Until now, all prescription drugs approved to enhance sexual functioning have been for men. Addyi is the first such drug for women. Wrongly dubbed the female Viagra, Addyi has been shown to modestly increase sexual desire in premenopausal women. Viagra increases arousal for men who have desire, but it does not increase desire.
I was involved in a study of Viagra in women for Pfizer, the drug-maker, and we found that if women’s free testosterone was in the mid to upper level, arousal and often orgasms were enhanced, just as they would be for men. Pfizer never applied to the F.D.A. to get Viagra approved for women, but many doctors have prescribed Viagra on an off-label basis for women over the years.
Men have been prescribed testosterone when their levels are low or low normal, which often enhances men’s desire and erections. Some compounding pharmacies have concocted a transdermal testosterone cream or gel to increase sexual desire for women, but there is no standard product on the market for women.
Men’s sexual problems have been more addressed by big Pharma than women’s sexual problems. This is of course not reasonable. It is time that women’s desire, arousal and orgasms be systematically addressed by sexual medicine.
Addyi is a first such drug. The drug was turned down twice by the F.D.A. because the effectiveness and side effects were troublesome. There are still critical questions about whether it is at all safe to mix the drug with alcohol, and side effects include severely low blood pressure and fainting. Doctors and pharmacists must take an online course about the drug before using it with patients.
Unlike Viagra, which is taken before sex, the drug must be taken daily. No big ad campaign is planned, leaving the initial emphasis on educating doctors and pharmacists about the drug. It is unknown what the cost will be, or whether the pills will be covered by insurance.
Doctors could use the drug off-label for postmenopausal women, and even for men, although there are no studies for these populations yet. The drug is thought to work by altering the balance of brain neurotransmitters like dopamine and serotonin. The drug was originally developed as an anti-depressant, but it was found to have some sexual properties.
More studies are planned. The company has been sold for a billion. This shows how important it is to deal with women’s desire, but we cannot forget sex therapy here. The drug may help some women improve their desire. However, like Viagra for men, there is no magic pill for women’s desire. The truth is desire and arousal are complicated, which requires a full understanding by sex therapists, doctors and researchers.
There is no substitute for a comprehensive treatment plan developed by a board certified sex therapist in conjunction with a physician with specific training in sexual medicine. Unfortunately, most physicians lack this training. I refer and work with those with this training. This team approach is the only effective way to treat sexual desire, arousal and orgasm for both sexes.
I applaud Sprout for developing and researching Addyi, but this is only the first of several new drugs that must be thoroughly tested and hopefully eventually approved and released. One study found that about ten to fifteen percent of premenopausal women have hypoactive sexual desire, but I believe the percentage is much higher. It is also critical that the sexual needs of postmenopausal women be dealt with.
My concern is that some women and men will jump for joy that a pill is out to increase women’s desire. It is not so simple, or so conclusive. The data are not all in. We need more attention on women’s desire, arousal and orgasms. In the meantime, both sexes need to see a sex therapist when there are sexual problems, and the therapist will then include appropriate physicians.
The relationship issues, distorted and inhibited thoughts, overall health, drugs that may impair sex, and other critical issues must all be addressed in order to fully solve sexual and relationship problems.