By now most of you have read about the new FDA approved drug “Addyi” used to enhance a women’s sexual drive. There’s lots of debate on whether this drug should have been approved at all.
A lobbying campaign helped push for approval of Addyi (pronounced ADD-ee) accusing the Food and Drug Administration (FDA) of gender bias for ignoring the sexual needs of women, given the many options available to men. Well…theres a problem with that statement in that Viagra, and other medications available for men are approved to help achieve erections or to treat testosterone deficiencies…not to increase sexual desire. Men don’t typically have a problem with libido (back me up here guys). Also, Sprout Pharmaceuticals, the drug maker of Addyi payed part of the expenses for the coalition (Even the Score) lobbying for approval.
Critics on the other hand, felt the advocates of the drug pressured the FDA into approving a drug that was minimally effective and had concerning side effects such as low blood pressure, fainting, dizziness, nausea, and sleepiness. Not much fun if you want to get frisky!! It is also interesting that this medication was rejected by the FDA twice, in 2010 and 2013 for the same reasons. So what changed now? Pressure by lobbyists? In one trial, the drug did not increase desire more than a placebo when measured by a daily diary, but did so modestly when measured by a monthly questionnaire.
Another consideration is the price. It was decided that the price of Addyi would cost roughly the same as the monthly cost of erectile dysfunction pills. But erectile dysfunction meds are taken as needed (not daily) while Addyi is supposed to be taken at night every day. So 10 Viagra pills (average monthly use) cost about $400. You do the math…Insurance may cover it but who knows.
The biggest barrier I found was that Addyi could only be prescribed or dispensed by doctors and pharmacists who took an on-line slide presentation and passed a test. That doesn’t seem like a lot of time, but practitioners will need to assess whether it’s more trouble than its worth? Addyi is not supposed to be used by women who drink alcohol (because it would enhance side effects) and is indicated only for pre-menopausal women. Already doctors are talking about how they would still prescribe it to “casual” drinkers, post-menopausal women and even men. Well, which is it?
There is some disagreement on defining normal sexual desire in women. Is it truly a problem for some women or is it a problem for their partners? Studies have shown that all types of women, both premenopausal and postmenopausal can have a low sex drive. In large women’s surveys conducted around the world, about 30% of women (even those in their teens and twenties) report a lack of sex drive (lack of thoughts about sex or desire to have sex). This is different than intimacy.
Here are the facts:
Women need several hormones in play to drive sexual desire while men need only one, which is testosterone. Research conducted on women with low sexual desire found no difference between their levels of testosterone than those women who reported healthy sex drives. But women are complex and the hormones involved include estrogen, DHEA (dehydroepiandrosterone), testosterone and oxytocin. Out of all these hormones, none is as significant as Oxytocin. This hormone makes us feel relaxed and connected to others. It is the hormone released during breast feeding. Women with healthy levels of oxytocin have less worry and fear and accept their partners more for who they are and feel a sense of romantic attachment again. Natural ways to release oxytocin include cuddling, hugging, soft touch, massage, music, singing, physical exercise, positive social contacts and orgasm. Oxytocin releases dopamine which lights up the reward centers of the brain and helps women think of sex as something they want. This is why intimacy, romance, foreplay and making that connection turns women on!
The other big factor is how stress plays a negative role in sex drive. Our stress hormone, Cortisol competes heavily with testosterone and inhibits the release of oxytocin. Addyi is thought to work by changing the balance of certain brain neurotransmitters like dopamine and serotonin. I give them credit in getting closer to the biochemistry of what might work, but what about women already on an antidepressant (SSRI’s) that already increases serotonin? This puts them at risk for serotonin syndrome, a severe condition causing agitation, confusion, muscle rigidity, diarrhea, headache, shivering, fever, seizures and death.
There are still questions and concerns about this drug. I prefer to discuss the factors that influence a woman’s sex drive. Many things are involved but what I see is the stressful lifestyle that we are all trying to manage and how chronically high levels of cortisol can effect not only sex drive but all aspects of our health. Oxytocin, bio-identical testosterone and estrogen, and DHEA are all available for women if they have deficiencies to help support hormone balance. If you choose to take Addyi, which is predicted to be available starting October 17 this year, make sure you discuss all the side effects and your true risks and benefits.
Reference: Pollack, A. The New York Times: Health. “F.D.A. Approves Addyi, a Libido Pill for Women”. Aug 18, 2015
Hertoghe, T. “Passion Sex and Long Life: The incredible Oxytocin Adventure”. International Medical Books. Jan 2010.
Hanley, K. “Lost Your Appetite for Sex”. Whole living.com. may 2010, p. 78-80.