So, friendly reminder those who forgot: while there are definitely women and other humans with vaginas who experience sexual dysfunction and would love to take a pill about it, Addyi is almost certainly not that pill.

A few facts:

Flibanserin was officially approved to treat hypoactive sexual desire disorder, a diagnosis removed from the DSM before the drug hit the market. As far as I can determine, Addyi is not currently approved to treat HSDD's replacement diagnosis, female sexual arousal/interest disorder (FSAID).

One of the major differences between HSDD and FSAID is that HSDD could be diagnosed on the basis of a partner's report of insufficient sexual desire, while FSAID must be diagnosed based on patient reports. Basically, you can get diagnosed with HSDD if your boyfriend doesn't think you're putting out enough, whereas you can only get diagnosed with FSAID if YOU, the patient, think there's a problem. And Addyi claims to treat the boyfriend version.

Side effects of flibanserin include dizziness, nausea, tiredness, sleepiness, and (ironically) trouble sleeping. Those are not the kind of side effects anyone would put up with from Viagra, but hey, apparently they're fine in a "little pink pill".

When flibanserin was first released in 2015, it included a "Don't drink alcohol ever" warning on the bottle because mixing the two substances could torpedo blood pressure. Apparently that's been downgraded to "either sober up before you take your daily pill, or skip it for the day if you've had 3 or more drinks".

Daily pill? Daily pill. Unlike Viagra, which can be taken more or less at the moment of need, flibanserin is supposed to be taken daily if it's to be effective.

And how effective is it? Not very! The most recent published studies are vague (or at least their publicly accessible summaries are), but the studies released with the initial marketing push in 2015 were touting effects like one whole additional satisfying sexual event per month, and the more recent ones are vague about everything except "it's totally better now". That's not a lot for an expensive daily med with serious side effects.

So if this med doesn't really work, it has serious side effects, and it claims to treat a disorder that hasn't been on the books since two years before it was released, how the hell did it get FDA approval? The answer is a massive marketing campaign, including an astroturf group called Even The Score that was put together by the pharma company Sprout Pharmaceutical after the FDA initially denied approval.

But don't worry! Sprout was acquired by a bigger pharma company, Valeant, for $1 billion right after Addyi hit the market. So there's a happy ending after all. 🫠

I realize griping about the marketing of a decade-old drug is kind of off-brand for me, but I'm frankly creeped out that someone decided to follow up The Misogyny Election with a massive ad buy for a daily roofie that can be prescribed if a woman's partner wants more sex than he's getting. It's very "your body, my choice".

Oh, and it'll run you $400 a month.

I was going to delete this ask because it’s in the FAQ and that’s the rule. However, you are an asexual therapist? 

Q: What’s wrong with flibanserin/addyi/“female Viagra”

A: You can see a collection of articles here. There’s a bunch in that tag from my favorite article on the matter to mentions of an asexual task force 4 years ago that was like whoa whoa why are targeting us with your marketing here? 

If you’d like to learn the history of this beyond just Addyi there is a documentary called Orgasm Inc on Netflix. It’s from 2009, but it gives you backstory long before the Addyi problem. The documentary is sexual in nature so beware of that, but does have some gems like the following. The clearest example of corporate sponsored creation of disease is female sexual dysfunction. - Ray Moynihan, British Medical Journal.

Addyi at least (I’m not versed with Vyleesi) was a once a day pill, that had a high bar of don’t do other things while on this and a very low bar of added sexual encounters while on it. (I think it was +2 every month) It was also only to be used on a young population and when loss of sex drive is reported and not linked to another problems is most often reporter older people which this was not made to help.

I’d also like to link you to the asexual related DSM post I have that mentioned how in 2013 “*If Asexual Does Not Apply” marker was added. Which even the phrasing makes me worry “What if they don’t know the label? What if they hate their asexuality?” But you’d know the common phrasing of it better than me. 

I think it is you absolutely your place and your due diligence as an asexual therapist to be bothered by this until you know acephobia isn’t being spread in the name of mental health. 

(Link to the post mentioned)

The ads also make me uneasy. 

Long story short for some more context, HSDD isn’t even in the DSM-V (latest psychiatric diagnostic manual), and the updated related diagnoses have exceptions for if a person self-identifies as asexual while HSDD does not. (But what if a person hasn’t heard of asexuality but would otherwise self identify as such? And since the drug is approved to treat HSDD not the newer FSAID, does that even matter?)

Also the drug doesn’t even work as it’s marketed, so whoops?

Imo, its existence is basically pathologizing low/no sexual desire (especially in women) and if that is seen as a problem that needs medicated, and if asexuality isn’t very widely known, its very easy for this all to make an unnecessary mess. It’s very compulsory sexuality, it’s very amatonormative, and it’s very pisses me off.

Somewhat luckily, flibanserin was originally approved in 2015 and was kind of a flop. Still, the ads I was seeing were concerning because of the same reasons different drug(?). There is some conversation in the notes of the post linked above and I will also link some older posts about flibanserin if anyone is interested in reading more.

I saw your questions about addyi/flibanserin and why it gets so much criticism - it’s got a bit of a complicated history but here are a couple of initial links that can give some additional background: Rotten Zuchinnis has posts about it here and  here, and I have some scattered thoughts about the latest campaign and their previous campaign (with many of the same problems). You can also see posts from the ace flibanserin taskforce (which unfortunately is no longer active). For more mainstream criticisms (that are less focused on implications for ace communities), the NWHN also has a summary and the CNN article in the original post has a decent summary of some points as well. 

The most common critiques are that it barely works, if at all (they had to try a bunch of different testing measures until they found one that didn’t indicate that it was almost all placebo effect); that it has dangerous side affects that may outweigh any potential benefits; and that the marketing blatantly targets groups who are completely contra-indicated for a diagnosis of HSDD* and who the drug has not been approved for. ( *technically speaking, as of the DSM-5 updates in 2013, [M]HSDD is only used to refer to low sexual desire in men, and the equivalent low desire disorder for women is classified as FSIAD. Which is another reason I would be hesitant to trust that site as an appropriate medical information provider. )

With regard to the new campaign in the post:  The first thing to know is that the ad campaign in question is funded entirely by Sprout Pharmaceuticals, the company that sells the only HSDD* drug on the market, so they have a vested interest in getting people diagnosed and on pills, whether it’s appropriate or not. They have no interest in actually giving accurate information about HSDD/FSIAD or women’s health in general.

Unfortunately “you should take this drug to make your husband happy / save your relationship” is pretty much one of their main selling points: 

Also, technically speaking, HSDD is only supposed to be diagnosed when:

1. It is causing clinically signficant distress to the patient 2. The patient is not post-menopausal 3. The loss of desire cannot also be explained by much more common causes like  relationship troubles, stress, pregnancy, menopause, pain during sex, other medical issues, etc.

However, if you take the quiz, even if you check every single contra-indicator and state that you have no distress, it will still recommend that you talk to your doctor about HSDD. The wording of the quiz questions is also explicitly framed in such a way that long term low libido is positioned as if it’s always a bad thing - even if in previous questions you indicate that you have no problem with low libido and see it as a healthy state for yourself:

Anyway, that’s just touching the surface. I have a longstanding grudge against Addyi and the way it’s marketed so I’m happy to elaborate if anyone has more questions about it or why so many of us are mad about.

Looking at some old arguments about Addyi/Flibanserin...

One thing that always frustrated me, is that so much of it was arguing, not with people who suffer from HSDD, but with people who have taken it upon themselves to defend the group.  It is demanded that we empathize with people with HSDD, but my usual method of feeling empathy for a minority group involves listening to people who are actually in the group, not just listening to their proxy defenders.

And the thing is, even when you seek out people with HSDD, they’re hard to find.  Therapists say they’re common, but as a group they entirely lack any self-advocacy.  Back in 2010, I helped to initiate an interview a female sexual dysfunction activist, but they did not have HSDD, and to my recollection did not mention knowing anybody with HSDD.  I have come no closer since then.  You can try looking at sexual dysfunction forums--asexuality is frequently mentioned but HSDD is practically never mentioned.

I’m glad you found the information useful. ( These [ text ] are my FAQ’s to which you might have been referring. ) 

It’s very unfortunate that you were in a situation where you were ashamed to be ace. I look forward to a world where nobody is ever made to feel that way. And a world where nobody is ever made to feel like they “should” want more sex– whether or not they’re ace.

In terms of the other stuff ( e.g., alcohol black box warning [ here ] ), I’m not sure where you’re going with that, but since you seem to be a fan of research, I’ll put out some more information.

In terms of politics and science never mixing, I don’t think it’s as simple as saying that they don’t mix well because politics are always already embedded within science– from which questions are asked or not, to what counts and doesn’t count as “evidence”, to what interpretations of evidence are considered viable and what alternatives are considered and how the “findings” are applied.

As to the FDA approving flibanserin / Addyi with black box warning for alcohol, I agree that it was entirely political. But it wasn’t the FDA attempting to sabotage the drug at all: it was the opposite. 

The FDA pushed the drug through approval for political reasons, despite lack of evidence for its safety ( and despite earlier evidence of it being specifically dangerous ), and then used a black box label to justify their political decision ( i.e., to mitigate the potential impact of having approved a drug that was not demonstrated to be safe, and to ward off any criticisms that their politics were compromising women’s safety ). Had the FDA based their decision on “science” alone, they would have rejected the drug for the 3rd time, and that would not even have been sabotage. 

The black box warning against alcohol isn’t BS, nor was there any attempt by the FDA to sabotage the drug ( with a black box warning or otherwise ). Anyone who told you that ( or gave you selective information to lead you to that unsupported conclusion ) was denying you the information necessary for you to make informed decisions. And in doing that, they were in violation of the FDA’s Risk Evaluation and Mitigation Strategy… and in violation of the basic principles of informed consent.

Here’s a lenthy discussion below the cut of:

of the FDA’s purpose ( and the goal of evidence-based medicine )

why the FDA approved Addyi / flibanserin ( i.e. for political reasons ), 

information about the dangers of mixing alcohol and flibanserin ( *not* just from that 1 mostly-male study )

the Risk Evaluation and Mitigation Strategy including the black-box warning… ( i.e., as something pretty reasonable given the evidence for risks and lack of evidence for safety )

Una de las reacciones más comunes de quienes escuchan por primera vez acerca de la asexualidad es preguntar si acaso no se tratará más bien de una enfermedad o trastorno no diagnosticado.  Esto podría terminar solo en una anécdota, una más de las formas en que la asexualidad se suele negar en lo cotidiano, si no fuera porque estos comentarios son muchas veces respaldados y llevados a la práctica por profesionales relacionades al área de la salud.

Los diagnósticos más comunes son trastornos relacionados al deseo sexual, así que en esta publicación les hablo de qué son, cuáles son los avances en torno a la asexualidad del último manual diagnóstico de la Asociación Psiquiátrica Estadounidense (el DSM-5), y una visión general acerca del medicamento más reciente para su tratamiento, la flibanserina.

Para más información relacionada, visiten Recursos sobre Asexualidad para Profesionales de la Salud

So, this is basically like @redbeardace​‘s Asexuality in the DSM-5, plus context, plus a summary of the flibanserin situation. And also like 32 links, because references for everything.