Clinical Management of Hypoactive Sexual Desire Disorder

Sheryl Kingsberg, PhD, IF; Stephanie Faubion, MD, FACP, NCMP, IF


Menopause. 2019;26(2):217-219. 

In This Article


Treatment for HSDD may include psychotherapy, pharmacotherapy, or a combination of both. Flibanserin, the only FDA-approved pharmacologic option, is a nonhormone, once-daily-at-bedtime, 100-mg oral therapy indicated for acquired generalized HSDD in premenopausal women. Flibanserin is a multifunctional serotonin agonist and antagonist with a presumed mechanism of action that involves decreased serotonin levels and increased dopamine and norepinephrine levels in selected brain regions. Although clinical trials have shown that flibanserin incrementally improves sexual desire in postmenopausal women, it is not FDA approved for use in this population. Prescribers and pharmacists are required to certify through a risk evaluation and mitigation program because of the risk of hypotension or syncope when flibanserin is combined with alcohol.[10]

Testosterone is another off-label treatment for low sexual desire in women, although no FDA-approved testosterone products are currently available for women. A number of studies have shown transdermal testosterone to be effective in treating HSDD in postmenopausal women. The use of off-label testosterone products in women requires careful monitoring for androgenic adverse effects because of inconsistent dosing from titrating male products or compounding testosterone products.

Other pharmacologic options that may be on the horizon include bremelanotide. Bremelanotide, a melanocortin-4-receptor agonist, is an investigational drug that has demonstrated acceptable safety and efficacy in the treatment of HSDD in premenopausal women.