue depends on this.

An open system will of medicine is cost effective and patient centered. Its context examines what is wrong but also “what is right about what is wrong”. When we explore symptoms and illness from this framework, we can heal our patients at causal levels. We can use the pathological model within the larger context of a healing model, seeing pathology as a symptom rather than an end.

This context is transforming medicine and evoking health at The Ommani Center for Integrative Medicine. This is a prototype of an ‘open system’.  This was a way I could make medicine REAL and restore and reclaim its SOUL. Becoming Real is the calling of our time. This is our collective path. This can transform our medical system and restore it to what it was originally intended to be.  This will involve physicians who are open to working from this context and patients who expect it.