Why Isn’t Anyone Taking The Female Desire Pill?
(Photo: Getty Images)
I’m at a sparkly movie premiere at Toronto’s TIFF Bell Lightbox. Photographers are giddily snapping photos, and many of the attendees are dressed in hot pink. It feels like I’m having a Barbie movie flashback, but this crowd of mostly midlife women aren’t here to see Margot Robbie strapped into roller skates. They’re here because they want sex—or rather, they’re here because they want to want sex. And the movie they’re about to watch, The Pink Pill: Sex, Drugs and Who Has Control, is all about the campaign to bring a medication to market that might be able to help.
The Canadian documentary, which was partially funded by the Knix Fund (yes, your favourite leakproof panty brand), details the long battle that Sprout Pharmaceuticals waged with the FDA to get approval for Addyi—or, as it’s known in scientific circles, flibanserin—to treat hypoactive sexual desire disorder (HSDD) in women. Addyi was approved in the U.S. for pre-menopausal women in 2015 and has been available in Canada since 2018 for pre-menopausal women and since 2021 for menopausal women.
But thanks to this new documentary, Addyi endorsements from no less than our Holy Mother Menopause Crone Gwyneth Paltrow as well as Oprah, not to mention a U.S. decision last December to fling open the pharmacy doors to menopausal American women, the buzz around this medication has been building.
Addyi—which has sometimes been incorrectly dubbed the “female Viagra”—is a daily pill that treats HSDD. The disorder is defined as the persistent absence of sexual fantasies, thoughts and/or desire for, or receptivity to, sexual activity, which causes distress. ( If you’re not feeling frisky, but you don’t care, you don’t have HSDD.)
It’s estimated that one in 10 women have HSDD, and up to 40 percent of women are unhappy with the strength of their libidos or sexual responses. Unlike erectile dysfunction drugs, which target blood flow, Addyi doesn’t work directly on the body. Instead, its creators believe it affects neurotransmitters in the brain like dopamine, norepinephrine and serotonin to increase sexual desire and responsiveness and turn down inhibition. Think of it like a volume knob for horniness that can take up to eight weeks to kick in.
Addyi doesn’t help women whose disinterest in sex is due to depression, the side effects of other meds like SSRIs, vaginal symptoms related to menopause like dryness or atrophy, relationship problems or other medical conditions that impact sexual functioning. Personally, I’ve never met this magical, carefree, well-rested midlife goddess with a perfect marriage, no health issues and the bouncy vagina of a 20-year-old, but let’s pretend she’s real, just for funsies. Is she taking Addyi? Has she even heard about it?
While I could throw a rock and easily hit 100 women taking hormones, antidepressants or GLP-1s, nobody in my circle of women, both straight and queer, seems to even know Addyi exists. While reporting for this story, I spent weeks trying to find a Canadian who is taking it, with zero success. That could be due to a host of reasons, including the fact that availability has been spotty over the last year as Sprout switched distributors.
But because of my work as a journalist and my not-very-passing interest in all matters of midlife sex, I did know that Addyi existed, and I broached it with both my family doctor and the fancy menopause ob-gyn she referred me to when—how can I put this delicately?—my kitty dried up and shut down for business like a slab of angry shoe leather. Both of my doctors were unenthusiastic about Addyi, and instead put me on a cocktail of estrogen, progesterone and a little off-label splash of testosterone gel.
In my case, that was the right call, because Addyi doesn’t fix gynecological issues. But it’s difficult to say with certainty how much Addyi is actually being prescribed in Canada. As a private company, Sprout doesn’t have to—because of course I asked—release sales information.
When I interviewed several clinicians who specialize in sexual medicine, reviews were mixed. Dr. Lori Brotto is a psychologist and researcher who specializes in women’s sexual health. She’s a professor at the University of British Columbia and the director of the UBC Sexual Health Laboratory. If anyone knows what drugs doctors are prescribing to treat women’s libido, it’s her.
“I don’t know a single physician in a Canadian practice who has written more than a handful of Addyi prescriptions,” she says. “And I’ve asked.”
Addyi’s placebo-controlled clinical trials showed a decrease in sexual distress and a small improvement in desire, leading to an additional 0.4 to one episode of satisfying sex per month. This sounds pretty underwhelming until you imagine a scenario where there’s, say, a couple who isn’t having any sex at all. Going from nothing to once a month could be life-changing, both for the relationship and for a woman’s self-esteem.
Dr. Stephen Holzapfel is a family doctor at Women’s College Hospital in Toronto and the director of its Sexual Medicine Counselling Unit. While he stresses that treating women’s libido requires a holistic approach, he does prescribe Addyi for certain patients. For some, it doesn’t help, or they find it too expensive (Addyi starts at $240 per month and many insurers don’t cover it), or patients can’t tolerate common side effects such as dizziness, fatigue and nausea. You also need to limit and strictly time any alcohol intake when taking Addyi because it can cause low blood pressure and fainting. But for other patients, it’s a home run.
“I had one woman come back just glowing,” he recounts. “Their insurance didn’t cover it, so her husband sold his favourite motorcycle just so they could continue to afford it.”
Addyi’s existence has certainly opened the eyes—and wallets—of pharmaceutical companies keen to capitalize on women’s ever-louder complaints that their sexual satisfaction is a health issue and deserves to be addressed. “There’s no magic bullet,” says Holzapfel. “If they had that drug, there would be lineups from here to Buffalo.”
More medications for women’s sexual health are, however, in the pipeline. There’s a drug called Lybrido about to enter Phase 3 trials that’s a combination of sildenafil (the active ingredient in Viagra, which also works on clitoral tissue) and a small dose of testosterone. There are efforts underway to create a testosterone treatment that’s specifically for women, rather than relying on products designed for men. And while it’s not a drug, there’s more and more data that shows that specific mindfulness practices can rev up a stalled libido.
While I still have, in my opinion, a perfectly respectable sex life for a post-menopausal woman who has been monogamous with the same person for almost two decades, I’m the first to admit that I’m not as interested in sex as I was even a few years ago. And I miss that wanting. I’d love nothing more than to be able to pop a pill and turn into a juicy little horn dog who just can’t get enough. (My husband wouldn’t cry about it, either).
When I posted on Instagram looking for women taking Addyi, I didn’t find any. But I received several DMs, many from women I’ve never met, asking me about it and sharing their own struggles with a sex drive that had gone AWOL. Women are clearly looking for an answer. Addyi might not be the end of the road when it comes to a successful medical treatment for low sexual desire and satisfaction, but it might be a beginning.
