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

No one really owns this part for women. They do for men. It's urology. Absolutely right. That's right. Yes. But usually it falls under psychiatry. I know. I can't even. I mean, that is like, that is the biggest misconception, though, that everything that goes wrong for women as it relates to sex is rooted in emotion. And everything that goes wrong for men is rooted in biology. And that is the big diss. The views and opinions expressed on Unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. I first met today's guest, Cindy Eckert, many years ago, long before the Galveston diet or menopause education was even on my radar. At the time, I was a practicing general academic OBGYN. My world was pregnancies, deliveries, emergency surgeries, and the day-to-day rhythm of patient care. Cindy was speaking at a women's conference in Phoenix about her company, Sprout Pharmaceuticals, and the female low-libido drug she had developed and brought to market called Addy. But what struck me that day wasn't the drug. It was her conviction that female sexual health was real, important, and worthy of science, funding, and conversation. In four years of residency, I'd been trained to handle nearly every kind of pregnancy emergency, every surgical complication, every crisis that could walk through the door. But we had never covered female sexual health in any meaningful way. I didn't know that there were FDA-approved options that might even help. I didn't even know how to start the conversation. Up until then, when my patients wanted to talk about sexual function, I was completely unprepared. About a quarter of my patients, 20 to 25 percent, would pause just as I reached the door after an annual exam, take a deep breath and say, doctor, there's one more thing I need to talk to you about. And there I was, rushed, overwhelmed, another patient in labor, a surgery waiting, frozen in place while this woman gathered the courage to tell me she was struggling with sexual dysfunction. And I had no idea how to help her. The best I had been taught to say was something vague and dismissive, like try to relax or have a glass of wine. It'll get better with time. Sex was treated as something women give their partners, not something they deserve to enjoy. So when I sat in that audience listening to Cindy Eckert discussing women's sexual function with calm, clarity, and absolute purpose, it was groundbreaking. I felt a rush of recognition and honestly shame for what I hadn't been taught. I had tears in my eyes thinking, how did I not know this? How did an entire generation of physicians miss this? That day changed the way I thought about my field, my patients, and women's health as a whole. And it's why I am so honored to have Cindy here today to remind us that women's pleasure, desire, and agency are as valid and as worthy of care as any other aspect of our health. I'm Dr. Mary Claire Haver, a board-certified obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to Unpaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. Women in midlife face questions that don't come with easy answers. conflicting research on hormone therapy, financial decisions, relationship shifts, questions about your own health that require real thought, not just a quick search. Claude is an AI built for that kind of thinking. When you're trying to understand why experts disagree or work through something personal and complicated, Claude doesn't give you a quick answer and move on. It sits in the complexity with you, asks follow-up questions. helps you think through the trade-offs. And Anthropic, the company behind Claude, has committed to keeping Claude ad-free. Claude's responses will not be shaped by advertisers or third parties. When you're making decisions about your life, that integrity matters. Try Claude for free at claude.ai slash unpaused to see why problem solvers choose Claude as their thinking partner. This podcast is supported by FX's love story, John F. Kennedy Jr. and Carolyn Bessette. The new limited series from executive producer Ryan Murphy. It explores the complex courtship of the iconic couple considered to be American royalty, whose love story captured the attention of the nation. Their fairytale romance would unfold in front of the public eye, where their private love would also become a national obsession. FX's love story, John F. Kennedy Jr. and Carolyn Bessette. Watch now on FX, Hulu, and Hulu on Disney Plus for bundle subscribers. So welcome to Unpause. Thanks for having me. Where did you grow up? Okay, let's start. Rochester, Fiji, Rome, D.C. I was totally nomadic. My dad may have a sick sense of humor, so we moved every year from the fourth grade through senior year of high school. Oh, my God. Your dad was a diplomat? Yes, State Department and just truly like an adventurer to his core. So I'm grateful for that childhood. It was hard during it, but in retrospect, wonderful. We were expats for a couple of years. Yes, that's right. And so we hung out with a lot of State Department families and kids. And it was a really interesting learning of their lives and their lifestyles and this kind of moving every couple of years. But their kids were all so resilient and had these amazing adventures all over the world. So it was an experience I really enjoyed. Good for your kiddos, too. So good for my kids. Yes. Incredible. They're citizens of the world now. Yes. I say to my dad all the time, were you like secretly training me to be an entrepreneur? Was this your master plan? So was that your plan? What'd you go to college for? College business, like always a bit of a nerd, like loved what makes one thing great versus another. and I was lucky enough to have a female professor who like recognized that weird ambition of it. I don't know if it was ambition. It was a bit of like relentless curiosity. Like she knew. So she would give me extra assignments, like go read this magazine and tell me why this company is doing this thing. And she really cultivated that in me as a strength as opposed to like an odd, you know, quirk. Where did you do your undergrad? In D.C. I actually moved back to D.C. my senior year of high school. How fun. A new kid, your senior year. And like my single criteria is I will not leave this area. So I only applied to schools in the D.C. area. I didn't want to move again. I went immediately because of this professor. I made like a unilateral decision. I will work for Fortune's most admired company. OK. And at the time it happened to be Merck. It happened to be a pharmaceutical company. Like I think all the time, you know, the concept of sliding doors, Like, what if it had been aerospace? And this time it was Merck. And I told her I'm going to work for Merck. And I think she then got a little bit nervous. Like, you should apply a number of places. But as luck would have it, Merck was hiring. And I went there to learn from the best. And what did you do there? Sales. So started like first, you know, rung of the ladder. You have to move up. It's like a very big corporate, like you have to do this and you do this. And what was funny is while I was like, I felt like I'd won the lottery. I was working for like the most admired. I got in there and I realized very quickly, Cindy, you do not fit in big. You have a want for people to listen to what you have to say. And when you're like employee 4,472, they're like, just sit in the corner and do the thing you're hired to do. How long till you jump ship? Took me almost four years. So I'm very grateful for the training. Like foundationally, it was so good for me. Also in like what I didn't want to do. It taught me that as much just what I wanted to. And I went, my brother, I have two big brothers, very influential in my life. And one of them worked for a startup. And I was like, what's a startup? He worked for a dot-com company back in that day. And he was given equity. And I'm like, equity? And so I started chasing, how do I go to places where I also have a bit of skin in the game for the value I create? So I jumped ship four years later and never looked back. But you went back into pharmaceutical. Yeah, I was. I went to progressively smaller pharma companies where I was getting closer and closer to innovation. You know, I was getting into the places where they would hand you a job you'd never done before and they're like, you'll figure it out. And I loved it because that's what I loved about the industry. Like what Merck did awaken in me is my love of science and the impact you can have in people's lives. And so the closer I could get to that innovation that was groundbreaking or new, you know, I chased it relentlessly. When did you start your first company of your own? 2007. What kind of company? Pharma. Okay. Which is, you know, very like pharma startup feels like it doesn't fit in the same sentence. Pharma is so calculative, so difficult. Like, and yet I had this, you know, now a track record in the industry where I met all of these folks that were, you know, uninspired in big environments. I thought, well, what if we could put a collection of them together against a product? I was like, what could we do? That was really the thesis. I called the first company Slate. It was like truly clean slate. And did you have like a product in mind? I was going to go find a product. And we found at the time the only FDA approved long acting testosterone treatment for men. Okay. And that's how I landed in sexual health. So I was finding a product that wasn't marketed and that was an FDA approved. And that was the beginning of it all. What gave you the idea for Sprout? So you started with Slate. Did you sell that company or? Yes. So Slate was excellent because here I am in sexual health, right? And here's why I love sexual health. Change somebody's connection with the person they want to be most connected to. You change their life. It was like on a different level than any other category I had been in. I had been in all these different medical categories, cardiovascular, bone health, all of that. And then this was just so deeply meaningful when you had this impact in somebody's life. So here I am running a male sexual health company. I am the lone woman in pink in a sea of blue pills, as I like to describe it. And yet I was at a meeting in 2010 and they were presenting data on what it is that unlocks desire for women. And I looked around the room and recognized like no company was running toward this. And it was really like lightning struck me. How can I be a woman running a company and loving actually the difference I was making in men's lives, but not have the recognition that there are 26 at that time, FDA approved treatment options for men to lead a more satisfying sex life and not a single one for women. Did your team say, amazing, let's do that. So were they like Cindy? My all male board was like, hi, our company is flying. And listen, Slate was like a classic startup. You know, the first year you're just like, oh, it's so tough. And then you find your stride if you have a great product and it just goes like this. And we were loving that. Like we were the only long acting. It was a great technology. It is the original testosterone pellet, the FDA approved version that now is knocked off a lot of different ways. But, you know, we were doing so well. And then I get like this wild idea, like, no, no, we're going to go take this on for women. And we're small. And they're like, well, no, Pfizer needs to do that. Glaxo needs to do it. What are the big companies? And it was such a deep calling to me that I was doing no matter what. And luckily, I was convincing and they all went along. So we had to sell Slate off. Reason I called it Sprout is we actually acquired the technology of Addy inside of that company. And the day that we saw, we sprouted that out to start a new company and sold off Slate. And I looked at all of those investors and I'm like, I'm going to need some of that money back to go do this for women. And they said yes. So what was the next step in the process? Well, you know, I know this is where the story gets interesting. Yeah. Well, first, let me say, why did lightning strike me? I'm standing at the Sexual Medicine Society meeting in Miami, Florida. There's a researcher who's presenting a paper that had just been published in neuroscience. And what they had done is they'd taken women who were struggling with their libido, put them into an MRI. They'd taken women who were like, you know, I'm good. Like, nothing's changed. These women are like, I don't think about it anymore. Like, I want to, but I just don't. Something's happened. put them both in an MRI, expose them to porn, their brains light up totally differently. And they published this result. And it was like the room was looking at this brain scan imaging. And it was as if in a collective, all of us went like, holy shit, it's biology. And exactly at that moment, like it's almost so absurd that we hadn't considered it before that everything we had told women who were struggling with this issue was something rooted in her emotion. Relax, schedule date night, you're stressed. Those things may all be true. Right. But also, of course, we're wired biologically to have sex drive. And so the room looked at it and that is what really lit me up. So when we took on the science, you know, the fun was like, what do you do? You sit down with the FDA. The FDA actually defines success. FDA tells companies, these are the endpoints you must demonstrate in clinical trials with statistical significance versus placebo, right? So you have a roadmap. And that was the beginning as we just started out on that roadmap. Then it got interesting. So let's back up a little bit. Walk our listeners through what is Addy? So what is this drug? How does it work? Do you rub it on your vagina? That's such a great, great question. We are brain flow, not blood flow. I think this is the beginning of all of this. This is where desire Female Viagra is a misnomer. Totally. Right. Because there's arousal. And then there's desire. Totally. Viagra is for arousal. Yes. And it actually works in women. Yes, for sure. And desire is where most women complain. That's right. Adi is a mood drug. So it's got a fun origin story. You know, so does Viagra. Viagra is a blood pressure drug with a really interesting side effect of directed blood flow. And when they found that observation, by the way, this is common in like medications. This is the story of Botox, which was being used for, you know, helping folks with strip ismus or their eyes being crossed because it relaxed the muscle and actually was discovered because they're like, but wait a minute, all their wrinkles went away. Like this is the nature of drug discovery. So Adi was a mood drug that happened to have this really interesting effect in that it promoted sex drive. And once they saw that, like that, that was its it factor. I wonder, like, that's not a standard questionnaire question where women just like, hey, Hey, not only am I happier, but I want to have sex. You know why it was found? Because actually every other mood drug we have like on market today, so classically like an antidepressant. Decreases sex drive. Decreases sex drive. So when you're studying these drugs, you actually have to use an instrument that measures how much am I sort of killing your sex drive. Okay. And in this case, all the scores went the other way. And they were like, ooh, what? and then they changed the course of study right then and there. And they were looking at desire, as you said, desire specifically, because that is women's most common issue. Actually, what's interesting, even in our data, is once you ignite that desire, actually those other variables of sex, arousal, orgasm, everything improves. Right, because the neurotransmitters increase blood. I mean, you know, it all works together. It is. It's like I say it. My non-Dr. Mary Claire Haver way is you get the party started. The party starts in the brain. When you start the party in the brain, everything else starts to respond. And then you get a great sort of reward feedback loop because it's a better orgasm. So now I have more desire to do it the next time. So, yeah. Awesome. Okay. So we have this medication. Women have increased desire when they're taking it. Yeah. You're reading the studies. You know there's a biological component to this. And female desire is complicated. I describe it like a traffic circle. There's several things that kind of feed into it. But, you know, for the patients who have a great partner, a great relationship who used to have desire, and then now it suddenly is gone without like an environmental factor causing it. And they can orgasm. They don't have any issues with arousal. Yeah. This is a medication that may be helpful for them. A hundred percent. So if a woman hears this. Yes. And says I feel like this is me And I feel like I would like to try Addy This may be something I interested in Where does she go How does she find it Walk me through So any doctor can prescribe it but don be surprised if your doctor has never brought this up before And what we're finding is that women are really leading this conversation specifically. So some are our audiences, OBGYNs, family practice, all of the above in which a woman has really led this. And what they can expect is, look, you need to talk to your doctor directly and whether or not this is right for you. Let me say that. But it's just a return of that drive. The first thing we hear from patients in trials where it's working, and it's not a panacea, no drug works for everybody. But the first thing we hear is like, oh my gosh, I'm having little thoughts and fantasies again, which makes perfect sense when you think about the mechanism in the brain. And I was just at a trade show and a woman came up to me, she was a nurse practitioner, and she said, oh my gosh, I just sent my first nude. I'm like, okay, don't show it to me, but I'm so glad to hear. But it's that percolating of interest and desire. And then we see them being receptive to their partner, where they probably were going to bed early and avoiding sex, and then they're initiating themselves. And that's really the progression. How long, when you start the medication, would you expect? It works on neurotransmitters. So just like other drugs, wait. We basically say, You know, if at eight weeks you haven't seen a result, you're not going to. So you can stop taking it. But there's a climb. Like it's not zero to 60. You're not taking home the hot waiter tonight. Sorry, ladies. You are waiting because it's building in your system over time. And it's those little things that percolating that you start to notice and get back to that place where you were happy with your desire. It's very similar to all other mood drugs in that regard. Right. If we took an antidepressant, we wouldn't expect to be euphoric the next day. Right. It's going to take a little bit of time. And it's not that you're going from depressed to euphoric. Same with Addy, right? You're not going from never having sex to nymphomania. You're coming back to that place that you were happy with, that was your normal. Okay. I actually spent a year just talking to women with this condition before I ever pursued it. Because I wanted to see what was the there there. And at that time, I knew all of these amazing sex researchers in the world who'd built the the house of Viagra, so to speak, like all of those researchers. And I'm like, are you seeing female patients? Can I talk to them? And what's so funny that you just said that triggered me is every single one of them started the conversation like this with me. I love my partner. They wanted to make sure I knew like it. I love my partner, but like something's changed. Like it's like the switch went out. I heard it over and over and I, they were different walks of life, different ages, different background, different relationship status. Every single one of them told me the same story. And when I've been told that story over and over again for a year, I'm like, there is something there. And while I will concede that humans are complicated, this is what I do take issue with. Women aren't uniquely complicated. Like we're not uniquely complicated when it comes to sex. Men are complicated actually when it comes to sex too, right? So I think that's a bit of it. I mean, men in the Viagra trials get an erection on placebo. True. So like there is like this whole, you know, biopsychosocial thing going on. But I think that we've sort of allowed women to be so complicated that we didn't have to bother to fix it. I was taught that women tend to somaticize psychological conditions. So and that her decreased libido is probably a side effect of that. And there's not much we can do for that. That's the basis of my training. Okay, so you've got this drug. The whiny women. You know, preliminary studies are showing that, you know, it should work. Yeah. Now you go to the FDA. Well, you don't know, right? FDA, I go to the FDA, they give the roadmap and we did the work. Like we went out and we did these studies. What does the roadmap look like? So there were three things we had to prove. So in clinical trials, not one thing, three things. We had to prove that women who took the product had more interest in having sex, more desire for it, that when they had sex, it was more satisfying for them and that it actually decreased the distress they were feeling because of this issue. Because look, if you're not having sex and you don't care, you would never take a product for it. I mean, actually, I think what we miss because we joke about sex or we minimize it is people are really struggling with this. Like they're struggling not only in their relationships and interpersonally, but personally, how they feel about themselves. And so we had to measure those three things. So now you do the studies, you break the blind, you see like, okay, what's our effect versus placebo? And we'd made it. And I was so excited because you don't know. How many patients had you put through the trials? Yeah. And how much does this cost? Oh my God. Okay. So first of all, I'm very proud of this. We are the largest ever studied drug in women submitted to the FDA. 13,000 patients in our clinical trials. That is not the norm. The norm is when you include rare disease in there, it's like just a little over a thousand. But as you know, let's use Viagra as the comparator. They had about four thousand. OK, so look at that like that difference, right? Three times as many patients worth of data. And it cost hundreds of millions of dollars. I mean, I went out and by the way, VCs laughed me out of the room. OK, so what's VC venture capitalist? Right. So you have this drug. Yes. And you're like, I need to raise money to get people to invest in this so we can do these studies. Because you're not so expensive. Yeah. Because the trials are very, very, very expensive. So you have to go to rooms full of old guys and convince them. And that was not going well. No. And let me just remind you, I'd sold a company already with a male sexual health drug for hundreds of millions of dollars. And yet I remember presenting at the biggest healthcare conference, like the biggest banking conference where companies like me get to go showcase and you might get investors. And I started to talk about it and the whole room broke into laughter. Laughter. And I thought, you're joking me. And I can remember, like I had a countdown clock, you know, I was watching it like, this is your shot and you're losing this time. And I can remember, I like fast forwarded my slides as fast as I could to the brain scan imaging of women. And I pointed to that screen and stayed silent till the room went quiet. And I'm like, I'm just here to talk about the biology sex and women. Can I begin? And they all shut up and we started to go. But still, it wasn't getting me checks. I was laughed out of rooms. So we ultimately raised $100 million through private individuals. So I put all my money on the line, like all in. All in, I so deeply believe in this. And it's not about a product. It's always been about so much more than a product for me. So you've raised the money. You get the sign off from the FDA, prove these things. You have this giant cohort. Yes. And the numbers are in your favor. You're so excited. So excited. Then what happened? They say no. And I really, like, I couldn't believe it. How? How could they say no? Because they're the FDA and they get to make the decision ultimately. And really what they said, and this is the tell, is they said, well, the benefit is only modest and therefore no risk would be worth it. And I think really what you have to look to there is if we assign no value to the benefit of something, then sure, any risk would be too great. And were we really just saying that we don't think women need this? because we 26 times we looked at medications for men that have benefits and risks. And we said, yeah, here you go. Make the decision with your doctor. But we wouldn't do this. And it became like this media frenzy of like, oh, well, how many more times do they have sex a month? And how many more times is the right amount of times? And my answer to that is go ask the woman struggling with it. Go ask her if going from not having sex to having satisfying sex, even once a month, is meaningful. You ask her. Because in our trials, by the way, we also had to use an index. It's called the Patient Global Impression of Improvement. Just nerd terms for, does it matter? And they said yes, with statistical significance. And so data was on our side. I mean, when we got the news that FDA rejected us. I got to tell you, I was blindsided by it. I couldn't believe it. You did everything right. We did the work. You defined success and we made it with statistical significance. And now we're going to debate the merit of how much is enough for her to deserve it. That was brutal. And really, I thought the end. I mean, I can remember the day I got the news. I happened to be flying in. I'm based in Raleigh. I'd been in New York. And my assistant called me right when I got off the plane, like, oh, no, I need to tell you this because they'd sent it through. And I went to the office and I basically gathered everybody around the table and really to set the mood, like the champagne was chilling because we knew the results of the trials at that point. We'd broken the blind and like everybody came to the table, like here's Cindy is, here's the great news. And I said, go home and work on your resumes. It's over. And I took that weekend and I swear this is a bit of like women have always been the people who've directed me, right? Right. A woman who'd been watching the results. Nobody knew this tiny little company doing this at this point, right? No, the media frenzy hadn't even begun. And she reached out to me because she saw it like a blip probably coming across like AP or something. And she said, I need to speak with you. And she'd been a patient in one of our trials. I drove to DC, sat with her, and I was reminded of why I did it in the first place. Like it was for her. It was for her. It was the validation. And I went back on Monday morning. I gathered my team around the table and I said, we're going to fight the FDA. And my IT guy said, can you do that? I'm like, we're about to find out. And that really, the next day he put a pair of boxing gloves on my desk and they've been there ever since. So walk us through the fight. It was brutal in that like the minute we did that, Nightline shows up, right? Like here's this tiny little company rally, knock, knock. Hi, you're fighting the FDA. And then it just, everyone was coming and commenting. And what was really happening was the great cultural debate of does it matter for women to have pleasure? And we were maligned and smeared. You were. This is the part I remember as a young practicing physician with this new medication. It really doesn't help that much. The very first headline, like I still remember, was female Viagra. Isn't that jewelry? I mean, that's not that long ago. And so it just started coming. I mean, there were the things that were printed, the photographs of me where I'm red like the devil. My brother still has it as a screensaver on his phone when I call him, because what would a big brother be if not doing that to you? I look back on it. And at that moment, I just built an armor of pink, right? Like I was going to, we were going to have this conversation. Go ahead, come for me. Let's talk about it. Because in the end, I have the data and science cures bias. I'm not backing down. And that was really the with the FDA as well. You know, being in that room, my pink kept getting brighter and brighter and brighter because this was the conversation we were going to have that you minimize, view it as weakness. You know, go ahead, honey, just have a bubble bath. It'll be OK. No, no. I think, you know, progress begins when somebody says no out loud. And so it was a wild Good ride. A lot of smear. And the FDA, to their credit, opened their doors to the public. And this is actually their mandate. We pay for them with our taxpayer dollars. And their mandate is to put patients at the center of conversations. It's called patient-focused drug development. Who should we be talking to if not the people that are affected by the condition? And so to their credit, they had all these public meetings that were like a three-ring circus of media and picketers. And it's crazy. Because why? Because we so don't want women to have a medical option, an FDA approved medical treatment that is proven safe and effective to the standards of the FDA for a medical condition that was first characterized in 1977. So ultimately, we won fair and square on science, but women won. But you brought the patients into the FDA. Yes. And they did too. They invited patients into the, and they're the heroes of the story. I think about it like women who arranged for childcare, took time off work. And got up and told probably some embarrassing stories. You're at a federal agency and you're like opening the doors of your bedroom to tell your most private struggles. And they did it because they knew if I don't say it, it never changes. And like, they're my heroes. I'm going to get emotional. I sat in the audience with them, you know, watching them up there and they were mocked, ridiculed, berated. Stories were written about them in the press. And there was one moment in particular where a woman had just gotten up and said, like, really, this had caused the demise of her relationship. It wasn't sex alone. But once they stopped having sex, like all the resentment started to build. And she was on the brink of divorce and somebody got up and they said, hey, I have something you can do for this. Eat chocolate. and I just sat there gritting my teeth. I cannot believe we talk to women this way about a medical condition. What were some of the biggest misconceptions about female sexual desire that you, I mean, because I didn't know much about it. You had a lightning bolt moment watching those images of the brain scans. Which have been repeated all over the world now. Like Stanford did big work in the United States. It was discovered in the Netherlands. Like this is unequivocal. But that didn't trickle down. I know. But it's really so much about what is so deeply embedded culturally about our right to desire. So, you know, no one owns this in medicine. So OBGYN barely covers it. Totally. At least until 2018, I was a program director. Yeah. We didn't touch on desire just barely. Right. And I got zero in my training. Yeah. And urology, they get tons for men and almost nothing for female, you know, family medicine, all the primary care docs. But OBGYN, really, there's not, you know, a female sexual specialty. I mean, there's organizations that you can join after you finish your training. That's right. Like Ish-Wish. Sure. But no one really owns this part for women. They do for men. It's urology. Absolutely right. That's right. Yes. Yes. But usually it falls under psychiatry. I know. I can't even. I mean, that is like, that is the biggest misconception, though, that everything that goes wrong for women as it relates to sex is rooted in emotion. And everything that goes wrong for men is rooted in biology. And that is the big diss. And it actually happens across medicine, right? It's what you talk about so beautifully all the time. I mean, we've had, you know, so far on the pod, We've had cardiology, urology, internal medicine, and obesity medicine. And really, it's everywhere. Like it's outside of the bikini, the breast, the uterus, you know, the part of the body covered by the bikini. Yes. You are a man with, you know, like Miss Potato Head. You just pop on the breast and pop in the uterus and ovaries. And that what we're understanding now and what I'm pushing is actually every cell in our body is different. Yeah. And it's going to respond differently. Yeah. To different medications. All right. So you go and you fight. Yes. And when did it get approved? It got approved in 2015. So we're at 10 years on the market, 10 years. And to this day, they print misinformation. That is crazy. We got approved. And I can remember it got approved. I was in my office. Of course, they waited until 730 at night. So I sat there all day. Oh my God, is it coming? Oh my God, is it coming? And all my family came and everything to wait for the big news. 7.30, we got it. I got on an airplane. I went, I mean, this was a huge news story. Like if you think about it, more women struggle with this than men have ED. So let's just contextualize like prevalence of this. ED is erectile dysfunction. Yes. So if you think about that, right, like more women struggle in the bedroom than men. Now there is for the first time ever an FDA-approved treatment option for it. And I went up to do the morning shows, and it doesn't change. The questions they asked, like a very famous broadcaster had me on to talk about the big news And he like yeah but it has side effects I like does the blue pill you take have any side effects Because I pretty sure there was death in the clinical trials But it not likely to happen in real life These are clinical trials. You test extremes to understand. And yet it's that. It's exactly the dismantling of WHI. It's the fear mongering that when something exists for a woman, we lead with the risk. And when something's for a man, we lead with the benefit. Time magazine put Viagra on the cover of Time magazine. It was the world's, like the biggest invention of its time. How long did it take for Viagra to make it through the FDA approval process? Oh, I love this question. Okay, let's do a tale of two sexes, pink pill, blue pill. Blue pill is deemed to meet such an important unmet medical need, a national emergency, if you will, that it was fast-tracked for approval in six months. Six months. Men getting erections was that important. Pink pill, six years. Two rejections, public meetings. and we had three times as many patients worth of data. There's more data. This is a great news story, but I do think it's missed because we often talk about in women's like sexual health, even we need more research and we need more research. Let's not miss that there's more research in a product for women's sexual health than any product for men's. We have research actually. Now we're finally having the conversation. Then you get approved and then you sell. I did. That was always the goal, right? Well, we were 34 people. I think nobody knows that. We were like this tiny little band of scientists. And, you know, I'm the business person. I have this great scientific team. And we were like determined on this mission. But, you know, this is a condition that affects, you know, first of all, half the population. The recent Mayo Clinic data said 50% of women over 50 have this. 50% of women. Okay. So huge prevalence. We're 34 people. This deserved the attention of a big company to globalize it, to do the education, to have the Super Bowl commercial with Bob Dole. I can think of like more interesting women than him on both of my hands that are, you know, on Addy. Like it was really that opportunity to scale. That was the dream. And then they didn't do it. Walk me through how you felt when you like they bought it and you're like, OK. Yeah. And they put it on a shelf. Brutal. I mean, never been more depressed in my life. We got one. We crashed the ceiling. where more innovation, more products would come to market for women. We sold it. They were going to globalize it. I was going to stay. Within three months, they dismantled our entire team and they shelved it. They never launched it. That's also a mistake that people make in this story because I think what happens is, oh, well, Big Pharma did it and it didn't work. No, women couldn't get it in the pharmacies. And I sat every day and thought about those women who went to a federal agency and said, please give me a product for this. And they couldn't get it. And I was crushed. Like I felt like I had let my team down, the medical community down, and those women down. It was brutal. But you got the company back. Hell yes. At some point, wallowing in my, like I said, progress begins when somebody says no out loud. I thought, not on my watch. No. And I picked myself up. They had at the time changed the CEO. And I asked the new CEO if he'd have breakfast with me in New York. And he sat down and I said, give it back. And he looked at me and he's like, what? Like, we've paid you a bunch of money for it. Like we own it. And I'm like, yeah, but women can't even get it. Give it back. And I will give him credit. Like it took us a while and a little bit of a battle, a legal battle. But ultimately, they did give the they gave the product back. And now we've had been able to launch it on our own terms. Still a tiny company. What's the hardest lesson you learned through this whole thing? That no matter what, the smear still comes. You just have to stay the course in issues like this where we've deemed them taboo or stigmatized or we feel no personal accountability for putting our opinion on somebody else's suffering. Yes. That is extraordinary to me. I do think it's breaking, but I do think it has taken a really long time. And I still sit with physicians who I love, who have no idea how this even works. No idea, nor would they bring up the conversation. And it's like bit by bit, you just keep going and you've got to build whatever that armor is that allows you to do that. What are the plans for Addy in the future? Maybe I will have a Super Bowl ad. I think I deserve one. It would have taken me this long to have, honestly, like somebody come out and admit they're on it. I mean, I know a lot of people behind the scenes who are on it, but, you know, they're nervous about having this conversation and like society's got to get to a place of permissiveness. I mean, when we got it back and we, you know, first we went back to the FDA and we unburdened the label with some nonsense actually that had been there. But we also like couldn't advertise because all of our ads were taken down because they said sex in them, which they have to by regulation because the name of the condition is hypoactive sexual desire disorder. And like we've had to change meta policy and this it's just been a long, a long road. But what's great is that once you change it, you change it for everybody else who's coming behind you too. Did you know that hormones can affect your skin? They can affect collagen, hydration, elasticity, all of it. 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Go to quince.com slash unpaused for free shipping on your order and 365 day returns. Quince is now available in Canada too. That's quince.com slash unpaused to get free shipping and 365 day returns. Quince.com slash unpaused. What advice would you give to, I know you mentor. you coach and you fund a lot of female tech and female entrepreneurs. Talk a little bit about that. That was the value of keeping the money that the big pharma company paid me. So even though I got it back, I kept their money. And that has helped with other female disruptors. And that's my love. Like, who's the person doing that work in particular? And how do you help them get there faster than you got there yourself? Like, what are the landmines they don't have to step on. And so we've done everything from infant formula made to standards that are better than what the FDA standards were at the time. They've improved them. And an epidural that's more comfortable for women. Those are the things I love when it's women's health and it's disruptive. A date break drug? Yes, that was to detect. Basically, I could stick my finger in this and see if there's a date or drug. Yeah, that was so cool for the Rohybnal. So if someone comes to you and is pitching something, how do you mentor and coach those women? It's so much less about the idea and so much more about who's championing it. It comes down to the jockey always. And I do see what are the stakes for them? What is that passion? I remember, I actually, it's funny, the guys, many of them who laughed me out of the room back in the day, I gave them a billion reasons to believe. And now they want to look at things with me when I'm thinking about investing. And I love that, actually. I think I never sat in the frustration or anger with them for having embarrassed me or laughed me out of the room. I kept the door open for them to make a better decision the next time. I think if you keep that open, you don't hold on to that, you actually allow them to change with you. But we were sitting in a room and a woman came in and I can remember she presented in the middle of the pitch, she started to cry. And we walked out of the room and it's funny. They looked at me and they were like, why didn't you say to her, like, listen, you know, there's no crying in baseball kind of thing. Like you can't cry in the middle of a pitch. And I said, boy, we see the world so differently. The moment she started to cry was the moment I knew I was, I was putting money in because I could see in her all of that emotion, all that passion that she's going to wake up every day and work on this tirelessly until she sees it through. Win or lose, she's going to put it all in the field. And like that was such a, and they were like, God, I've never thought about it that way. So, you know, I coach them to be authentically themselves. That's the truth, right? That is, that's the best lesson is show up in pink, right? Show up in pink and be you. And like, it's going to piss some people off. If you're changing something, 100% it will. But you just, you can never allow that to push you back or to tone you down. Yeah. I have, of course, my husband and I, me first, but then he's jumped in to help. You know, we have a company, we have self-funded, we've built this company from scratch. But we have through the years had VC and private equity come to us looking to perhaps invest. And so, you know, we take all the calls because why not? I want to hear what they have to say. And we've never accepted any, but there's this theme. And so, of course, I have a menopause company and it's always, almost always a man. And he has to start the conversation with his mother or for his daughters and why he wants to do this. And I know he seems sincere, but it's like, isn't this just a good fucking idea? Yes, it is. Exactly. You know, like, do you have to feign interest in women's health? It's like, when Viagra, when they were looking for investors in an erectile dysfunction, did they talk about the health of their son's penis? Right, exactly. You know, or their son's sex? I'd be like, this is a goddamn good idea. Of course. I mean, all you have to do is look at prevalence. You're like, okay, let's see, half the population, this percentage of them have it. Like I can see the sick of people sleeping on women's health. Yeah. And like this is this real. Totally. And women are ready to invest in their own health. Of course, they will rue that day. If you look at the control of wealth and everything else, the wealth transfer to women, etc. Like you are really out of touch if you're not looking at these opportunities right now. Yeah. And we still get the calls and we just kind of laugh. Yeah. OK. Yeah. Sure. How do you think like women's sexual health? You know, you've been in it. You've seen it from the men's side. sadly seen it from the woman's side, but I feel like things are changing. I do. I'm new to the party. Yeah. So but where how do you see this changing? We're having the conversation. I mean, I think that's extraordinary. And the conversation doesn't begin with nothing but hand wringing and qualifying language. Like it's really that we're saying, yeah, like, finally, we're talking about this. And and I think that people understand, like, it is my responsibility. I mean, look, this is my favorite thing of all. At this point, you can't become a board certified OBGYN, internal medicine, urologist, or family practice physician without answering a question about HSD and ADDIE. That's huge. That's how it changes, right? Once it becomes embedded in the education system. But I think even like in practice, I didn't get it in medical school, you feel it. Like you can feel this right now. A significant percentage of my non-pregnant patients complained about this. And I was a deer in the headlights, Cindy. I was like, I remember walking out to my boss at the time. You know, we'd go to our more seasoned wisdom, you know, older people, and who happened to be a man. I don't want to, you know, make this about being, you know, sexist. And he would say, oh, tell her to have some wine. You know, just very dismissive, very platitudes. and that there was nothing, nothing to do. And these poor women, and like you said, I love my husband. Yes, always. And so I started reading on my own and I found Venus and Mars in the bedroom. Do you remember that book? Yeah, I do, of course. And so I read it and I took notes from it. Of all things, this was the only piece of literature I could find because I've had access to the medical library. I'm scanning the literature and there was just almost nothing that wasn't rooted in psychology or psychiatry. So, you know, you telling that story as I had no idea what you were going to say, you were just a business owner talking about this business. And as an OBGYN, I was just sitting there like, and I remember standing up and just like, I think it was a little teary and being like, hi, I'm an OBGYN. And so many of my patients are complaining of this. And I have, I didn't even know about your drug. I didn't know that I could help them. So I love that so much. I remember that. I remember that meeting in 2016. I think it was. So many years ago. Look at this. We're almost at a decade from there. And it's just, but it is thanks to people like you. Like, I can't go. I write you. I send you little texts. I'm like, oh my gosh, I'm here. And every woman comes up to me and they're like, do you know Dr. Mary Claire Haver? And I'm like, I do. It's like my best rock star status. But it's really that women also are fed up. And so they're going to force the medical community to keep step with them. Like they're forcing this conversation in a lot of ways. There's so much that is good and bad about social media. But one of the good things I think is that stories of women that were kept behind locked doors, that women had begun sharing these things and everything from, you know, their sexual function to libido to, you know, how to make a chicken. But it's this feeling of, oh my God, that happened to me. And I don't want to say me too, but I'm not alone. Wow. I mean, one of my most viral videos, frozen shoulder, palpitations, things that no one had connected in the past on a larger scale with menopause. And I think people being honest and sharing their stories of their sexual function and their frustration and this real thing about libido, I think social media has allowed women to realize they're not alone. and that there's stuff that they can do for it. They don't have to suffer. Agreed. And I think there's been a dismantling of other even stigmatized conditions. Like I'm very interested in, I would be interested in your take, like the conversation around obesity. I got to speak in LA. So I asked this question to the audience. I'm like, by a show of hands, how many of you have ever tried a fad diet, right? And like the whole thing, right? The whole audience raised their hand. And I'm like, but there were people we've always known who like, no matter what they did, They couldn't get like the weight off. Like there was something and it's as if we're just now being like, sorry, it might also be genetics. Of course. And I think so too will the story go around sex for women that like, why would we not even consider that it would also be a biological issue? Like it doesn't mean it always is. If you in a bad relationship and that why you don want to have sex That the first question I asked No pill is going to fix it I was like do you love your partner I absolutely hate him I like well you need a new partner We can fix that right But I think that it just like thinking about us like if women could be considered, which you say, and it just makes me like, you know, the hair on the back of my neck stand on it every time you talk about the whiny woman, like the WW in the medical chart, like if we could just consider them like biological beings, And if we would start there in science, in a scientific interaction, we'd be so much further along. So I have a question that we had an expert on and we talked about the orgasm gap. Yeah. We talked about same-sex partners and heterosexual and how there's a difference there. Were any of the people in the study unpartnered? They were, so FDA criteria was that they had to be in long-term relationships and this had to have been going on for some period of time. That said, the measure of satisfying sex could also be masturbation. Okay. So it could be on the partner. What's the masturbation data say? It's good. I mean, more satisfying sex. And that might have been, for some of them, like their own masturbation, not partnered sex. So I think that was part of what was looked at. But like the enrollment criteria was long-term partnered, long time. Like women had been struggling with this for at least five years during the trials. You didn't have to, you know, if the FDA was not in the picture, how would you have designed this study? Oh, interesting. This is going to be the craziest thing that anybody has ever said designing a clinical trial. But I would have actually started with women who had survived breast cancer. And here's why. Because this is non-hormonal. And because I think we might have gotten out of our own goddamn way and had a little bit of compassion. And if you think about a woman who goes through that and has struggled and survived, and she's now given a life sentence of like a lack of libido and a lack of that intimacy, you would actually not be arguing about like, does it matter if she has it? Like, that's honestly what I would have done. I mean, this is, you can understand like in clinical trials, there's so much going on for, you know, a patient who has cancer that a lot of times that's not the population they would want to look at. They are very loud right now, which is great about our needs are not being met. Like, okay, you've cured my cancer, but you've left me with this armamentarium of side effects. And my quality of life is so poor. Listen, 80, it's north of 80, I'm going to say 85%, right? 85 to 90% of women who survive breast cancer will struggle with this medical condition that Addy treats. And yet less than a third get any information about it. And what's crazy to me now, I'm going to go back. Maybe the greatest thing I had in my back pocket is that I had built a company in male sexual health and I knew what happened there and what the trials looked like. And, you know, suddenly I started getting asked all different questions that I'd ever been asked before. But like when men survive prostate cancer, one of the outcomes of surgery might be that they become impotent or they have erectile dysfunction. You better believe we go to work on that fast. We're like, oh, that can't happen. So like, let's put them in a program. Let's have this. Let's have that. And yet here we are with women, cancer survivors, who are going to have sexual side effects. And we're like, well, just be happy you're alive. Well, you're alive, but you're not living or you're not living life on the terms that you want to live life on. That's how I would have done it differently. 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If you've been thinking about elevating your everyday look, this is your sign. You can get 20% off your first order with Jenny Bird by visiting Jenny-Bird.com and using the code UNPAUSED at checkout. What would you tell your younger self walking into those all-male meetings in your pink outfit? What makes you think that they know better? They may sit there. They may, you know, criticize your idea. they may marginalize it they may tell you it can never be done but why do you think they know better than you do so it's out we prescribe it in our clinic our patients are sometimes struggling to get it filled or covered yeah you have a good story i want you to share oh man i gotta tell you this is also like this is where it never ends right and like who bears the responsibility for this? Like, what journalist? Who wrote the article that minimized this, that said there was a reporter in the FDA announcement, sorry, sidebar, that just came out that was so big. And he stood up in the room. And I can remember the very first time I had a conversation with him about HSD. He's like, but aren't they just sad? And I thought, so it's just this reaction, right, that I have to it. now I lost my total train. So the story from denial. So listen to this. An insurance company sent a basically prior authorization, which is the hoop jumping that insurance companies do to try to deny. And so a woman who'd been like diagnosed with HSTD, been prescribed Addy by her physician, It's the, you know, one of the FDA approved drugs. She gets it. They send a prior out and they say, well, first she has to try marriage counseling. Just to fail marriage counseling. Fail it. What does that look like? Yeah. I don't know. If she sends her a divorce certificate, does she get the medication then? Is that what it looks like? This is a huge national insurer. Are you kidding me? You must first fail marriage counseling? Please. So, of course, you know me. I'm like, well, please show me a time in which you have required that a man fail marriage counseling before he gets Viagra, Cialis, any other medication. Because if you don't, I'm printing it on the front page of The New York Times. Like, this is the thing. It's unacceptable. We have to be thoughtful about what our responsibility is in that if we position this for women as just an emotional thing. Because then they can get away with saying it. I think that's, by the way, let me be a little optimistic here. I think that's the next domino to fall, that actually insurers are going to cover the things that are approved for women. That's the next domino to fall that actually, you know, because we talk a lot and, you know, we have this conversation as well about we can talk a lot about women need more funding. We need more research. We need more of those things. Yes. But for the things that do that, right, that get the research, get the approval, then they can't access them anyway. Right. So what is the incentive for anybody to go here and do that? And like, that's the thing that has to crack. I talk to rooms of friends who like have a perception like, well, there's nothing for women. I'm like, well, actually, look at this page I have of all of these different things are approved for you. You just have either never heard of them from your physician or they're not covered by your insurance. And that's crazy. Like, we can't have a world in which your vasectomy is covered, but your care for miscarriage is not. I often say, where do they think the Viagra-laden penises are going? You know, like you can't treat half of a couple. Yeah. And some of the, you know, feedback, does your husband know you're on this? And, you know, that I've heard from patients coming back of just how lots of people not in the relationship feel like they need to weigh in from pharmacists down to their insurance coverage. Unbelievable. And they don't see that when their husbands go get vasectomies or Viagra. Right. You know, but when you get your tubes tied or, you know. That's right. When it's your health, your right, your choice, you know, again, this is a bigger conversation. And don't, and let's just say this here. Don't mistake that paternalism is only male. Oh, God. Yeah. So many women are so paternalistic about this. And I think they're blinded by their own superiority. It really seems to be a certain generation. This really seems to be generational when I talk to other clinicians. One, if you're at the bedside, if you are treating the patient, it's less. If you are an academician who is not actually seeing patients sitting there getting the emotional like waves of this coming off of a patient, it's a lot easier for you to dismiss this and dismiss, you know, what this medication could do for the patient. I also think there is a definite generational thing where maybe this generation of scientists was not in their own socio, you know, psychological and socio biopsychosocial development. And this was not a thing. They were expected to serve and fade and not to embrace their own sexuality. Now, Lauren Stryker is not like that. You know, I had just had her on the podcast. Yeah. She's, you know, a little bit older than me and definitely has been training a lot longer. I was a geologist before, so I have a little gap. But, you know, it's not all. I certainly don't want to generalize this by age. But I do see, you know, if you're at the bad side, if you're actually treating patients and if you you tend to be have been brought up with this biopsychosocial sex is a good thing. You deserve to have pleasure. Yes. Then you're a lot more easy to embrace. Yes. There's just so much we have to dismantle. So much and so much judgment in it that we really need to self-examine of like, why would we? That was always what was so fascinating to me. Like, I feel like I've lived this like unbelievable social experiment, you know, in Addy, like watching reactions. and what is like the cultural embedding of that. But like what I could never quite put my finger on and I can never explain for another person is why would you ever stand in the way of somebody else having it? If you don't want it, no problem. Don't take it. Why would you not want somebody else to have it? What is that? Like what is that with sex or with women specifically that you feel entitled to stand in her way of having access to it? That is a crazy thing. And I will just say, because I'm a little less forgiving than you are for all of the, you know, excuses I have heard through the years of, well, I just wasn't trained on it. You know, I too was not trained on Microsoft Excel, and yet I've had to learn how to do it to be a CEO. And so I feel like there's also just a requirement in this world, right, to keep learning and evolving so that you can take the best care of people. What's one myth about women's sexual health? You want to retire forever. Okay. right here, right now, we're doing this. It's men's right to receive pleasure and it's women's to deliver pleasure. Own your pleasure in the bedroom, in life, in the boardroom, wherever it is, own your pleasure. Awesome. All right. What is the documentary, The Pink Pill, Sex, Drugs, and Who Has Control? Oh my God. Tell me the story. You were sitting at home one day and the phone rang. Actually, I'll tell you because it's a shared friend of ours, Dr. Rachel Rubin, gave a lecture in DC and she told my story. And a woman who was there for her own learning, because she was going through menopause, came up and said, do you know this woman? She's like, yes. And I can remember she called me and she was so excited. She's like, somebody wants to make a film about this story. I'm like, nope. And she's like, what do you mean? And I said, no, it's always twisted. Like I have so much PTSD from all the twisting and manipulation. And like, we've gotten so far, I couldn't look back. Like I've always been just like, keep going, just keep going, just keep going. We're going to make progress. And we have made so much progress that I didn't want to go backward and basically re-litigate everything again. And I will give credit, this filmmaker called me for three years. I was like, please don't ever call me again. And she's fabulous. She's like, you know, these are like award-winning women. Yeah, they're incredible. And ultimately, she said, look, we're telling the story sort of with or without you, but I'd really like for you to sit for an interview. And I sat for an interview. And she said, in order to earn your trust, I'll show you. So I have no involvement, like no editorial control, nothing. Right. So we just gave an interview. It's very scary for me because the product is doing so well in the market and we are shaking off the myths and misconceptions. And we are having this conversation. And she said, to earn your trust, I'll let you see a sneak preview. And I sat in a room and I cried like a baby. And I just think it honors why you fight for this, why the stakes, why it matters. And I think it honors all of the women in the room that day who stood very bravely and like you said told their most personal struggle to change it in front of a panel that was looking at them like this. And like they and they got mocked and they were made fun of and they did it anyway. And I think that's all my emotion in it when I watch it. And it's also so spectacular that it shows the you, right? What is the Mary Claire Haver effect? What is the Rachel Rubin effect? Like, what is this like this new guard of women who are just not accepting it anymore on behalf of other women? And we're saying women are smart. Give them all the information. They're going to make their best decision with their doctor. I believe that. Why do we gatekeep information or prejudge it? And it's just it honors that so deeply. And that is what I love about it. And I'm incredibly honored to be the subject of this film. Who would have ever thought? Like, again, when I started this, I built a company for male sexual health. I just thought, no, no, no, no, no. It's just because you could have taken your process. I mean, Cindy, you could have taken your big fat check. Yeah. Paid off your people. Yeah. And gone off into the sunset. You didn't have to work again, I'm guessing. I mean, you know, it's true. So, yeah, like you're always working. I'm always working. What is it? I know it's it's because this is my passion. And like I'm not I won't stop working until it's done. And when it's done is when we're not having these nonsense conversations. We're really treating women equally when it comes, not differently, equally. Like again, with the FDA, I never asked that we get special consideration. I asked that we got equal consideration. Same standard. That's it. That's all I asked for. And that's what I hope we get to in women's sexual health. I think it's the next frontier. All right. So why do you keep doing this, what is driving you right now? I've decided I'm allergic to hypocrisy. That is awesome. 2016, I sat in a room and you were the first person in all of my training and all of my years who made me look at how we treat women's sexual desire as a medical condition. And you changed my life. And therefore, you changed the life of all of my patients and now millions of followers. So thank you. I adore you. Thank you. You can find Cindy on Instagram at Cindy Pink CEO and through Addy's website at addy.com. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness and navigating midlife at thepawslife.com. My upcoming book, The New Perimenopause, is available for pre-order at Amazon. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on Unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.