Two FDA-approved medications can increase sexual desire in women, and a handful of off-label options and supplements show varying degrees of promise. Both approved drugs treat a specific condition called hypoactive sexual desire disorder (HSDD), a persistent loss of interest in sex that causes real distress. They work through different brain pathways, come with different trade-offs, and produce modest but measurable improvements for roughly half the women who try them.
The Two FDA-Approved Options
Flibanserin (brand name Addyi) is a daily pill taken at bedtime. It works by shifting the balance of brain chemicals tied to desire: it raises dopamine and norepinephrine while lowering serotonin. Think of it as recalibrating the brain’s motivation and reward signals rather than acting directly on the body. It’s approved for premenopausal women with HSDD.
Bremelanotide (brand name Vyleesi) is not a pill. It’s a self-administered injection given in the thigh or abdomen at least 45 minutes before sexual activity. It activates receptors in the hypothalamus, a brain region involved in regulating sexual response. Because it’s used on demand rather than daily, some women prefer its flexibility. It’s also approved only for premenopausal women with HSDD.
Neither drug is a quick fix for anyone who simply wants a boost. Both require a clinical diagnosis of HSDD, meaning a persistent, distressing drop in desire that isn’t explained by another condition, relationship problems, medication side effects, or substance use. A clinician also considers your age and life circumstances before diagnosing it.
How Well They Actually Work
The honest answer: modestly. In clinical trials, the difference between flibanserin and a placebo was about 10 to 15 percentage points across measures of desire, satisfying sexual experiences, and reduced distress. Roughly 48% of women on flibanserin reported meaningful improvement in desire scores compared to 38% on placebo. That means about 1 in 10 women benefits specifically because of the drug rather than the placebo effect.
Bremelanotide performed similarly. In two large trials, about 58% of women using it reported a meaningful response, compared to roughly 36% on placebo. Women using bremelanotide also reported a 25% improvement in desire scores versus 17% for placebo. These are real but moderate gains. For some women the improvement is enough to feel like a significant change; for others it’s barely noticeable.
Side Effects Worth Knowing
Flibanserin’s biggest safety concern involves alcohol. Drinking within two hours of taking the pill, or taking it after three or more drinks, can cause a dangerous drop in blood pressure and fainting. The FDA placed a boxed warning on the label for this reason. If you have one or two drinks, you need to wait at least two hours before taking your dose at bedtime. After taking it, you should avoid alcohol until the next day. Other common side effects include dizziness, sleepiness, and nausea, which is why it’s dosed at bedtime.
Bremelanotide comes with a different set of problems. Nausea is the standout: 40% of women in trials experienced it, compared to just 1.3% on placebo. About 13% of users needed anti-nausea medication, and 8% stopped treatment because of nausea alone. Flushing affected 20% of users, headache hit 11%, and vomiting occurred in about 5%. A small number of women (about 1%) developed patches of skin darkening on the face, gums, or breasts. Overall, 18% of women on bremelanotide dropped out of trials due to side effects, compared to 2% on placebo.
Off-Label Testosterone
No testosterone product is FDA-approved for women in the United States, but some doctors prescribe low-dose topical testosterone off-label for postmenopausal women with low desire. The typical starting dose is about one-tenth of what’s prescribed for men, usually 5 mg of a 1% gel applied to the skin daily, sometimes increasing to 10 mg if needed.
Noticeable improvements typically appear within 6 to 8 weeks. If nothing changes after 6 months, treatment is usually stopped. Testosterone levels need monitoring every few weeks initially, then every 4 to 6 months once stable. Injections, pellets, and oral testosterone are not recommended for women because they can push hormone levels far above the normal range and increase the risk of side effects.
For premenopausal women, testosterone therapy for low desire is generally not recommended. The evidence of benefit in that group is still insufficient, according to current clinical guidance from the VA and other bodies.
Supplements and Herbals
Maca root is the most commonly discussed natural supplement for female libido. Some preliminary studies suggest it can improve sex drive compared to placebo, and one study found it helped postmenopausal women with antidepressant-related sexual problems. It doesn’t appear to work by changing hormone levels, and researchers still aren’t sure what mechanism is responsible. It’s generally well tolerated, and some practitioners report it helps their patients, but the overall evidence remains limited and inconclusive. There’s no established effective dose.
Other supplements like ashwagandha, fenugreek, and tribulus appear in libido products marketed to women, but the clinical evidence behind them is thin. Most studies are small, short, and not well controlled. None of these supplements are regulated for quality or potency the way prescription drugs are, so what’s on the label may not match what’s in the bottle.
Why Desire Is Harder to Treat Than Arousal
Male sexual dysfunction drugs like sildenafil work on blood flow, a relatively straightforward physical process. Female sexual desire is driven more by brain chemistry, hormonal balance, stress, relationship dynamics, sleep, mood, and dozens of other factors that no single pill can address. This is why the medications that do exist show modest effects and why many experts recommend combining medication with therapy, stress management, or addressing underlying causes like depression or hormonal changes from menopause.
If your loss of desire started after beginning a new medication, particularly antidepressants, birth control, or blood pressure drugs, that’s worth discussing with your prescriber. Switching medications or adjusting doses resolves the problem for many women without adding another drug to the mix.