Can Diane (ethinyl estradiol and cyproterone acetate) cause decreased libido?

Diane (Ethinyl Estradiol and Cyproterone Acetate) and Decreased Libido

Yes, Diane (ethinyl estradiol and cyproterone acetate) can cause decreased libido as a known side effect. This is primarily due to the anti-androgenic properties of cyproterone acetate, which can significantly impact sexual desire.

Mechanism of Action and Impact on Libido

Diane contains two active ingredients that can affect libido:

1. Cyproterone Acetate (CPA):

   • Acts as an anti-androgen by blocking androgen receptors
   • Reduces testosterone levels
   • Testosterone is crucial for maintaining libido in both men and women

2. Ethinyl Estradiol:

   • Combined hormonal component that can alter hormone balance
   • May increase sex hormone-binding globulin (SHBG), further reducing free testosterone

Evidence Supporting Decreased Libido with Diane

Research directly examining Diane's effects on libido shows:

• In a study of women with hirsutism treated with cyproterone acetate and ethinyl estradiol, reduced libido was reported in 4 out of 10 patients 1
• The FDA label for ethinyl estradiol specifically lists "changes in libido" as a reported adverse reaction 2

Risk Factors for Decreased Libido

Several factors may increase the likelihood of experiencing decreased libido while taking Diane:

• Hormonal fluctuations: Significant fluctuations in testosterone levels are associated with decreased libido in women 3
• Pre-existing conditions: Depression and vaginal dryness can compound medication-induced libido changes 3
• Duration of treatment: Longer duration of anti-androgen therapy may increase risk of sexual side effects

Clinical Considerations

When prescribing Diane, consider:

1. Baseline assessment: Evaluate pre-existing sexual function before starting treatment
2. Monitoring: Regular follow-up to assess for sexual side effects
3. Alternative options: For patients experiencing significant decreased libido, consider:
   • Adjusting dosage if possible
   • Alternative treatments with less impact on sexual function
   • Referral to sexual health specialist if symptoms persist

Management of Decreased Libido

If decreased libido occurs:

1. Validate patient concerns: Sexual health is an important component of quality of life 4
2. Consider medication adjustment: Weigh benefits of treatment against sexual side effects
3. Psychosocial support: Sexual counseling may help patients integrate and adapt to changes 4
4. Rule out other causes: Depression, relationship issues, and other medications can contribute to decreased libido 4

Important Caveats

• The anti-androgenic effect of cyproterone acetate is likely the primary mechanism for decreased libido 1
• Sexual dysfunction is multifactorial and may involve both physiological and psychological components 4
• Patients should be informed about this potential side effect before starting treatment
• Decreased libido may persist throughout treatment but typically resolves after discontinuation

For patients experiencing significant impact on quality of life due to decreased libido, a thorough evaluation of the risk-benefit ratio of continuing Diane should be conducted, with consideration of alternative treatments if appropriate.