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

They do for men, it's yourology. - Absolutely right, that's true. - 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 dis.

(upbeat music) 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 guests, 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 in 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've 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% 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, "Dry 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 Unpause. 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.

- So welcome to Unpause. - Thanks for having me. Where did you go? - Okay, let's start Rochester, Fiji, Rome, DC. I was totally nomadic, my dad may have a sixth 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 adventure 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 was great. - And so we hung out with a lot of state department using kids, and that was a really interesting learning

of their lives and their lifestyles, and this kind of moving every couple of years. But their kids were also resilient, and had these amazing adventures all of the world. So I was in experience, I really enjoyed.

- Good for your kids. - So good for my kids. - Yeah, incredible. - They're citizens of the world, yes. I say to my dad all the time,

“were you secretly training me to be an entrepreneur?”

- This is 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. - But 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,

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 DC? - I actually moved back to DC,

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 the schools in the DC area. I didn't wanna move again.

I'd went immediately because of this professor, I made like a unilateral decision. I will work for Fortune's most admired company. - Okay. - And at the time, it happened to be Mark.

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? In this time, it was Mark, and I told her, I'm going to work for Mark,

and I think she then got a little bit nervous.

“Like you should apply a number of places,”

but as luck would have it, Mark was hiring, and I went there to learn from the best. - And what did you do there? - Sales, okay. - Okay.

- So started like first, you know,

wrong 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 as a 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 sitting the corner

and doing 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 as 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?

- 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, like, how do I go to places where I also have a bit of skin in the game?

- Yeah. - For the value I create. So I jumped ship four years later, and never looked back. - But she went back into pharmaceutical.

- Yeah, 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 as my love of science and impact you can have in people's lives. And so the closer I could get to that innovation that was groundbreaking or new, I chased it relentlessly. - When did you start your first company of your own?

- 2007, what kind of pharma? - Okay. - Which is, you know, very, like, pharma startup feels like it doesn't fit in the same sentence. Pharma's so, so, so, 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 and big environments. I thought, well, what if we could put a collection them together against a product, 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 a, like, a product in mind? - I was gonna go find a product.

- And we found at the time the only FDA proved 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 proved in 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 'cause 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 on locks 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.

Oh my God, I like, Cindy. On my all male board was like, hi, our company is flying in 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.

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 gonna go take this on for women and we're small. They're like, well, no, Pfizer needs to do that.

Glock said needs to do it. What are the big companies? And it was such a deep calling to me that I was doing it 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 a 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 gonna 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, 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 exposed and deported. They're 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, oh, you should, 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,

your stress, like those things may all be true. That's true. Right, but also, of course, were 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 defined 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, you know, started out on that roadmap, then they got interesting.

So let's back up a little bit. Walk our listeners through. What is Adi? So what is this draw? Like, how does it work?

Yeah, Adi, rub it on your vagina.

That's such a great, great question.

We are plain flow, not blood flow.

“I think this is the beginning of all of this.”

Yeah, because this is where desire-- Demiagra is a misnomer. Totally. Right. Because there's a route.

Totally. And then there's desire. Totally. Biagra is for a rousal. Yeah, 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 Biagra. Biagra was a blood pressure drug with a really interesting side effect of the directed blood flow. And when they found that observation, by the way, this is common in medications.

This is the story of Botox, which was being used for helping folks with strip ismus, or their eyes being crossed, because it relaxs the muscle. And actually, it was discovered because of, 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 was its effect.

I wonder, like, that's not a standard questionnaire question. Where women just like, hey, right? 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 anti-depressant decreases such increases 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 blip blip blip. I mean, you know, it all works. It is. It's like, I, I, I, I, I, my, my non-doctomeric, hair-haver way as you get the party started.

The party starts in the brain. When you start the party in the brain, you know, everything else starts to respond. And then you get a great, like, 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. OK, 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 and female desire is complicated.

They're several things that kind of feed into it. Yeah, 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 a rouse alert. Yeah, this is a medication that may be helpful for them. 100%. So if a woman hears this, yes, and says, I feel like this is me. And I feel like I would like to try out it.

This may be something I'm interested in. Where does she go? How does she find it? Walk me through. So any doctor can prescribe it, but don't 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, our, our audiences, OBGYN's family practice all 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. Like that's, the, the first thing we hear from patients and trials where it's working, and it's not a panacea. No drug works for everybody, right?

But the first thing we hear is like, oh my gosh, I'm having like little thoughts and fantasies again, which makes perfect sense when you think about the mechanism in the brain. Right. And you know, I was just at a, 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 like percolating of interest and desire. And then we see them, you know, being receptive to their partner

where they probably were like going to bed early and avoiding sex. And then they're initiating themselves. And that's really the progression. How long do, like when you start the medication? It works on neurotransmitters.

So just like other drugs wait. Like 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 wait or 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 know

notice and get back to that place where you were happy with your desire.

“It's very similar to all of their mood drugs in that regard, right?”

If we took an anti-depressant, we wouldn't expect to be. Right. 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 you foric.

Same with Adi, 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 like what was the there there. And like at that time, I knew all of these amazing sex researchers in the world who built

like, you know, the house of Iagra. 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 back with different relationships 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?”

Um, so I think that's a bit of it. I mean men in the Viagra trials get an erection on placebo. So like there is like this whole, you know, biosyco-social 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 somewhat of, some out of size, psychological conditions. So and that her decrease 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 strong, 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, yeah, go to the FDA. They give the roadmap and we did the work.

Like we went out and we did the roadmap. 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.

Right. I mean, actually, I think what we miss because we joke about sex, we minimize it, is people are really struggling with this. Like, they're struggling not only in their relationships and interpersely, but personally, how they feel about themselves.

And so we had to measure those three things.

You see, like, okay, what's our effect versus placebo? And we've made it. And I was so excited because you don't know much. How many patients had you put through the trial? 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 4,000.

Okay. 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, Vc's left me out of the room.

Okay, so what's Vc? Venture capitalists. 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. They're not expensive because the trials are very, very, very expensive.

“So you have to go to rooms full of old guys and convince them.”

Yeah. 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 in the whole room, broken to 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 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 cohorts. Yes. And the numbers are in your favor. Yes.

It's exciting. So excited. Then what happened? They say no. And I really, like, I couldn't believe it.

How did 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 will we really just say that we don't think women need this? Because we, 26 times, we looked at medications for men, but 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, how many more times do they have sex a month? And how many more times is the rate amount of times? And my answer to that is, go ask the woman's 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, whisked statistical significance.

And so data was on our side, I mean, when we got the news that FDA rejected us, I've had to tell you that was, I was blindsided by it. I couldn't, I couldn't believe it. You did everything right. We did the work.

You, you defined success and we made it with statistical significance. And now we're going to debate the merit of like, 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.”

That happened to be flying in, I'm based in Raleigh, I've 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 broke in 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

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 sought, 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 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.

And that, like, the minute we did that, nightline shows up, right? Here's this tiny little company rally, not 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, doesn't matter for women to have pleasure.

And we were maligned and smeared, and you were, I had this, 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 screen saver 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 in science, curious 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 okay. No. I think, you know, progress begins when somebody says no out loud. And so it was a wild 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 this center of conversations, it's called patient focused drug development. Yeah.

“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 has 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. They did too.

They invited patients into the, into the, and they're the heroes of the story. Yeah. I think about it, like women who arranged for child care. Took time off work. And got up and told probably some embarrassing stories.

You had 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 are 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 when 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. I'm going to leave chocolate. And I just sat there, like, greeting my teeth. Like, I cannot believe we talked 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 that. You had a lightning bulb moment watching those images of the brink scans, which had been repeated all over the world now. Stanford did big work in the United States, it was discovered another one, slightly. 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, yeah.

Oh, be Jen. Yeah. Really covers it. Totally. At least until 2018, I was a program director.

Yeah. We didn't touch on this.

Right. And I got zero in my training. Yeah.

“And neurology, they get tons for men, and almost nothing for female, you know, family,”

medicine, all the primary care docs, like, but OBGYN, really, there's not no, you know, a female sexual specialty. I mean, there's there's organizations that you can join after you've got your training. That's right. Like, I wish.

But no one really owns this part for women. They do for men. It's neurology. Absolutely right. That's right.

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 dis. And it actually happens across medicine, right? It's what you talk about so beautifully all the time. And I'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 biochemistry. The breast, the uterus, you know, part of the body cover by the bikini, yes. You are a man with, you know, like, misputated head. You just pop on the breast and pop on 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. Yeah. Two 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 into this day. They print misinformation. That is crazy.

We got approved.

“And like, I can remember, like, you know, it got approved.”

I was in my office. Of course, they waited until 7.30 at night. So I sat there all day. Oh, my god, is it coming? Oh, my god, is it coming?

Oh, my god, is it coming? And all my family came and everything to wait for the bikini's 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 E.D. So let's just contextualize, like, prevalence of this. E.D. Is erectile dysfunction?

Yes. So we 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's like, yeah, but it has side effects.

“I'm like, does the blue pill you take have any side effects?”

Because I'm pretty sure there was death in the clinical trials. But it's not likely to happen in real life. Like, these are clinical trials you test extremes, too. Understand. And yet, it's that it's exactly the dismantling of WHO.

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 biograph 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?

Oh, I love this question. Okay. Let's do a tale of 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 track 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 sexual health, and we need more research. We need more research. Let's not miss it. There's more research in a product for women's sexual health.

In any product for men's, we have research actually, now we're finally having the conversation. Yeah. 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 was a, this is a year of condition that affects, you know, first of a half the population, the recent Mayo Clinic data said 50% of women over 50 have this 50% of women. Okay.

So, huge prevalence were 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. 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, okay. Yeah. And they put it on a shelf?

Brutal.

I mean, never been more depressed in my life.

We crashed the ceiling where more innovation, more products become 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, a big farmer 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 in those women

down. Those brutal. But you got the company back. Hell, yes. At some point, while we were 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 you'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 paved you a bunch of money for it. Like we own it and I might give it women can't even get it, give it back. And I will give him credit, like it took us a while in 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, we enabled a launch it on our own terms, still a tiny company.

“What's the hardest lesson you learned for this whole thing?”

That no matter what the smear still comes, you'd just have to stay the course. And issues like this where we've deemed them taboo or stigmatizer, 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, somewhere where 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 adding 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 emit their on it. I mean, I know a lot of people behind the scenes who are on it, but 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 and them, which they have to buy regulation because the name of the condition is hyperactive sexual desire disorder. And like, we've had to change meta policy and this, it's just been a long, long road. Yeah. But what's great is that once you change it, you change it for everybody else who's

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That's q-u-i-n-c-e.com/unpaused to get free shipping and 365 day returns. Quince.com/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 hates me.

So even though I got it back, I kept their money and that is helped with other female disruptors and that's my love. Who's the person doing that work in particular and how do you help them get their faster than you got their yourself? What are the landmines they don't have to step on?

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 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 rate?

Yes. That was to detect, basically I could stick my finger in this and see if it's a daily drug. Yeah. That was so cool. For the webinar.

So if someone comes to you and is pitching something, how do you mentor and coach those women? So much less about the idea and so much more about who's championing it.

Like it comes down to the jockey, always.

“And I do see like what are the stakes for them, what is that passion?”

I remember I actually, it's funny that 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, like I think I never sat in like the frustration or anger with them for having like embarrassed me or laughed me out of the room, I kept the door open for them to make a better decision the

next time. Like I think if you keep that open, you don't hold on to that. You actually allow them to change with you and 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. I think like you can't cry in the middle of the pitch and I said, boy, we see the world so differently. The moment she started to cry, it was the moment I knew 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. Winner loose, she's going to put it all in the field and like that was such it 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 of in pink, right? Show of in pink can be you and like it's going to piss some people off if you're changing something, a hundred percent 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 built this company in scratch and, but we have through the years had BC 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.

Yep. 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 like, you know, like, do you have to fain interest in women's health?”

It's like, when Viagra, when they were looking for investors in a structural decision, did they talk about the health of their son's penis, right? You know, or their son's sex, I mean, that's a goddamn good idea.

This percentage of them have it, like, I can see them.

I'm just so sick of people sleeping on women's health. And like, this is this real, this totally, and women are ready to invest. That's right. Of course, they will ruin 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. We, we still get the calls and we just kind of laugh. Yeah, okay. Yep, 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 women's side. But I feel like things are changing. I don't know. 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 handling 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, OB2YN, internal medicine, urologist or family practice physician without answering a question about HSD and Adity. 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 in a 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, and I was like, I remember walking out to my boss at

the time. You know, we go to our more exseason wisdom show, older people, and who happen 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 just very dismissive. Very platitudes and there was nothing, nothing to do in these poor women.

And like you said, I love my husband. Yes. Anyway. So I started reading on my own, and I found Venus and Mars in the Bedbrain. Yeah.

Do you remember that? I do of course. And so I read it, and I took notes from it, this, this, all things. This was the only piece of literature that was fine because I had access to the medical library.

I'm scanning the literature. It's just, yeah, almost nothing that wasn't religion psychology or psychiatry. Exactly. 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 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.”

I mean, like, hi, I'm an OBGYN, and so many of my patients are complaining of this. And 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. Yeah. So many years ago, look at that. 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, I send you little text, and I'm like, oh my gosh, here I'm here and every woman comes up to me, and they're like, do you know Dr. Mary Clarke for? And I'm like, I do.

It's like my best rock star status, and, but it's really that women also are fed up. And so they're going to force the medical community to keep stuck with them. Well, 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, 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 you know, I'm not alone. Wow.

I mean, one of my most viral videos for us in shoulder, palpitations, you know, 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, you know, this, this real thing about libido, I think social media has allowed women

to realize they're not alone, and that they, they're 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, the audience, and like, by a show of hands, how many of you have ever tried to fad diet, right, and like the whole thing, right, the whole audience freezer 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?

sense. No bill is going to fix it. Do you love your partner? I absolutely hate him. I'm like,

“well, you know, you need a new partner. We can't fix that, right? But I think that it's 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 next hand on that every time you talk about the whiny woman, like the WWE 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 here. Or any of the people in the study unpartnored. 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 masturbation day to day. Yeah. I mean, more satisfying sex. And that 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. So we had trials. You didn't have to, you know, if the FDA was not in the future, how would you have designed this study? Oh, interesting. Oh, this is going to be the craziest thing that anybody has ever said designing the clinical

trial. But I would have actually started with women who had survived breast cancer. And here's why because this is not hormonal and because I think we might have gotten out of our own god damn 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, doesn't matter if she has it? Like,

I, 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. Okay, they are very loud right now, which is great. Yeah, our needs are not being met. Like, okay, you cured my cancer, but you left me with this armamentarium of

“side effects and my quality of life is so poor. Listen, 80, it's, it's north of 80, I'm going to say 85”

percent, right, 85 to 90 percent of women who survived breast cancer will struggle with this medical

condition that adi treats and yet less than a third get any information about it. Right. And what's crazy to me now, I'm going to go back, maybe my 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, yeah, one of the outcomes of surgery

might be that they become impotent or they have a reptile 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 your life. 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 it done it differently. One of the real talents is for all jobs. Medvisos deia. 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.

I want you to share. Oh, man, I got to tell you. This is also like, this is where it never ends,

right? And like, who bears the responsibility for this? And how many sure no, what is, what this, like, 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, that I have to it. Now I lost my total train. So the story from, oh, I did not okay to train child. So listen to this. And insurance company sent a, a basically prior authorization, which is the hoop jumping, right, that insurance every single person listening to no sort of fire off it, right? Try to deny. And so a woman who'd been like diagnosed with HSD, been prescribed atty by her physician,

it's the, you know, one of the FDA crew drugs, she gets it. They send a prior out then they say,

well, first she has to try marriage counseling. Just a failed marriage counseling.

Fail it. What does that look like? Yeah, I don't know. What if she censored divorce, did she, did she get the medication? That is, is that what it looks like? This is a huge

“national insurance. 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 the demand, 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 in unacceptable. We have to be thoughtful about what our responsibility is, and that if we position this for women is 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 ensures are going to cover the things that are approved for women. That's the next domino to fall that actually, you know, we, 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. So what is the incentive for anybody to go here and do that? And like that's the thing that has to crack. I talked 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 to approve 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 viagrid, late in penises are going?”

It's, 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, from 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 pharmacist down to their insurance. Uncovered. Unbelievable. And they don't see that when their husbands go get vasectomy or vibraphy, right? Yes, right. You know, when you get your tubes tied or, you know,

right, when it's your health, you're right, your choice, you know, again, this, 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 were treating

the patients, they, it's less. If you were an academician who is not actually seen patients, sitting there, getting the emotional, like waves of the deafening off of a patient, it's a lot easier for you to dismiss this. Yeah. And dismiss, you know, what this medication could do for the patient. I also think there is a definite generational thing where that's, maybe this generation of scientists was not in their own sociological, you know, psychological

and socio-bioseclic social development. This was not a thing. They were expected to serve and fade and not to embrace their own sexuality. Now, Lauren's striker is not like that. You know, I had just had her on the pie gas. Yeah. She's a, you know, little bit older than me. And definitely has been training a lot longer. I was geologists before. Yeah. So I have a look at it. But you know, it's not all. I certainly do not want to generalize this by age. But I do see, you know, if you're

up with this biocycle social sex is a good thing. You deserve to have pleasure. Yes. Then you're

“a lot more easy to embrace. Yes. It's just so much we have to dismantle. 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. And, you know, in adi 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 was 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 and life in the board room wherever it is on 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 like you were sitting

at home one day in the phone ring. Actually, I'll tell you because it's a shared friend of ours, Dr. Rachel Ruben. Yeah, 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 a word when women, women, yeah, they're

incredible. And ultimately, she said, "Look, we're telling the story sort of with her without you, but I'd really like for you to set for an interview." And I sat for an interview. And I, she said, "In order to earn your trust, I'll show you." So I've no involvement, like no editorial control, nothing, right? And you just gave an interview. Like it's very scary for me. Yeah. Because like 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 the women in the room that day, who stood very bravely. And like you said, told their most personal struggle to change strangers. In front of a panel that was looking at them like this. And like they, in they got mocked. And they were made fun of. And they did it any way. 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 Ruben

effect? Like what is this like this new guard of women who are just not accepting it any more 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 gate keep 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 Melsechwa if I just thought, not, not, not, not, not, not. It's just because you could, it's just in your child process. I mean, Cindy, you could have taken your big fat check. Yeah, paid off your people. Yeah. And gone off into the sense that you didn't have to work again. I'm guessing. I mean, you know,

it's true. So, like, you're always working. I'm always working. What is it? I know 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.

special consideration. I asked, we got equal consideration. Same standard. Yeah. That's it.

“That's all I asked for. And that's what I hope we get to and 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 sending on Instagram @sindypinkceo and through Adi's website at adddy.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

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