What medications, such as Addyi (flibanserin) or testosterone therapy, can increase libido?

Medications to Increase Libido

For low libido, testosterone therapy is recommended if morning testosterone levels are below 300 ng/dL, while flibanserin (Addyi) is FDA-approved specifically for premenopausal women with hypoactive sexual desire disorder.

Testosterone Therapy

• Testosterone therapy should be considered for men with low libido if total morning testosterone levels are less than 300 ng/dL and there are no contraindications for replacement therapy 1
• Testosterone treatment has shown small but statistically significant improvements in global sexual function (standardized mean difference 0.35,95% CI 0.23-0.46) in men with low testosterone levels 1
• Testosterone therapy may also improve erectile function, though the effect size is smaller (standardized mean difference 0.27,95% CI 0.09-0.44) 1
• For optimal results, testosterone levels should be monitored and maintained within the normal physiological range 1

Flibanserin (Addyi)

• Flibanserin is FDA-approved specifically for premenopausal women with hypoactive sexual desire disorder (HSDD) 2
• Clinical trials demonstrated statistically significant improvement in sexual desire using the Female Sexual Function Index Desire Domain (FSFI-D) compared to placebo 2
• Dosing is 100 mg once daily at bedtime to minimize side effects 2
• Common side effects include dizziness (6.4%), somnolence (6.9%), and insomnia (7.7%) 3
• Important safety concerns include:
  • Risk of severe hypotension and syncope when combined with alcohol 2
  • Contraindicated with moderate/strong CYP3A4 inhibitors 2
  • Not approved for postmenopausal women, though studies suggest potential efficacy in this population 3

PDE5 Inhibitors

• While primarily indicated for erectile dysfunction, PDE5 inhibitors (sildenafil, vardenafil, tadalafil) may indirectly improve sexual desire by enhancing erectile function and sexual confidence 1
• PDE5 inhibitors have demonstrated high efficacy for erectile dysfunction with approximately 69% of men reporting improved erections versus 35.5% with placebo 4, 5
• PDE5 inhibitors may also help with orgasmic problems in men 1
• Dose-related improvements have been observed with sildenafil (50 mg vs. 25 mg shows improved efficacy) 4
• Common side effects include headache, flushing, rhinitis, and dyspepsia 1

Combination Approaches

• For men with erectile dysfunction and low testosterone, combination therapy with testosterone plus PDE5 inhibitors may be more effective than PDE5 inhibitors alone, though evidence is limited 1
• For women with HSDD, integrating pharmacological treatment with sex therapy may provide optimal results given the multifactorial nature of sexual desire disorders 6

Important Clinical Considerations

• Always rule out underlying medical conditions (diabetes, cardiovascular disease, depression) that may contribute to low libido 1, 5
• Consider medication side effects as potential causes of low libido before adding medications to increase desire 5
• For patients with low libido and psychological concerns (anxiety, depression), appropriate treatment of these conditions may improve sexual desire 1
• For patients with HSDD not responding to first-line treatments, referral to a sexual health specialist is recommended 1

Common Pitfalls

• Prescribing testosterone for men with normal testosterone levels is not recommended and may increase risks without clear benefits 1, 5
• Using flibanserin with alcohol significantly increases risk of hypotension and syncope; patients must be counseled to avoid alcohol completely while taking the medication 2
• Failure to recognize that sexual desire problems often have multiple contributing factors (psychological, relational, biological) that may require comprehensive management 6, 7
• Not providing adequate follow-up to assess medication efficacy and side effects 5