Orgasms, Testosterone, and the Causes of Anorgasmia

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Dr. Maupin continues her discussion on “women and sex” focusing on the causes of anorgasmia.

Summary:   Doctors traditionally divide the female and male orgasms into four stages as though all were the same and progressed identically along the same pathways.  After more than three decades of helping women with their sexual issues and a little over one decade of treating men for similar problems, I can tell you that the classic approach could hardly be more incorrect.  This underscores one of the deficiencies in medical training.  Doctors are taught very little about human sexuality; and, as a consequence, most don’t feel, and maybe aren’t, qualified to diagnose or treat a not uncommon problem – lack of an orgasm.

Unsurprisingly, many real-life women find it difficult to describe an orgasm in objective terms because an orgasm, by its very nature, is explicitly subjective.  And they almost never depict any “stages” of their sexual experience.  Some women, though, have never had an orgasm.  This condition is called anorgasmia.  Anorgasmic women often feel incomplete and as if they are only going through the motions when they engage in sex with their partners.  In some cases, they become frustrated to the point of giving up on sex because there is no bonus for them.

This podcast is designed to increase your understanding of the female orgasm, to inform you of the hormone that is necessary for an orgasm, and to educate you about anorgasmia.


Masters and Johnson conducted years of clinical research of the sexual act, some of it in St. Louis at Washington University School of Medicine, and decided there are four stages of having an orgasm.

  1. Excitation is stimulating the “hot spots” that prepare the brain and body for orgasm.  Normal people call this foreplay.  It can begin with the mere suggestion that your partner wants to have sex in the near future; or it may be stimulated by you or your partner sexually touching the clitoris, labia, vagina or cervix; or, lastly, sexual visualization and pornography have been known to aid arousal.  This phase is accompanied by an increase in heart rate, blood flow to the skin and dopamine secretion in the brain.
  2. Plateau is the stage in which observable physical bodily changes take place. This may include involuntary dilation of the vagina, blood flow to the pelvis, and swelling of the labia.  One’s focus is tunneled to the area being stimulated.
  3. Orgasm is the stage where sexual tension is released. Surges of dopamine and serotonin are produced in the brain.  Muscles throughout the body may contract or jerk.  Kind of the whole point, really.
  4. Resolution is the relaxing stage where blood flow, heart rate and neurotransmitters go back to normal. Women generally enjoy the ability to have shorter resolution periods than men.  Women have the potential to have repeated orgasms where the resolution phase is very short and they reenter the excitation phase.

 If you have great orgasms, be thankful for yourself and your partner.  There is not a better way to enjoy sex and bond.  But certainly not all women are alike, and not all orgasms are alike.  Various studies have shown the rate of anorgasmia among women of child bearing age to be somewhere between five and ten percent with the degree of the condition ranging from women who have never had an orgasm (primary anorgasmia) to those who only infrequently fail to have one.  This rate increases dramatically as women age if they fail to address the hormonal deficiencies that come with aging.

Recently I had two patients on the same day who had never had an orgasm.  This coincidence was a little surprising to me given the rather low rate of occurrence for primary anorgasmia.  Both women had experienced all the necessary stimulation and had partners who were cooperative and supportive of their efforts.  Let me tell you my approach to treating these two patients.

One of the first steps was to take a detailed medical and social history.  Psychological problems stemming from past sexual abuse as well as spousal conflict, severe fatigue and medications (antidepressants and some blood pressure meds) can impair a woman’s ability to achieve an orgasm.  But these women had no such negative historical experiences and had attentive partners.

Both patients were in menopause and one had had a hysterectomy.  But because their anorgasmia predated the hysterectomy and the menopause, I was able to dismiss these as contributing factors.

If you are a patient of our practice, you know that current blood work, appropriately analyzed, is the center point of any treatment plan.  The blood work showed that both of these women had very low testosterone and estradiol levels.  In talking with them, they both stated they had never had strong desire for sex even when they were in their peak years of ages 16 to 30.  Also, they had not had acne or much body hair as young women.  This is highly suggestive that they had never had adequate testosterone which is necessary for both libido and orgasm.

Even though testosterone is the primary sexual hormone, women in menopause need estrogen for adequate vaginal wetness; and women experiences better climaxes when they have at least a small amount of estradiol along with their testosterone pellets.

On the day of their visits, I replaced their testosterone with T pellets and an estradiol pellet.  Their outcomes were excellent, and both women became orgasmic as the pellets rapidly became effective.  They, of course, were thrilled, but their spouses were also understandably ecstatic.  I doubt these women would have become completely orgasmic with any other treatment.  T pellets bring back sex drive and orgasms better than any other medication or bio-identical hormone delivery system I have ever heard of.



If you have experienced sexual abuse or suffer from depression or other emotional problems, the best first step is to seek counseling.  If these aren’t issues, you should start with your gynecologist to check for physical problems with your anatomy and possibly educate you on where your “hot spots” might be to help you stimulate the proper areas.  If this is unavailing, you should find a doctor who follows blood levels of testosterone and estrogen and uses T pellets.

Our practice does regular blood work to evaluate all the sex hormones as well as the other hormones (such as thyroid and adrenal hormones) that affect your general health.  We treat all hormone deficiencies to normalize them to the levels you had when you were at your optimal physical state.  This generally means supplementation or outright replacement but can also require that some hormones are actually suppressed to achieve the proper balance.  We have been extremely successful with helping women become orgasmic for the first time as well as those who develop this problem with age.

I am very aware of other drugs that have been developed to improve orgasms but have found them to be ineffective and expensive.  This is not a good combination.  Why would someone take an expensive drug with side effects that doesn’t work as well as T pellets?  Remember that T pellets provide countless anti-aging benefits in addition to orgasm enhancement.

If you are interested in further information on this topic, I recommend two books by Dr. Beverly Whipple, Orgasm, G-Spot and The Science of Orgasm, and, of course, my own book, The Secret Female Hormone.  I’ll give you a hint – the secret is testosterone.

Go to my website at to hear more Healthcasts, or you can go to YouTube and search for BioBalance Health or Dr. Kathy Maupin.


This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author.  (314) 993-0963

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