Medications for treatment of low libido
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FDA-Approved Medications for Low Libido
Two main medications have been approved by the FDA for treating low libido, specifically in premenopausal women: flibanserin and bremelanotide. Flibanserin is a daily pill that works on brain chemicals like serotonin, dopamine, and norepinephrine. It has shown statistically significant, but modest, improvements in sexual desire and satisfaction. However, it comes with notable side effects and is not to be taken with alcohol due to safety concerns. Bremelanotide, approved more recently, is an injectable medication used as needed before sexual activity. It activates certain brain pathways involved in sexual response and has been shown to improve sexual desire and reduce distress about low libido. Side effects of bremelanotide include nausea, flushing, headache, and injection site reactions, among others. Both medications are only approved for use in premenopausal women with hypoactive sexual desire disorder (HSDD) 2346.
Off-Label and Investigational Medications
Testosterone Therapy
Testosterone therapy is not FDA-approved for women but is often prescribed off-label, especially for postmenopausal women with low libido. Clinical trials have shown that low-dose testosterone can improve sexual desire, arousal, frequency, and satisfaction in women, particularly when combined with estrogen. Short-term use appears safe, but the long-term risks, including effects on heart health and cancer, are not fully known. Careful monitoring is recommended for women who use testosterone therapy 679.
Other Medications
Other drugs sometimes used off-label to address low libido include:
- Bupropion: An antidepressant that may enhance libido, especially in women experiencing sexual side effects from other antidepressants.
- Buspirone: Sometimes used to counteract sexual side effects from selective serotonin reuptake inhibitors (SSRIs).
- Sildenafil and other PDE5 inhibitors: These are primarily used for erectile dysfunction in men but are sometimes tried in women to improve sexual function, though evidence is limited 26.
Medications Not Recommended
Aromatase inhibitors, which affect hormone levels, have been studied in men but are associated with an increased risk of low libido and are not recommended for treating sexual dysfunction .
DHEA and Other Supplements
Dehydroepiandrosterone (DHEA) is a hormone supplement sometimes used to try to improve libido. However, studies in postmenopausal women have not shown significant benefits over placebo, and side effects like acne and increased hair growth are more common with DHEA 19.
Some herbal supplements and adaptogens, such as Tribulus Terrestris, are marketed for libido enhancement, but scientific evidence supporting their effectiveness is limited .
Special Populations
For women with a history of breast cancer, flibanserin has been used cautiously and appears generally well-tolerated, with some reporting benefits in libido and other aspects of sexual function. However, more research is needed in this group .
Non-Pharmacologic Approaches
While medications can help some people, psychological therapies like cognitive behavioral therapy and mindfulness are also important and may be preferred, especially given the modest benefits and side effects of current drugs .
Conclusion
Medications for low libido include FDA-approved options like flibanserin and bremelanotide for premenopausal women, and off-label use of testosterone for select postmenopausal women. Other drugs and supplements are sometimes used, but evidence for their effectiveness varies. All medications have potential side effects, and long-term safety data are limited, especially for off-label therapies. Non-drug approaches remain important parts of treatment.
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