Decreased sexual desire is a common complaint for many women, both premenopausal and postmenopausal. The reason(s) can be varied: physical, emotional, relational, hormonal…and sometimes multifactorial.
Often the hormonal component of decreased desire is minimized by a lab measurement of hormones falling in the “reference range” and therefore relegated to the “normal” category and thus, not considered a reason for decreased desire.
However, remember, “normal is not necessarily optimal”.
The reason why I bring it up is a recent summary from the New England Journal of Medicine Journal Watch which discussed the February 29, 2016 JAMA Internal Medicine article on the new FDA approved drug for female hypoactive sexual desire disorder called Addyi (flibanserin). See JAMA Intern Med 2016 Feb 29.
Addyi produced the following outcomes compared to placebo:
- The number of satisfying sexual events per month increased by 0.5 (leave it to statistics to experience something less than once!).
- The mean increase in sexual desire intensity score was 1.6 (on a scale of 0-84).
- The mean increase in the desire domain of the Female Sexual Function Index was 0.3 points (on a scale of 1.2-6).
- Addyi users experienced dizziness and drowsiness 4 times as often as placebo users
- Addyi users experienced nausea more than twice as often as placebo users
- Addyi users experienced fatigue almost twice as often as placebo users.
The authors concluded:
“these findings suggest that the benefits of flibanserin treatment are marginal, particularly when taking into account the concurrent occurrence of Adverse Events.”
I personally was amazed at the candor of the editorialists (those reviewing the study publication) who stated…
“while it is unclear how strongly politics influenced the decision (ie, FDA approval of the drug), it is clear that the science was weak.”
So why does a pharmaceutical company push for FDA approval of a drug that has such minimal if any helpful benefit while producing negative side effects? Suffice it to say, bioidentical hormones cannot be patented by a pharmaceutical company while a synthetic is patentable and a source of revenue to keep the stockholders (not the patient) happy.
With optimized levels of hormones achieved with BHRT (not those just barely in the “normal” range), many women, whose reason for the decreased desire is truly hormonal, find significant improvement and benefit without the negative effects described for Addyi. BHRT….it’ll do the body good!