Female Libido in Menopause: Desire Loss, Biology & Solutions with Cindy Eckert

Eckert emphasizes that women must lead this conversation because physicians receive minimal training in female sexual health. She notes that even OB/GYNs may have no knowledge of Addyi. The drug acts on neurotransmitters in the brain, unlike Viagra's blood-flow mechanism, so it's a mood-regulating therapy requiring daily use, not on-demand. In clinical trials, success was measured by increased desire, more satisfying sexual experiences (including masturbation), and reduced distress. Satisfying sex frequency increased from zero to something meaningful for patients. Eckert's company now provides resources for women to bring to their doctors.

Eckert identifies one myth she wants to retire: 'It's men's right to receive pleasure and it's women's to deliver pleasure.' She urges women to own their pleasure in all areas of life—bedroom, boardroom. This simple but radical shift counters internalized shame and passivity. It also empowers women to seek help for sexual dysfunction without guilt.

Eckert points out that board certification exams for OB/GYN, internal medicine, urology, and family practice now include questions on HSDD and Addyi. The host (Dr. Haver) shares her own experience of getting zero training in residency and feeling unprepared until she heard Eckert speak. This protocol aims to normalize sexual health inquiry and arm clinicians with evidence-based options.

Cindy Eckert recalls attending a sexual medicine society meeting in 2010 where a neuroscience paper was presented. Women with low libido and women without were shown erotic stimuli in an MRI. The brain activation patterns were starkly different. This collective realization—'holy shit, it's biology'—punctured decades of psychologizing female desire. Eckert saw that no company was pursuing this, and it sparked her mission to bring a biological treatment to women. The finding has since been replicated worldwide, including at Stanford, but the cultural bias persists.

Eckert details the stark contrast: Viagra approved in 6 months, Addyi in 6 years with public meetings and ridicule. Her drug studied 13,000 patients, three times Viagra's 4,000. The FDA required three endpoints—interest, satisfying sex, and reduced distress—all met with statistical significance. Yet the agency initially said no benefit would outweigh any risk. Eckert argues this signals that the FDA assigned zero value to female sexual satisfaction. The debate became a culture war, with media mocking the 'pink pill' and questioning whether women 'deserve' it. The fight involved public patient meetings where women testified about their suffering, facing mockery.

Eckert shares the story of a woman prescribed Addyi whose insurance sent a prior authorization requiring her to try and fail marriage counseling. Eckert points out that no insurer has ever required a man to undergo counseling before covering Viagra or Cialis. She sees this as a consequence of framing female desire as purely relational/emotional, giving insurers an excuse to gatekeep. She threatened to expose them in the New York Times. This illustrates the ongoing fight even post-approval.

Eckert spent a year interviewing women with low desire before pursuing Addyi. Every single one began by saying 'I love my partner, but something's changed.' She argues that while medicine acknowledges the biopsychosocial nature of male sexual function (e.g., men in Viagra trials get erections on placebo), women's sexual difficulties are still relegated solely to emotion. This asymmetry allows the medical system to dismiss the problem rather than treat it.