Rachel Rubin, MD, an assistant clinical professor in urology at Georgetown University and a urologic surgeon, discusses the treatments for hypoactive sexual desire disorder currently available and those not yet approved.
Pharmacy Times interviewed Rachel Rubin, MD, an assistant clinical professor in urology at Georgetown University, a urologic surgeon who specializes in the treatment of sexual dysfunction in both men and women, and one of only a handful of physicians trained in both female and male sexual medicine, on hypoactive sexual desire disorder (HSDD) and the current treatments available for this medical condition.
Alana Hippensteele: Are there any potential treatments for HSDD on the horizon that are not yet approved that you are keeping your eye on?
Rachel Rubin: Potentially. So, we have 2 really great options that are already FDA-approved. The first one on the market was called flibanserin, or Addyi, and it's a partial serotonin agonist and antagonist, and it boosts dopamine in the brain, and it works like any medicine that works on the brain.
It works in about 50% to 60% of people who take it, and it's pretty good if you say, ‘Hey, I have a 50% to 60% chance of improving your libido, and side effects are not so dangerous—nobody's ever died or gone to the hospital with this medication. So, side effects are not so bad. Would you like to try it? Major side effects being it makes you sleepy and have a good night's sleep.’ That doesn't sound so bad to me.
So, it's been actually not so hard to give to patients. It's just been hard to get other providers to even bring up libido as a conversation starter. I don't know about you, but a doctor has never asked me about my libido in any medical setting ever.
So, that is a great option. There's a medicine called Vyleesi, which is bremelanotide, which works on melanocortin receptors. It's an auto-injector subcutaneous injection that you do an hour before you want to want. So, it's more of an on-demand—sort of think Viagra, [but] it doesn't work like Viagra because it works on your brain, [so] think of it as more of an on-demand option that's sort of like a hit of dopamine. Both of these therapies will improve increased dopamine in your brain to make sex more desirable, if you will. So, the worst thing that happens is they don't work.
In terms of future treatments, I think I would love to see an FDA-approved testosterone for women on the market because I think the postmenopausal patient population, which also benefits from these drugs, but they're off label for that patient population, and they really do need something biological, both hormonal and non-hormonal, to help them.