What medications can help with low libido?

Medications for Low Libido

For low libido, bupropion is the first-line medication option for both men and women due to its favorable sexual side effect profile and effectiveness in improving sexual desire. 1

Gender-Specific Medication Options

For Women:

1. FDA-approved medications for premenopausal women:

   • Flibanserin (Addyi): Specifically approved for acquired, generalized hypoactive sexual desire disorder in premenopausal women 2, 3

     • Dosage: 100mg taken at bedtime
     • Important warnings: Cannot be combined with alcohol (risk of severe hypotension and fainting) 3
     • Effectiveness: Approximately one additional satisfying sexual event every 2 months 2

   • Bremelanotide: Another option for premenopausal women with low sexual desire 1

2. Other options:

   • Bupropion: First-line option for women concerned about sexual side effects 1
   • Buspirone: 20-60 mg/day, shown to improve sexual function with low impact on libido 1
   • Testosterone therapy: For postmenopausal women, though safety data for hormone-sensitive cancers is limited 2
   • DHEA (dehydroepiandrosterone): Shown to improve sexual desire, arousal, and overall sexual function in survivors of breast/gynecologic cancer 2

For Men:

1. Testosterone therapy: First-line when total morning testosterone is <300 ng/dL 2

   • Contraindicated in prostate cancer on active surveillance or ADT 2
   • Can improve erectile dysfunction, ejaculation problems, and orgasm issues 2
   • Shown to improve sexual function, desire, and activity in older men 2

2. PDE5 inhibitors (e.g., sildenafil, tadalafil):

   • Primarily for erectile dysfunction but may help with libido secondarily 2
   • Contraindicated with nitrates due to risk of dangerous blood pressure drop 2
   • Start with conservative dosing and titrate as needed 2

Addressing Underlying Causes

Medical Conditions:

• Liver disease: Sexual dysfunction is common in chronic liver disease due to hormonal imbalances 2

  • In men: Low testosterone from hypogonadotropic hypogonadism
  • In women: Altered estrogen metabolism affecting the hypothalamic-pituitary axis

• Cardiovascular disease: May require specific considerations for sexual activity 2

  • Caution with PDE5 inhibitors if taking nitrates

• Alcohol use: Can affect the hypothalamic-pituitary axis and directly impact sexual function 2

  • Acamprosate may help maintain abstinence in alcohol-dependent patients 2

Psychological Factors:

• Depression/anxiety: Often contribute to reduced libido 1
  • Consider switching from SSRIs (which often cause sexual dysfunction) to bupropion or mirtazapine 1

Treatment Algorithm

1. Identify and address underlying causes:

   • Check hormone levels (testosterone, thyroid, prolactin) 2, 4
   • Review current medications that may affect libido (e.g., SSRIs, beta-blockers) 1
   • Assess for psychological factors (depression, anxiety, relationship issues) 4

2. First-line pharmacological options:

   • For men with low testosterone: Testosterone replacement therapy 5
   • For premenopausal women: Bupropion, flibanserin, or bremelanotide 1, 3
   • For postmenopausal women: Consider hormone therapy if not contraindicated 2

3. Lifestyle modifications:

   • Smoking cessation, weight loss, increasing physical activity, reducing alcohol consumption 2
   • These modifications have been shown to improve sexual function 2

Important Considerations and Pitfalls

• Do not ignore hormonal causes: Always check testosterone levels in men and consider hormonal status in women 2, 5

• Medication interactions: Be cautious with PDE5 inhibitors and nitrates; flibanserin has numerous drug interactions 2, 3

• Primary vs. secondary reduced libido: Distinguish between primary reduced libido (not associated with medical conditions) and secondary reduced libido (associated with hypogonadism, hyperprolactinemia, psychopathology) 4

• Multifactorial nature: Low libido often has biological, psychological, and relationship components that may all need addressing 6, 7

• Underreporting: Patients rarely volunteer information about low libido; direct questioning about sexual function is necessary 1

Remember that low libido is the most frequently reported sexual dysfunction and requires a comprehensive approach that addresses both the biological and psychological aspects of sexual health 8.