Medications to Treat Hypoactive Sexual Desire Disorder

In my practice, I have a growing number of women who come to me wanting a quick fix to low sexual desire. They want a pill, a shot, a fixable diagnosis for WHY their libido has dropped. And I don’t blame them one bit. When the loss of desire becomes distressing to an individual, it is often paired with negative impacts on their romantic relationship, declining feelings of self-worth, and accompanying anhedonia and/or depression. These women WANT to desire their partners and feel like their bodies are not responding to their cognitive commands of “turn on” and “get in the mood”.

Apomorphine vs Vyleesi (Bremelanotide) vs Flibanserin (Addyi) vs Bioidentical Testosterone

Women who are in my office often wonder if maybe it’s a hormonal issue or even something like iron deficiency due to their heavy menstrual cycles. The honest answer is… if you’re lucky, we’ll find something like that. The majority, we have to be more creative.

The further I go into the world of sexual health and treatment of this very important, yet unknown disorder of HSDD (hypoactive sexual desire disorder), the stronger I feel about the following statement.

“Low desire in women is very rarely a

physiological disorder alone”.

Meaning treatment using lifestyle, nutrient therapies, hormonal approaches, and medications should always accompany the exploration of one’s relationship to self and their romantic partner. Body image concerns, trauma history that emerges in mid-adulthood, loss of respect/attraction/connection to one’s romantic partner, and parental and/or work burnout are all common confounders of the HSDD condition. Fortunately, sex therapists, individual counselors, and lots of reading material (see my library recommends) are readily available to those who are willing to do the work. In my practice, I do a fair amount of counseling in combination with prescribing therapeutic agents because they are both important for successful outcomes.

I wish I could tell you that the medications below – which we will discuss – are the magic bullet for the majority of my patients. But it wouldn’t be honest. They help, but the female brain is a complex organ that keeps us, even those who have one, all guessing.  

Pharmacotherapeutics

Apomorphine: Probably the least known of the short-list here. It is a dopamine stimulant medication, only available through a compounding pharmacy. Dopamine is the pleasure-seeking neurotransmitter in the brain and has a vast role in the initiation of desire.  It is also used for the treatment of erectile dysfunction in men. In the small research that is available, it was most efficacious when taken daily in a 2 or 3mg dose over at least 2 weeks. Nausea and headache were the most common side effects. No serious side effects were noted. As needed dosing did not change baseline values significantly.   ***This medication contains no pain medication despite the name “morphine” in the spelling. No addiction potential***

Pros: Works on the central acting component of the brain to enhance dopamine and has low side-effect risk. Works well for women struggling with anhedonia, depression, and low mood.

Cons: Research is limited, and compounding pharmacies can be expensive.

Bioidentical Testosterone: Definitely my HSDD medication of choice IF a woman has lower testosterone levels on lab testing. Plentiful data on this agent being successful in raising libido in women. I am still shocked we do not have FDA approval for this medication for women given the limited data we have for the following two agents, but the abundance of data we have for testosterone… Here I go on my soapbox. I am cautious about any woman who may want to try to conceive as it would be contraindicated. Can come with mild, unpleasant, but non-serious side effects such as acne, oily skin, and unwanted hair growth if the dose is not watched closely. Works well, if someone is low, within a few weeks to months of initiation.

Flibanserin (Addyi): This medication was the first FDA-approved agent for HSDD and it is really a total flop. Lots of risky side-effects, and contraindications with alcohol intake, and commonly causes fatigue and possible fainting episodes. This is a non-starter for me. FDA wanted to make a political statement that they were advancing women’s sexual health and this was approved. In my opinion, not worth the expense, risk, or side effects. It did have some mild improvement in sexual satisfaction surveys over 24 weeks.

Vyleesi (Bremelanotide): Another dopamine stimulating agent in the brain but this time, indirectly. It works by stimulating a regulatory molecule of dopamine and thus can enhance the cascade to speed up dramatically and quickly. Administered as an as-needed injectable agent no more than eight times monthly. Once injected effects typically onset between 30 minutes and two hours. Can cause significant flushing and nausea in two out of ten women. Can raise blood pressure and shouldn’t be used for those with high blood pressure to start. I have had some big successes in my practice with this one, some women LOVE it and feel like it’s given them control over their sex life again. However, in those who do experience nausea – it’s a non-starter. Who wants to have sex when they are sick to their stomach? The experiences women have reported are enhanced orgasm, warming of the genitals, and enhanced arousal for up to 24 hours after injection – yes, you do sleep, if you choose to.

For more on HSDD check out my 2 Part Series:

Low sex drive? You may be suffering from Hypoactive Sexual Desire Disorder – Dr. M. Leary

HSDD Part II: The role of neurohormones and neurotransmitters – Dr. M. Leary

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Writer: Michelle Leary
Writer: Michelle Leary
September 16, 2022

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