Hypoactive Sexual Desire Disorder (HSDD) is a broad diagnosis for sexual disorder, which mainly occurs in women. It's a common disorder that can affect up to 1/3 of adult women in the US.
At my integrative medicine practice in Minneapolis, I frequently see patients that complain of having a low libido. It's important to note that having a low libido does not necessarily mean there is a sexual disorder. Libido fluctuates throughout our lives depending on age and circumstances. If you and your partner have different libidos but it does not cause any distress in your relationship, then you don't necessarily have a sexual disorder.
Symptoms of HSDD
Having a lower sex drive than partner to a point where it causes distress in the relationship
Having no interest in sex with a partner or self
Being concerned about lack of sex drive
Causes of HSDD
Hormonal shifts: menopause, pregnancy and breastfeeding can all affect libido
Certain medical conditions: breast cancer, diabetes, urinary incontinence, thyroid disease, high blood pressure, and others
Lifestyle: fatigue, alcohol, smoking, certain prescription medications and mental health
Treatment Options for HSDD
Once other causes of sexual dysfunction, like pelvic pain and psychological, are ruled out, often the next consideration is medication.
There are several medication options for HSDD treatment for women, but none are guaranteed to work for everyone. Thus, there is a bit of trial and error.
In premenopausal women the medication flibanserin (Addyi) is FDA approved for female sexual dysfunction. It works on neurotransmitters and is taken nightly. Research shows statistically significant (though very small) improvement in symptoms. Common side effects are fatigue, dizziness, and nausea. Cash price is a whopping $500/month.
Off label, the antidepressant and smoking cessation medication bupropion is often used. It boosts dopamine and norepinephrine and is a cheap generic option.
Often, lower testosterone levels are playing a role in lack of desire. If that is the case, a trial of testosterone replacement therapy may be beneficial. Although there are no commercially available testosterone replacement options for women, there are several compounded options.
Some research shows that oxytocin, a peptide released from the brain (best known as the milk ‘let down’ and bonding hormone between a mother and her new baby), maybe be beneficial in both women and men for sexual desire and orgasm.
Lastly, a peptide called PT-141 (Bremlanotide or Vyleesi) is FDA approved for premenopausal HSDD. It works centrally in the brain binding to melanocortin receptors. It is nice in that is does not need to be taken every day, but rather on an as-needed basis. The commercially available product is a subcutaneously injection and can run more than $1,000 per fill. Fortunately, compounded PT-141 is available as a nasal spray at a fraction of the price. Contraindications include uncontrolled high blood pressure.
In addition to the above treatment options, lifestyle changes can also help with HSDD. These may include exercising regularly, quitting smoking, limiting alcohol consumption, learning stress coping mechanisms, and working on better communication with your partner.
Low libido in women is a common complaint I get from my patients. If you are unsure of what is causing it, schedule an initial consultation with me at Twin Cities Integrative Medicine.