Many primary care providers are uncomfortable addressing low libido or sexual dysfunction, often dismissing these concerns as psychological or simply a normal part of aging. Even when they do investigate, many limit their evaluation to checking testosterone levels—and if labs are normal, they offer little beyond “try talking to a therapist.” We recognize that diminished libido significantly impacts quality of life and relationships, and we offer evidence-based medical treatments for patients with low libido even when hormonal testing is normal.

FDA-Approved Treatments:

Vyleesi (bremelanotide) – An injectable melanocortin receptor agonist administered subcutaneously (like an insulin pen) 45 minutes before anticipated sexual activity. Vyleesi works by activating pathways in the brain that regulate sexual desire and arousal. Clinical trials demonstrated significant improvements in sexual desire in premenopausal women with hypoactive sexual desire disorder (HSDD). Particularly effective for many patients, with relatively rapid onset. Can cause transient nausea or flushing in some users, but side effects typically diminish with repeated use. Used as-needed rather than daily.

Addyi (flibanserin) – A daily oral medication that modulates serotonin receptors (5-HT1A agonist, 5-HT2A antagonist) to enhance dopamine and norepinephrine while reducing serotonin in key brain regions regulating sexual desire. Requires nightly dosing and takes 4-8 weeks to reach full effect. FDA-approved for premenopausal women with HSDD. Generally recommended to avoid use with alcohol due to possible blood pressure and syncope issues.

Off-Label Alternatives – While we’re happy to prescribe the FDA-approved options above, many patients find them expensive or prefer alternatives. We’re comfortable trialing other medications that have shown efficacy for low libido with the caveat that they are off-label and rigorous evidence for effectiveness is limited.

PDE-5 Inhibitors (Viagra/Cialis) – While primarily indicated for Erectile dysfunction, these medications may offer some benefit for libido issues or general sexual dysfunction for patients of all genders

Buspirone – A 5-HT1A partial agonist (similar mechanism to Addyi) typically used for anxiety, but (possibly for some patients) effective for enhancing libido through its effects on dopamine and serotonin. Significantly cheaper than Addyi (generic available). Typically dosed 5-15mg 2-3 times daily or 1-2 hours before sexual activity.

Bupropion (Wellbutrin) – By increasing dopamine and norepinephrine, bupropion for some patients might enhance libido and may be particularly effective for patients with comorbid depression or low energy. Unlike SSRIs which commonly cause sexual dysfunction, bupropion can improve sexual function. Can be used daily as an antidepressant or in some cases as-needed.

Trazodone – While primarily used for sleep, low doses of trazodone (25-100mg taken 1-2 hours before sexual activity) may enhance arousal and genital sensation through its effects on serotonin receptors and nitric oxide. Some patients might find it helpful for arousal difficulties.

Mirtazapine – An antiserotonergic antidepressant that, at low doses (7.5-15mg), may enhance libido by blocking the serotonin receptors that inhibit sexual function. Can be taken nightly if sleep is also an issue, or used as needed.

Cyproheptadine – An antihistamine with antiserotonergic properties, often used as-needed (4-12mg taken 1-2 hours before sexual activity) to counteract serotonin’s inhibitory effects on sexual function. It might be useful for addressing SSRI-induced sexual dysfunction.

SSRI-Induced Sexual Dysfunction – These same medications can may be effective for treating sexual side effects from SSRIs or other psychiatric medications. Many patients on SSRIs experience decreased libido, delayed orgasm, or anorgasmia—side effects their prescribing provider may not have warned them about or may dismiss as unavoidable. Rather than simply accepting sexual dysfunction as the price of treating depression or anxiety, we can add medications like bupropion, buspirone, or as-needed cyproheptadine to possibly improve sexual function while maintaining the psychiatric benefits of the SSRI.

Our approach is individualized based on your specific symptoms (desire vs. arousal vs. orgasm difficulties), medication tolerance, cost considerations, and whether you prefer daily medication or as-needed dosing. We take sexual health seriously and believe effective medical treatments should be accessible regardless of whether labs show hormonal abnormalities.