HSDD: Hypoactive Sexual Desire Disorder

There are four treatments I usually talk to my patients about for HSDD or Hypoactive Sexual Desire Disorder. 

• First is Bremelanotide. This is an injection, also known as Vyleesi. It’s a very tiny needle, you use it about an hour or so before you want to feel desire. It hugely increases your desire and then it is metabolized out of your system. Women can use it similarly to Viagra in that you use it when you want to be intimate. 

• The other one is called Flibanserin, otherwise known as Addyi. It’s a tablet that you take every day, it does take about six weeks to start working. And if it hasn’t worked by eight weeks, then it’s probably not going to work for you. It’s kind of similar to an antidepressant in some ways, except that it does increase overall desire. However, it’s not going to make you have a huge increase in desire, it’s just going to make you a little bit more interested and responsive overall. For a lot of women, this is great, especially because some of the side effects are sleepiness. So if you take it at night, it might help you sleep a little bit better. You just have to space out drinking alcoholic beverages when you take it because both are processed by the liver.

• The third one is Testosterone. We know testosterone is behind sex drive. And so especially if you’re post-menopause and your testosterone levels have been decreasing, which is what they do naturally, then this might be a good option for you. Prescription is only a small amount compared to what men use, specifically 1/10th of the dose. Beware of people offering testosterone pellets or huge doses of testosterone as we only know about the safety of testosterone for women at this dose. The goal is to get to levels similar to that of your pre-menopause testosterone state. We don’t want to give you the same levels as your male partner. Why? Because there are side effects! Some include acne, hair growth, etc. 

• Lastly, there are some over-the-counter options and some natural supplements. We don’t have great evidence for them but I have heard some good antidotes for some of my patients. Specifically, Ristela by Bonafide is one that a lot of my patients do like. (I don’t receive commission or anything like that from them!) It also takes about six weeks to start working so you need more than just the sample in order to find out if it’s going to work for you.