Low Libido in Women: Causes, When It's HSDD, and the Treatments With Trial Data

Low libido vs HSDD: rule out the causes first

Desire varies, and lower desire is not a disorder on its own. The drug labels define HSDD as low sexual desire that causes marked distress or interpersonal difficulty and is not due to a co-existing medical or psychiatric condition, problems within the relationship, or the effects of a medication or other drug ^[1][2].

That definition doubles as a checklist of common causes: depression and other conditions, medicines, relationship strain, and menopause symptoms such as vaginal dryness and pain. Treating an underlying cause comes before a desire drug.

Blood tests do not diagnose it. The Endocrine Society recommends against diagnosing an "androgen deficiency syndrome" in healthy women and notes that testosterone levels did not predict who responded to treatment ^[7].

Addyi (flibanserin): a nightly pill

Addyi is taken as 100 mg once daily at bedtime ^[1]. Its label, updated in December 2025, covers women under 65 with acquired, generalized HSDD ^[1]; when the FDA first approved it in 2015, it was for premenopausal women ^[5].

In three 24-week trials in premenopausal women, it added 0.5 to 1.0 satisfying sexual events per 28 days over placebo. In a trial of 902 postmenopausal women under 65 (mean age 55), the difference was 0.4 events per 28 days ^[1]. A meta-analysis of 5,914 women found a pooled gain of 0.49 events a month, with dizziness 4 times and sleepiness about 4 times as common as on placebo ^[5].

The label carries a boxed warning: alcohol close in time raises the risk of severe low blood pressure and fainting, so users should wait at least 2 hours after one or two drinks before the bedtime dose, or skip it after three or more. Moderate or strong CYP3A4 inhibitor drugs are contraindicated ^[1].

Vyleesi (bremelanotide): an as-needed injection

Vyleesi is a 1.75 mg injection under the skin of the abdomen or thigh at least 45 minutes before sex, no more than one dose in 24 hours and no more than 8 a month. It is indicated for premenopausal women only and should be stopped after 8 weeks if there is no improvement ^[2].

Nausea was reported by 40% of users, and 13% needed anti-nausea medicine. It raises blood pressure briefly after each dose (by up to 6 mmHg systolic), and 18% of trial users stopped because of side effects vs 2% on placebo ^[2]. Our PT-141 online page covers access and cost.

Testosterone: off-label, for postmenopausal HSDD

Testosterone preparations designed for women are not available in the US, the Endocrine Society notes ^[7], and the 2019 global consensus statement says that where no approved female product exists, off-label use of a male product in female doses, with blood levels kept in the female range, is reasonable ^[3]. The statement, endorsed by menopause, endocrine and sexual-medicine societies, says the only evidence-based indication is HSDD in postmenopausal women diagnosed after a full biopsychosocial assessment, and it recommends against compounded testosterone, pellets and injections ^[3].

A meta-analysis of 36 trials with 8,480 participants found testosterone increased satisfying sexual events by 0.85 a month, with gains in desire, arousal, orgasm and pleasure and less sexual distress ^[4]. Our testosterone for women page has the details.

After menopause: treat pain and dryness

For genitourinary symptoms not relieved by over-the-counter products, the 2022 position statement recommends low-dose vaginal estrogen or other therapies such as vaginal DHEA or oral ospemifene ^[8].

Vaginal DHEA (Intrarosa, prasterone) is FDA-approved for moderate to severe pain with sex due to menopause, as one 6.5 mg insert at bedtime ^[6]. See our vaginal estrogen online page and our DHEA for women explainer.