Pharmacy hours interviewed Rachel Rubin, MD, assistant clinical professor of urology at Georgetown University, a urological surgeon specializing in the treatment of sexual dysfunction in both men and women, and one of the few physicians trained in female sexual medicine and male, 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 and that you are monitoring?
Rachel Rubin: Potentially. So we have 2 very good 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 stimulates dopamine in the brain, and it works like any drug that acts 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 the side effects aren’t not so dangerous – no one has ever died or gone to hospital with this drug. So the side effects are not that bad. Would you like to try? The main side effects being that it makes you sleepy and passes a good night’s sleep. Doesn’t sound so bad to me.
So it wasn’t that hard to give to patients. It’s just been hard to get other vendors to 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 context.
So this is a great option. There is a drug called Vyleesi, which is bremelanotide, which acts on melanocortin receptors. It’s a subcutaneous injection by auto-injector that you do an hour before you want to. So it’s more of an on-demand drug, like Viagra, [but] it doesn’t work like Viagra because it works on your brain, [so] think of it as an on-demand option that feels like a dopamine hit. Both of these therapies will enhance the increase in dopamine in your brain to make sex more desirable, if desired. So the worst thing that happens is that they don’t work.
In terms of future treatments, I think I’d like 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 not in line with the label for this patient population, and they really need something biological, both hormonal and non-hormonal, to help them.