Hormones-Sex Connection with Ashley Koff, RD | Ep 49

Welcome to the Libido Lounge

Dr. Diane: Welcome to the Libido Lounge where we focus on all things love, lust, and libido. We believe that fabulous sex is just as important to health as exercise and good food.

Hey everybody, welcome back to another episode on the Lounge. I’m your host, libido expert Dr. Diane, and I am so excited about the conversation we’re having today with dietitian Ashley Koff. We’re going to have the best time talking about all sorts of reasons for low libido — and some you’ve probably never heard about on this show!

We’ll discuss additional hormones you need to know about, and how they relate to blood sugar, your vasculature, and other physical drivers that deeply impact libido and overall health.

Dr. Diane: Ashley, welcome to the Lounge! It’s so great to have you with me today.

Ashley Koff: Thank you! I just wish I was laying on your couch. It feels like, “Let me come on in and lounge!” Someday we’ll do this in person. We’ll invite everybody over, have wine… it’s all part of the vision.

What Are Incretins and Why Should You Care?

Dr. Diane: Let’s dive in. I know we want to talk about the incretin hormone family. Many listeners might be unfamiliar with that term — what is it and how does it relate to libido?

Ashley Koff: Most people haven’t heard “incretin,” but they have heard words like Ozempic, Zepbound, Mounjaro — medications getting attention for weight, metabolic, and even brain health. These meds are based on a hormone that’s crucial for understanding your libido picture.

The hormone we’re talking about is GLP-1, made naturally in the lining of your digestive tract. It’s like a switch — it flips things on, including your appetite regulation (leptin) and blood sugar balance (insulin). GLP-1 is a major player not just in metabolism but also in libido.

What is GLP-1 and How Does It Work?

Dr. Diane: So GLP-1 is made in the GI lining — but is leptin a type of GLP-1?

Ashley Koff: Great question. No, GLP-1 is a peptide hormone — glucagon-like peptide — and its job is to activate other hormones like leptin (for satiety) and insulin (for blood sugar). So while leptin and insulin are more familiar, GLP-1 is the one flipping them on.

Medications like Ozempic are synthetic versions of GLP-1. Some combine GLP-1 with other peptides like GIP — but for now, just know they’re based on what your body naturally makes.

Appetite, Satisfaction, and Your Sex Drive

Dr. Diane: Let’s help people connect the dots — how do leptin and insulin really tie into libido?

Ashley Koff: This is where it gets exciting. When we have disruptions in metabolic hormones like leptin and insulin — not just sex hormones — it can dramatically affect libido.

If you’re not feeling satisfied with your meals (low leptin), you may overeat. Overeating can make you feel physically uncomfortable or emotionally off, pulling you away from libido. On the flip side, being undernourished or constantly hungry can also suppress libido — your body’s too preoccupied trying to survive.

This is especially true for performers — athletes, entertainers, parents, or professionals under pressure. When you’re “on” in one area, libido can take a hit. And for many, leptin resistance — where the brain doesn’t register fullness — plays a role.

How Digestive Health Impacts Libido

Ashley Koff: If your gut is compromised — from antibiotic use, birth control, steroid meds, Celiac disease, IBS, SIBO, or anything that affects the gut lining — your GLP-1 production can suffer. That weakens your appetite regulation and insulin signaling, which in turn impacts libido.

So if you’re always hungry even after eating a “normal” meal, or feel like food doesn’t satisfy you, it might not be a willpower issue — it could be GLP-1.

Can You Test for GLP-1?

Dr. Diane: That’s so helpful. So, can we test GLP-1 levels? Or do we have to deduce from other markers?

Ashley Koff: Love that you asked. GLP-1 only sticks around for about 30 seconds — so there’s currently no reliable test for it. Instead, we assess indirectly by looking at symptoms and supporting markers like leptin, insulin, and overall digestive health.

We’ve created a free quiz to help people figure out if they should be optimizing GLP-1 — and yes, we’ll link that in the show notes.

Blood Sugar, Insulin, and Libido

Dr. Diane: Let’s move into the insulin and blood sugar conversation. We’ve talked about how high blood sugar affects blood flow and thus libido — but can you tie that into GLP-1 and hormone function too?

Ashley Koff: Absolutely. Insulin resistance often comes from blood sugar dysregulation — high peaks, low valleys, or even elevated “rolling hills.” When your blood sugar is consistently elevated, it harms tiny capillaries — the same ones needed for arousal and blood flow.

This is a key reason why libido can suffer with metabolic dysfunction.

GLP-1’s job is to yell out, “Hey insulin, it’s time to go!” in the presence of carbohydrates and fats. But if you’re not producing enough GLP-1, insulin doesn’t get the memo. You can be eating right, taking cinnamon or chromium, even exercising post-meal — but if GLP-1 is low, results may plateau.

Hormonal Balance Is a Two-Way Street

Ashley Koff: Poor digestion can affect sex hormones like testosterone, estrogen, progesterone — and vice versa. If your hormones are off, they can further disrupt digestion. It’s a vicious cycle. That’s why improving digestive health and GLP-1 production supports overall hormone balance and libido.

Also, insulin resistance is part of metabolic syndrome, along with high blood pressure and cardiovascular risk. All of that affects your vascular health, which is crucial for sexual function.

You don’t want sugar gumming up the tiny capillaries where blood needs to flow for pleasure and response. So improving insulin and GLP-1 helps with both metabolism and libido.

Where to Go From Here

Dr. Diane: This has been such a valuable conversation. I hope it opens people’s eyes to the metabolic side of libido.

Ashley Koff: Agreed. It’s about more than sex hormones — it’s about optimizing your gut, your appetite signals, your blood sugar, and ultimately your connection with your body.

Dr. Diane: Thank you so much for being here and sharing your wisdom!

You can find me on YouTube, on Instagram, and check out our Modern Libido Club for so much more!