You’re Not Broken—You Might Have HSDD: Finally, a Name for That Low Desire You’ve Been Feeling

We can all picture classic sitcoms where a wife isn’t in the mood for romance, so she makes up an excuse that she “has a headache.” And then the show’s laugh track erupts into giggles. But those depictions are terribly outdated. Today, we know that the struggle with low sex drive isn’t a punchline. It’s a real clinical health issue with a real medical diagnosis called hypoactive sexual desire disorder or HSDD. If you’ve noticed your interest in intimacy fading—and you miss that spark—you’re not alone, and you’re definitely not broken. In fact, approximately one in three¹ women experience distressing low desire.¹ But now for the first time, there are clinically proven treatments that can help. Keep reading about some truly uplifting advice from the nation’s top leaders on this sexual subject. Good news: You don’t have to roll credits on a rewarding sex life as you age. Cue the applause!

What is HSDD?

First identified in 1977, hypoactive sexual desire disorder is the fancy medical term for low sex drive or underactive sexual desire. The condition is biological and stems from an imbalance of brain chemicals. That distinction is important. Another condition called female sexual arousal disorder (FSAD) (now known as female sexual/interest arousal disorder or FSIAD) is defined by physical and mechanical problems such as poor vaginal lubrication or painful penetration.

HSDD starts in your brain, not your body

Our brain is a powerful sexual organ. We need a healthy balance of certain neurotransmitters to trigger the fantasies and positive feelings needed to initiate or enjoy good sex with a partner or alone. That includes a healthy dose of dopamine and norepinephrine that fuel sexual excitement and a balanced (not too high) level of serotonin, which can dampen our level of sexual desire.

Low desire is only a problem if you miss sex

A low libido on its own is not the same thing as HSDD. So what is HSDD, exactly? “HSDD is persistent low libido that’s distressing to the patient and can’t be traced to another identifiable cause, whether medical, medication-related or situational,” explains board-certified internist Heather Hirsch, MD, founder of the Menopause and Midlife Clinic at Brigham and Women’s Hospital.

Many people happily live without sexual intimacy. Others deeply miss the connection and desire they once felt. “I always tell patients, low desire at any given point in your life is okay if it doesn’t disturb you or cause a big disruption in your life,” explains Sameena Rahman, MD, a sex-med gynecologist, menopause specialist and founder of GYN Sexual Medicine Collective. When it causes tension, it becomes a condition worthy of treatment. She adds, “HSDD is where you want to want to have sex, you want that feeling again, but some women describe feeling dead inside.”

HSDD is real, it’s medical and it’s not your fault

Many women living with HSDD are experiencing a double burden: mourning the loss of their sex life and blaming themselves for it. You deserve better—and understanding HSDD can lift both weights off your shoulders. Dr. Rahman wants women to know, “There are completely biological reasons for this happening. You are not broken.”

Awareness is key. “Many women don’t know that low sex drive can be a medical condition. Many women go to appointments feeling upset, embarrassed or afraid that there’s something wrong with them,” reveals Louis Lerebours, MD, a family medicine physician at Freeman Recovery Center. “One of the main things I help my patients do is figure out that HSDD is real and that low sex drive has many causes, including hormones and stress in your life.” That awareness about what causes lack of interest in sexual activity can change everything. “When someone finds out what could have caused their lack of sex drive, it usually means they get relief.”

You’re far from alone: How common HSDD really is

HSDD is considered by many medical experts to be the most common sexual dysfunction in women. Women’s health champion Cindy Eckert, CEO of Sprout Pharmaceuticals, which has the only FDA-approved medication to treat HSDD in women under 65, called Addyi (flibanserin), says, “We used to say one in 10 women had HSDD.” But with greater awareness, that number has grown significantly.

“The Mayo Clinic recently found 50 percent of women over 50 understand that they could have this issue,” Eckert adds, referring to recent research on HSDD awareness. Now that there is a name for the condition and a clinically proven treatment option, there is greater talk and healing around it. Eckert herself was diagnosed with HSDD and shares, “Suddenly, we’re in a better conversation. It’s not stigmatized, it’s not shameful.”

That shift from shame to openness is exactly what makes diagnosis and treatment possible. Here’s how to start that conversation with a healthcare provider.

What is ADDYI?

ADDYI is a prescription medicine used to treat hypoactive (low) sexual desire disorder (HSDD) in both pre and postmenopausal women under 65 who have not had problems with low sexual desire in the past, no matter the type of sexual activity, situation, or sexual partner, and it is troubling to them. Their low sexual desire is not due to a medical or mental health problem, problems in the relationship, medicine or other drug use.

ADDYI is not for use in men or to improve sexual performance.

Skip Straight to Answers

Ready to get started?
Book a telehealth appointment today

Important safety information

What is the most important information I should know about ADDYI?

ADDYI can cause severe low blood pressure and fainting (loss of consciousness). Your risk is higher if you drink alcohol close to your dose. Do not take ADDYI with certain medicines or if you have liver problems. To lower your risk of low blood pressure and fainting:

• Do not drink alcohol close to the time you take ADDYI. Skip your dose if you had three or more drinks before bedtime. Wait at least two hours after one to two alcoholic drinks before taking ADDYI. After taking ADDYI, do not drink alcohol until the next day
• Talk to your doctor about the medicines and supplements you take and before starting any new ones.
• Do not take ADDYI if you have liver problems.
• If you feel dizzy or lightheaded after taking ADDYI, lie down right away. Get medical help if symptoms do not go away.

Speaking up: The importance of advocating for yourself

“The very first step is to determine what has caused a patient’s decrease in sex drive. To do this, a patient needs to be as honest as possible concerning their issues of low libido. This will help provide the most effective approach to treatment,” says Dr. Lerebours.

Beverly Young, MD, is a psychiatrist and cofounder of BRIA Academy, where she teaches therapists about sexual health changes in perimenopause. She says, “Women feel like something is not right, but are often ashamed to talk about it.” That’s why the healthcare provider’s approach matters so much. “The most important thing a physician or therapist can do is to ask a woman about her sex life in a non-judgmental and objective way.”

These conversations should have zero stigma. “It’s amazing how just asking the questions will elicit answers, almost like women have been waiting to talk about this issue,” Dr. Young says. “It’s comforting to find out that HSDD is a real health issue and that many other women suffer from the same concern.”

Finding a doctor who truly understands HSDD

Women need knowledgeable, compassionate healthcare providers—especially when trying to navigate HSDD. “Not all doctors learn much about low libido after menopause and its other changes, which is a freakin’ scandal given that half or so of the population will eventually need a doctor who understands what their menopausal patients are going through,” says Carol Queen, PhD, a sexologist, educator and LGBTQ+ advocate, pointing out a troubling gap in medical education.

Still other doctors might simply gaslight women into thinking it’s normal and natural to watch their libido vanish over time.

The best advice: Advocate for yourself by finding a doctor who can listen and understand. More and more women these days are having luck with telehealth appointments for sexual concerns, which offer privacy and convenience. Woman’s World is making it easy to connect with medical professionals who understand HSDD. Click here to schedule a telehealth appointment today.

How Addyi (the ‘pink pill’) treats HSDD

One exciting development is the FDA approval of the prescription drug Addyi with the active ingredient flibanserin, used to treat HSDD. It’s not an on-demand arousal pill like like some of the erectile dysfunction treatments for men. It is a once-daily, non-hormonal prescription medication.

Though the exact way Addyi works is not yet fully understood, it’s thought to act on the pleasure centers of your brain—boosting dopamine and norepinephrine and downgrading serotonin. Health insurance is more likely to cover Addyi with a documented HSDD diagnosis in your medical file, which could bring the cost of the medication to as little as $20 per month.²

Once these brain chemicals are rebalanced with Addyi, our mental messages about sex begin to fire again more naturally. It may take between four and eight weeks³, but many women report feeling more desire, whether with a partner or enjoying solo intimacy.

Help for HSDD is within reach

At the end of the day, if you’ve been missing the intimacy and desire that once felt natural, you don’t have to accept that loss as inevitable. HSDD is real; it’s treatable and you deserve to feel like yourself again. With the right support, honest conversations with a healthcare provider and proven treatment options now available like Addyi, you can reclaim the vibrant, connected intimate life you’ve been longing for. As Eckert says, “Desire doesn’t expire.”

Important Safety Information Cont.

Who should not take ADDYI?

Do not take ADDYI if you:

• Take certain medicines that increase ADDYI levels in your blood (including some treatments for HIV, fungal infections, antibiotics, hepatitis C, heart conditions, or depression such as nefazodone)
• Have liver problems
• Are allergic to ADDYI

What should I tell my doctor before taking ADDYI?

Tell your doctor about all your medical conditions, including if you:

• Drink alcohol, use drugs, or have a history of substance abuse
• Have ever had depression or other mental health conditions
• Have low blood pressure or a condition that can cause it
• Are pregnant, planning pregnancy or breastfeeding

Tell your doctor or pharmacist about all medicines and supplements you take, as they may interact with ADDYI.

What should I avoid while taking ADDYI?

• Do not drink alcohol close to your dose
• Do not drive or operate machinery for at least six hours after taking ADDYI
• Do not drink grapefruit juice
• Do not take supplements such as St. John’s Wort, ginkgo or resveratrol, or certain medicines like cimetidine, without talking to your doctor

What are the possible side effects of ADDYI?

ADDYI can cause serious side effects, including:

• Sleepiness
• Low blood pressure and fainting

See “What is the most important information I should know about ADDYI?”

The most common side effects include:

• Dizziness 
• Nausea 
• Tiredness
• Trouble sleeping
• Dry mouth

This is not a complete list of side effects. Call your doctor for medical advice. 

See full Prescribing Information including BOXED WARNING at ADDYI.com/PI.

What is ADDYI?

ADDYI is a prescription medicine used to treat hypoactive (low) sexual desire disorder (HSDD) in both pre and postmenopausal women under 65 years of age who have not had problems with low sexual desire in the past, no matter the type of sexual activity, situation or sexual partner, and it is troubling to them. Their low sexual desire is not due to a medical or mental health problem, problems in the relationship, medicine or other drug use.

ADDYI is not for use in men or to improve sexual performance.

US—2600185.01

1. Rosen et al. (2012). The HSDD Registry for Women: A novel patient registry for women with generalized acquired hypoactive sexual desire disorder. The Journal of Sexual Medicine, 9(4), 1097–1107.

2. Eligible patients only. Restrictions apply. See Terms and Conditions.

3. Talk to your doctor if your HSDD symptoms have not improved after eight weeks.