Does hormonal birth control kill libido, and can testosterone fix it?

What did @sophiaarudy actually say?

She says seven years on hormonal birth control, including a Mirena IUD, caused her to completely lose her sex drive, feel "numb" and "dissociated," and suffer recurring BV, UTIs, yeast infections, and a ruptured ovarian cyst. She says no doctor connected these symptoms to her IUD, she figured it out herself, and removing it resolved everything. She now uses Natural Cycles app for contraception and calls it fully effective.

She is upfront that she is not a doctor. She is not selling anything in this clip. Those are two things worth noting before we get into what the evidence actually says about her claims.

Does the science back this up?

On libido, yes, partially. The evidence is real but messier than she presents it. On recurring infections from the Mirena, the picture is more complicated. On Natural Cycles as reliable contraception, she is glossing over some important numbers.

Hormonal contraceptives, including low-dose levonorgestrel IUDs like Mirena, can suppress free testosterone by increasing sex hormone-binding globulin (SHBG), which binds testosterone and reduces its bioavailability. Panzer et al. (2006, Journal of Sexual Medicine) found that combined oral contraceptives significantly raised SHBG and lowered free testosterone, with SHBG remaining elevated even after stopping the pill in some users. A 2013 prospective study by Strufaldi et al. in the European Journal of Contraception confirmed similar hormonal shifts with low-dose pills and associated them with reduced sexual desire and arousal scores.

For the Mirena specifically, because it delivers levonorgestrel locally with lower systemic absorption, the libido impact is considered smaller, though not zero. Backed et al. (2014, Contraception) found mixed results depending on individual sensitivity. So her experience is biologically plausible, but attributing everything to the IUD alone is a stretch.

On recurring infections, the Mirena does not reliably cause BV or UTIs through a well-established mechanism. The intrauterine string can be a factor in ascending bacterial colonization, but the evidence linking Mirena specifically to recurrent UTIs or yeast infections is weak. Her ovarian cyst rupture is also not clearly IUD-related. Functional ovarian cysts can occur on any hormonal method and are common in general.

What did they get wrong (or right)?

She got the libido-hormone connection broadly right. The frustration of not being believed by doctors is also well-documented in the literature on women's pain and sexual health complaints being dismissed. That part of her story is consistent with a systemic problem in gynecological care.

Where she overreaches is in treating her IUD as the single cause of every health issue she experienced over two and a half years. Recurring BV has multiple causes, including sexual behavior patterns, pH disruption, and microbiome factors that have nothing to do with levonorgestrel. Connecting the ovarian cyst rupture to the Mirena is not supported by evidence.

The bigger problem is Natural Cycles. She says "we've never had a scare" and calls it "doable" without mentioning the actual failure rate. The FDA cleared Natural Cycles with a typical-use failure rate of around 6.5 pregnancies per 100 women per year, compared to less than 1 for hormonal IUDs. A 2018 Swedish Medical Products Agency review found a higher-than-expected pregnancy rate in real-world users. Presenting it as straightforwardly effective without those numbers is misleading, even if unintentionally so.

What should you actually know?

Hormonal birth control affecting libido is a real, underresearched problem that deserves more clinical attention than it gets. If you are experiencing significant sexual dysfunction on any hormonal method, that is a legitimate medical concern worth raising with a provider, and worth switching methods over if it persists.

But individual experiences, even emotionally compelling ones, are not a reliable guide to causation. She stopped her IUD and felt better. That does not prove the IUD caused every symptom she listed. Post hoc reasoning is powerful and often wrong.

If you are considering going off hormonal birth control, talk to a provider about your full contraceptive options. Natural Cycles and other fertility awareness methods require rigorous, consistent use and carry meaningfully higher pregnancy rates than long-acting reversible contraceptives. Non-hormonal options like the copper IUD exist and have strong efficacy data if hormones are the issue. Your decision should be based on complete information, not a 45-minute YouTube video or a TikTok, including this one.