Female Libido in Menopause: Desire Loss, Biology & Solutions with Cind

This week on unPAUSED, Dr. Mary Claire Haver sits down with Cindy Eckert, founder and CEO of Sprout Pharmaceuticals and creator of Addyi, the first FDA approved treatment for low libido in women. Cindy is a pharmaceutical entrepreneur who began her career at Merck before founding her first company in 2007, focusing on under marketed FDA approved products. After successfully building and selling a male sexual health company, she became the only woman running a sexual health company and witnessed firsthand the stark contrast between how medicine treats male versus female sexual dysfunction. Her journey to bring Addyi to market became a cultural battle about whether women's sexual desire matters, leading to two FDA rejections, public hearings, and ultimately a historic approval in 2015 after a six year fight.

In this conversation, Dr. Haver and Cindy explore how Addyi works differently from Viagra, targeting brain chemistry and desire rather than blood flow and arousal. Cindy explains that Addyi is a mood drug originally developed for depression that showed an unexpected effect on female libido during clinical trials. The medication works on neurotransmitters in the brain, building over approximately eight weeks to restore spontaneous thoughts, fantasies, and desire in women with hypoactive sexual desire disorder or HSDD. She walks through the massive clinical trial requirements, including 13,000 patients compared to Viagra's 4,000, and the three things they had to prove with statistical significance versus placebo: increased interest in sex, more satisfying sexual experiences, and decreased distress from the condition.

The conversation reveals the shocking disparities in how sexual health is funded, researched, and approved across genders. Cindy shares how venture capitalists laughed her out of rooms despite her previous success, how the FDA fast tracked Viagra approval in six months while Addyi took six years with two rejections, and why the statement that Addyi provides only modest benefit reveals the underlying assumption that women's sexual pleasure has no value. She discusses the brain scan imaging research from neuroscience that showed women struggling with low libido have measurably different brain responses to sexual stimuli, proving this is a biological condition rather than purely psychological. Cindy explains why no medical specialty truly owns female sexual health the way urology owns male sexual health, leaving women bounced between OBGYN, psychiatry, and dismissive platitudes.

Dr. Haver and Cindy address the barriers women still face accessing Addyi, from insurance companies requiring patients to fail marriage counseling before approving coverage to pharmacists questioning whether husbands know their wives are taking the medication. They discuss how breast cancer survivors who have an 85 to 90 percent chance of experiencing HSDD receive almost no information about treatment options, while men with erectile dysfunction after prostate cancer receive immediate intervention programs. Cindy shares her decision to fight to get Addyi back after the pharmaceutical company that acquired it shelved the product without ever launching it, and how she has used the proceeds to fund other female health disruptors working on innovations from infant formula to date rape drug detection.

The episode concludes with discussion of the new documentary The Pink Pill: Sex, Drugs and Who Has Control, which chronicles Cindy's battle with the FDA and features the brave women who testified at public hearings about their struggles with HSDD despite being mocked and ridiculed. This conversation provides both the science and the cultural context behind one woman's mission to change how medicine values female pleasure and desire.

ADDYI, flibanserin, is for women <65 with low sexual desire disorder who have not had problems with low sexual desire in the past, and who have low sexual desire that is troubling to them no matter the type of sexual activity, situation, or sexual partner. The low sexual desire is not due to a medical or mental health problem, problems in the relationship or medicine or other drug use. ADDYI is not for men or to enhance sexual performance.

Your risk of severe low blood pressure and fainting is increased if you drink 1-2 standard alcoholic drinks close in time to your ADDYI dose. Wait at least 2 hours after one to two drinks before taking ADDYI at bedtime and skip your dose if you drink three or more drinks that evening. If you take certain prescription, OTC or herbal medications, or have liver problems, the risk of low blood pressure and fainting increases and you should not take ADDYI. Do not take if you are allergic to any of ADDYI’s ingredients. Sometimes serious sleepiness can occur. Common side effects include dizziness, nausea, tiredness, difficulty falling asleep or staying asleep and dry mouth. See PI and Boxed Warning at addyi.com/pi

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