Kate Winslet, in case you’re curious, is juicy. She’s also sexy. And the reason for this is not just her considerable charisma but also because, according to her, she started taking testosterone. Ever since, her libido has allegedly been electric.
After uttering not a word about such things, all sorts of actors, doctors, and therapists are telling every other podcaster and People-magazine reporter about their overall juiciness and personal heat. Even Silicon Valley founders and venture capitalists have caught the fever.
Some of them are claiming to have come up with the next female Viagra. And if you’re rolling your eyes and asking, That again?—yes, your skepticism is warranted.
Because there’s really no such thing as Viagra for women; it’s a men’s drug that works on blood flow. But there is such a thing as an F.D.A.-approved drug that treats a dip in women’s sexual desire. There are, in fact, two: Addyi and Vyleesi. And if you haven’t heard of them, that may be because many doctors aren’t talking about them or prescribing them to their patients.
But first, let’s travel back in time to 1998, when men had Viagra and women had bubble baths and Chardonnay to get their motors running. One of those three things is an F.D.A.-approved drug. The others are not much more than a pat on the head. And yet an estimated 43 percent of women experience a reduction in sexual desire at some point in their lifetime, according to the Cleveland Clinic. Call me crazy, but that sounds like an issue that deserves some form of medical attention.
Cindy Eckert thought so. After creating a company that addressed men’s sexual dysfunction with a testosterone pellet, she noticed the data on the biological basis of desire in women. “At the time, there were 25 F.D.A.-approved treatments for some form of male sexual dysfunction and not a single one for women,” she says, “despite the fact that more women than men suffer.” She was suddenly hit by a figurative bolt of lightning. Given that a common side effect of the class of antidepressants called S.S.R.I.’s is reduced libido, she thought, “Maybe there’s something that would make it go the other way.” And that’s when she got to work on a drug that would affect brain chemistry.
After six years of development and testing, she and a team of scientists came up with a pill called Addyi. Maybe you’ve heard of it; probably you haven’t. When Eckert speaks at conferences, she starts by asking the audience how many people know about the pink pill for women’s libido. Only a few hands go up. How about the blue pill for men? The audience suddenly looks like they’re at a Taylor Swift concert.
That discrepancy inspires Dr. Rachel Rubin, a board-certified urologist who specializes in sexual wellness. “No one values women’s sexual health as a medical condition and a medical issue,” she says. “And that’s a huge problem because they’re really significant and affect our patients every single day. Libido is not something that we are teaching gynecologists or urologists to the level where they say, Women’s sexual health is my responsibility as a clinician.”
Some people call Rubin the Sex Detective because, in her long sessions with patients, she Sherlock Holmeses every aspect of sexual satisfaction for all genders, asking, How’s your libido?How’s your arousal? Can you orgasm? “I don’t know about you, but I’ve never been asked these questions in a doctor’s office.... Is it medical problems that are happening? Is it relationship problems that are happening? Is it both?”
She’s enthusiastic about Addyi. On her Instagram feed, she interviews several patients about their response to the drug. One explains, off-camera, that the Lexapro she takes for anxiety also depresses her libido. Yet after two months on Addyi, “it’s the first time I’ve been able to have a good sex drive.” Another patient says simply, “It got everything in motion, basically.”
But these drugs aren’t new—Addyi was approved by the F.D.A. in 2015, and Vyleesi in 2019. The simple reason there’s buzz around so-called female Viagra lies in a number of start-ups focused on sexual wellness in general and libido treatments in particular. And while that’s lovely, these companies don’t have the clinical studies to prove the effectiveness of their offerings. What they do have are clever names, stylish logos, catchy social-media campaigns, and a pile of press coverage. They make treating sexual dysfunction look cool—and there’s no harm in that.
“It’s the first time I’ve been able to have a good sex drive.”
One of the brands that addresses low libido in women is called Hello Cake. It relies on a drug from a compounding pharmacy that mixes oxytocin, L-citrulline, and tadalafil, none of which are F.D.A.-approved for this purpose. Oxytocin, for instance, is activated naturally during sexual activity, childbirth, and breastfeeding. When it’s administered as a drug, it stimulates uterine contractions, speeding up labor. But it hasn’t been tested or proven to enhance women’s sexual desire. Hello Cake also offers over-the-counter supplements, which don’t require F.D.A. approval for safety or efficacy. Representatives at Hello Cake declined to be interviewed for this story.
Rubin, a cheerleader for legitimate treatments for sexual dysfunction, is not enthusiastic about these latest offerings. Without citing brand names, she says, “There’s a lot of room for snake oil and for treatments that may cost a lot of money but don’t actually work or have evidence behind them.”
Which brings us to Kate Winslet and her testosterone thrill, another drug that isn’t approved by the F.D.A. for use in women. Rubin tells me there are five years of data that show its safety and efficacy; she also says it’s approved for women in Australia. She and many of her colleagues use off-label, generic testosterone for men, reducing the dosage to one-tenth the amount for their female patients. And, she adds, “it’s excellent.”
For those who’d rather not take a drug, no matter how excellent, there’s promising news from a Canadian study that cognitive behavioral therapy can improve the sexual concerns—including a decline in desire—that plague 68 to 86 percent of peri- and post-menopausal women. And Esther Perel, the renowned couples therapist, is also coming to the rescue this fall with a new online course about desire.
Addyi was criticized when it entered the world for, as Rubin calls them, “the Seven Dwarfs of side effects”— sleepiness, dizziness, and nausea, among them—but these are now managed simply by instructing patients to take the medication at night when they’re in bed. Eureka! “The worst thing that happens with these medications is you may be a non-responder,” says Rubin. “But the benefits of feeling like yourself again and having that spark, that tingly back—I mean, it’s magic every time we see it happen.”
The future looks spicy.
Linda Wells is the Editor at Air Mail Look
