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

This week on unPaused, Dr. Mary Claire Haver sits down with Cindy Eckert, founder and CEO of Sprout Pharmaceuticals and creator of Addyi, the first FDA approved treatment for low libido in women. Cindy is a pharmaceutical entrepreneur who began her career at Merck before founding her first company in 2007, focusing on undermarketed FDA approved products. After successfully building and selling a male sexual health company, she became the only woman running a sexual health company and witnessed firsthand the stark contrast between how medicine treats male versus female sexual dysfunction. Her journey to bring Addyi to market became a cultural battle about whether women's sexual desire matters, leading to two FDA rejections, public hearings, and ultimately a historic approval in 2015 after a six year fight. In this conversation, Dr. Haver and Cindy explore how Addyi works differently from Viagra, targeting brain chemistry and desire rather than blood flow and arousal. Cindy explains that Addyi is a mood drug originally developed for depression that showed an unexpected effect on female libido during clinical trials. The medication works on neurotransmitters in the brain, building over approximately eight weeks to restore spontaneous thoughts, fantasies, and desire in women with hypoactive sexual desire disorder or HSDD. She walks through the massive clinical trial requirements, including 13,000 patients compared to Viagra's 4,000, and the three things they had to prove with statistical significance versus placebo: increased interest in sex, more satisfying sexual experiences, and decreased distress from the condition. ADDYI, flibanserin, is for women <65 with low sexual desire disorder who have not had problems with low sexual desire in the past, and who have low sexual desire that is troubling to them no matter the type of sexual activity, situation, or sexual partner. The low sexual desire is not due to a medical or mental health problem, problems in the relationship or medicine or other drug use. ADDYI is not for men or to enhance sexual performance. Your risk of severe low blood pressure and fainting is increased if you drink 1-2 standard alcoholic drinks close in time to your ADDYI dose. Wait at least 2 hours after one to two drinks before taking ADDYI at bedtime and skip your dose if you drink three or more drinks that evening. If you take certain prescription, OTC or herbal medications, or have liver problems, the risk of low blood pressure and fainting increases and you should not take ADDYI. Do not take if you are allergic to any of ADDYI’s ingredients. Sometimes serious sleepiness can occur. Common side effects include dizziness, nausea, tiredness, difficulty falling asleep or staying asleep and dry mouth. See PI and Boxed Warning at addyi.com/pi http://addyi.com/pi Guest links: Cindy Eckert https://www.cindypinkceo.com/ Cindy Eckert https://www.instagram.com/cindypinkceo (Instagram) Recommended Books: “Mars and Venus in the Bedroom: A Guide to Lasting Romance and Passion,” https://www.amazon.com/Mars-Venus-Bedroom-Lasting-Romance/dp/0061015717 by John Gray “The New Perimenopause,”⁠ https://thepauselife.com/pages/the-new-perimenopause-book by Dr. Mary Claire Haver <a href="https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/059379625X/ref=sr_1_2?adgrpid=190238689390&dib=eyJ2IjoiMSJ9.djG88jtefTqLpTg36Li8QMNmXkpzLIfbFdY438Vro2vit_rKymy65UpF10hk_VTrxmazFUemwk7ywlmqHYY80j-V3LaeSD824-02PCtdlS8Fzp1XPcZs68nYHCL4V_ZdZBTJya---9Ng5PtKdOf-U3ENtuDXbDw68ULSk2wNk6Lt6mEhIPkuLM7FhztUzBJZ0wNBUQCSs6Pk1ZhoV2JDlzRapnMjnZgOq7PBA7Wy2KM._ZZSn21KJ43AyMvvSvI9_Hs3q74tpMBoCJ2zwi9enkc&dib_tag=se&hvadid=77 ...

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dr. Mary Claire Haver?

  No one really owns this part for women. They do for men. It's urology.

• 0:04Speaker 01

  Absolutely right. That's right. Yes.

• 0:06Dr. Mary Claire Haver?

  But usually it falls under psychiatry.

• 0:09Speaker 01

  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.

• 0:35Dr. 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. 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 OB-GYN. 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

• 1:20Dr. Mary Claire Haver?

  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%, would pause

• 2:01Dr. Mary Claire Haver?

  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

• 2:41Dr. Mary Claire Haver?

  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

• 3:23Dr. Mary Claire Haver?

  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.

• 3:38Speaker 02

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• 3:54Dr. Mary Claire Haver?

  So, welcome to UnPaused.

• 3:56Speaker 01

  Thanks for having me.

• 3:57Dr. Mary Claire Haver?

  Um, where did you grow up?

• 3:58Speaker 01

  Okay, let's start. Rochester, Fiji, Rome, DC. I was totally nomadic. My dad might have a sixth sense of humor, so we moved every year from the 4th grade through senior year of high school.

• 4:10Dr. Mary Claire Haver?

  Oh my god, your dad was a diplomat?

• 4:12Speaker 01

  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.

• 4:22Dr. Mary Claire Haver?

  We were expats for a couple of years.

• 4:24Speaker 01

  Yes, that's right.

• 4:26Dr. Mary Claire Haver?

  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. And but their kids were all so resilient and had had these amazing adventures all over the world. So it was an experience I really enjoyed.

• 4:42Speaker 01

  Good for your kids.

• 4:43Dr. Mary Claire Haver?

  So good for my kids. Incredible. They're citizens of the world now.

• 4:46Speaker 01

  Yes. I say to my dad all the time, were you like secretly training me to be an entrepreneur? Was this your master plan?

• 4:53Dr. Mary Claire Haver?

  So was that your plan? What'd you go to college for?

• 4:55Speaker 01

  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

• 5:08Dr. Mary Claire Haver?

  Ambition?

• 5:09Speaker 01

  recognition 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.

• 5:25Dr. Mary Claire Haver?

  Where did you do your undergrad?

• 5:26Speaker 01

  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 to schools in the DC 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.

• 5:47Dr. Mary Claire Haver?

  Okay.

• 5:47Speaker 01

  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? In 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.

• 6:08Dr. Mary Claire Haver?

  And what did you do there?

• 6:10Speaker 01

  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.

• 6:39Dr. Mary Claire Haver?

  How long till you jumped ship?

• 6:41Speaker 01

  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? 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?

• 7:12Dr. Mary Claire Haver?

  Yeah.

• 7:12Speaker 01

  For the value I create. So I jumped ship four years later and never looked back.

• 7:16Dr. Mary Claire Haver?

  But you went back into pharmaceutical?

• 7:17Speaker 01

  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 was, 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.

• 7:47Dr. Mary Claire Haver?

  When did you start your first company of your own?

• 7:50Speaker 01

  2007.

• 7:52Dr. Mary Claire Haver?

  What kind of company was it?

• 7:53Speaker 01

  Pharma.

• 7:53Dr. Mary Claire Haver?

  Okay.

• 7:54Speaker 01

  Which is, you know, very like pharma startup feels like it doesn't fit in the same sentence. Pharma is so calculated, 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, um, you know, uninspired in big environments. I thought, well, what if we could put a collection of 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.

• 8:21Dr. Mary Claire Haver?

  And did you have a like a product in mind?

• 8:24Speaker 01

  I was gonna go find a product and we found at the time the only FDA approved long-acting testosterone treatment for men.

• 8:32Dr. Mary Claire Haver?

  Okay.

• 8:32Speaker 01

  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.

• 8:40Dr. Mary Claire Haver?

  What gave you the idea for Sprout? So you started with Slate. Did you sell that company or?

• 8:45Speaker 01

  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 I, 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

• 9:27Speaker 01

  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?

• 9:48Dr. Mary Claire Haver?

  Did your team say, amazing, let's do that?

• 9:51Speaker 01

  Oh, God, no.

• 9:52Dr. Mary Claire Haver?

  So were they like, Cindy?

• 9:53Speaker 01

  On 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 gonna 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 that. One of the big companies. And it was such a deep calling to me, that I was doing it no matter

• 10:37Speaker 01

  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 sold, 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.

• 11:00Dr. Mary Claire Haver?

  So what was the next step in the process?

• 11:02Speaker 01

  Well, you know-

• 11:03Dr. Mary Claire Haver?

  I know this is where the story gets interesting.

• 11:05Speaker 01

  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, 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, and it was as if in a collective, all of us went like, holy shit, it's biology.

• 11:50Speaker 01

  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. Like, those things may all be true.

• 12:06Dr. Mary Claire Haver?

  Absolutely.

• 12:07Speaker 01

  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, you know, started out on that roadmap. Then it got interesting.

• 12:39Dr. Mary Claire Haver?

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

• 12:46Speaker 01

  Yeah, Addy-

• 12:47Dr. Mary Claire Haver?

  Do you rub it on your vagina?

• 12:48Speaker 01

  That's such a great, great question. We are brain flow, not blood flow. I think this is the beginning of all of this. It's like-

• 12:57Dr. Mary Claire Haver?

  Yeah, because-

• 12:57Speaker 01

  This is where desire-

• 12:58Dr. Mary Claire Haver?

  Female Viagra is a misnomer.

• 13:00Speaker 01

  Totally.

• 13:01Dr. Mary Claire Haver?

  Right, because there's arousal-

• 13:02Speaker 01

  Totally.

• 13:03Dr. Mary Claire Haver?

  And then there's desire.

• 13:04Speaker 01

  Totally.

• 13:05Dr. Mary Claire Haver?

  Viagra is for arousal.

• 13:06Speaker 01

  Yes.

• 13:07Dr. Mary Claire Haver?

  And it actually works in women.

• 13:07Speaker 01

  Yes, for sure.

• 13:08Dr. Mary Claire Haver?

  And desire is where most women complain.

• 13:11Speaker 01

  That's right. Addy's a mood drug. So it's got a fun origin story, you know? So does Viagra. Viagra was 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 strabismus 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 Addy 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.

• 13:50Dr. Mary Claire Haver?

  I wonder, like, that's not a standard questionnaire question, where women just like, hey,

• 13:57Dr. Mary Claire Haver?

  not only am I happier, but I want to have sex.

• 14:00Speaker 01

  You know why it was found? Because actually, every other mood drug we have, like on market today, so classically like an antidepressant.

• 14:08Dr. Mary Claire Haver?

  Decreases sex.

• 14:09Speaker 01

  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?

• 14:18Dr. Mary Claire Haver?

  Okay.

• 14:18Speaker 01

  And in this case, all the scores went the other way. And they were like, ooh, what? Um, 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.

• 14:43Dr. Mary Claire Haver?

  Right. Because the neurotransmitters increase blood, I mean, you know, it all works together.

• 14:48Speaker 01

  It's like, I, I say my, my, 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, 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.

• 15:05Dr. Mary Claire Haver?

  Yeah. Awesome. Okay. So we have this medication. Women have increased desire when they're taking it.

• 15:12Speaker 01

  Yeah.

• 15:12Dr. Mary Claire Haver?

  You're reading the studies. You know, there's a biological component to this. And, and female desire is complicated. It's, I, 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 or.

• 15:37Speaker 01

  Yeah.

• 15:38Dr. Mary Claire Haver?

  This is a, a medication that may be helpful for them.

• 15:41Speaker 01

  A hundred percent. So if a woman hears this.

• 15:43Dr. Mary Claire Haver?

  Yes.

• 15:43Speaker 01

  And says, I feel like this is me. And I feel like I would like to try Addy. This may be something.

• 15:48Dr. Mary Claire Haver?

  Thing I'm interested in, where does she go? How does she find it? Walk me through.

• 15:53Speaker 01

  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 are our audiences, OB GYNs, 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. Like that's the first thing we hear from patients and trials where it's working and it's not a panacea. No drug works for everybody.

• 16:25Dr. Mary Claire Haver?

  Right.

• 16:26Speaker 01

  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.

• 16:35Dr. Mary Claire Haver?

  Right.

• 16:35Speaker 01

  And, you know, 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, 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.

• 17:00Dr. Mary Claire Haver?

  How long, like when you start the medication?

• 17:03Speaker 01

  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 weight 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 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.

• 17:48Speaker 01

  You're coming back to that place that you were happy with, that was your, your normal.

• 17:53Dr. Mary Claire Haver?

  Okay.

• 17:54Speaker 01

  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. It's huge. Who'd built like, you know, 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, 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. Yeah. Different back, different relationship status. Every single one of them told me the same story.

• 18:38Speaker 01

  And when I'd 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, bio psycho 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 somatic, 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.

• 19:23Speaker 01

  That's the basis of my training. Okay, so you've got this drug. The whiny women. You, 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 a 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. Cause look, if you're not having sex and you don't care. You would never take a product for it. Right.

• 20:03Speaker 01

  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 much, how many patients had you put through the trials? Yeah. And how much does this cost? Oh, my God. Okay, so, so first of all, I'm very proud of this. We are the largest ever studied drug in women submitted to the FDA. Thirteen thousand patients in our clinical

• 20:47Speaker 01

  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, VCs laughed 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. Yes. To get people to invest in this, so we can do these studies. Because you're not. These studies are so expensive. Yeah, because the trials are very, very, very expensive. Totally. So, you have to go to rooms full of old guys. Yep. And convince them. Yeah. And that was not going well.

• 21:32Speaker 01

  No, and, 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.

• 21:57Speaker 01

  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.

• 22:42Dr. Mary Claire Haver?

  So you've raised the money, you get the sign off from the FDA, prove these things. You have this giant cohort.

• 22:52Speaker 01

  Yes.

• 22:52Dr. Mary Claire Haver?

  And you've, the numbers are in your favor. You're so excited.

• 22:56Speaker 01

  So excited.

• 22:57Dr. Mary Claire Haver?

  Then what happened?

• 22:58Speaker 01

  They, they say no. And I really, like, I couldn't believe it.

• 23:03Dr. Mary Claire Haver?

  How?

• 23:03Speaker 01

  It was just out of the blue. 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,

• 23:49Speaker 01

  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, 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. Cause 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 that was, um, I was blindsided by it. I couldn't, I couldn't believe it. You did everything right. We did the work.

• 24:31Speaker 01

  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. I happened to be flying in. I, 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've 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.

• 25:15Speaker 01

  And I took that weekend and I swear this is a bit of like, women have always been, the people who 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, the media frenzy hadn't even begun. And, 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?

• 26:00Speaker 01

  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.

• 26:07Dr. Mary Claire Haver?

  So walk us through the fight.

• 26:09Speaker 01

  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 and

• 26:33Dr. Mary Claire Haver?

  You were.

• 26:33Speaker 01

  I had

• 26:34Dr. Mary Claire Haver?

  This, this is the part I remember as

• 26:36Speaker 01

  Oh.

• 26:37Dr. Mary Claire Haver?

  A young practicing physician with this new medication. It really doesn't help that much.

• 26:41Speaker 01

  The very first headline, like, I, 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 gonna 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.

• 27:25Speaker 01

  You know, being in that room, my pink kept getting brighter and brighter and brighter because this was the conversation we were gonna have. That you minimize, view it as weakness, you know? Go ahead, honey, just have a bubble bath, it'll be okay. No, 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, 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.

• 28:02Dr. Mary Claire Haver?

  Yep.

• 28:02Speaker 01

  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.

• 28:33Dr. Mary Claire Haver?

  But you brought the patients into the FDA?

• 28:35Speaker 01

  Yes, and they did too. They invited patients into the, into the, um, and they're the heroes of the story. Like, I think about it like women who arranged for childcare,

• 28:46Dr. Mary Claire Haver?

  Mm-hmm.

• 28:46Speaker 01

  Took time off work.

• 28:47Dr. Mary Claire Haver?

  And got up and told probably some embarrassing stories.

• 28:51Speaker 01

  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 gonna 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.

• 29:34Speaker 01

  And I just, just sat there like gritting my teeth. Like, I cannot believe we talk to women this way about a medical condition.

• 29:44Dr. Mary Claire Haver?

  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 bulb moment watching those images of the brain scans.

• 29:57Speaker 01

  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.

• 30:04Dr. Mary Claire Haver?

  But that didn't trickle down.

• 30:05Speaker 01

  I know. But it's really so much about what is so deeply embedded culturally about our right to desire.

• 30:13Dr. Mary Claire Haver?

  So, you know, no one owns this in medicine. So, OB-GYN barely covers it.

• 30:18Speaker 01

  Totally.

• 30:19Dr. Mary Claire Haver?

  At least until 2018, I was a program director.

• 30:21Speaker 01

  Yeah.

• 30:22Dr. Mary Claire Haver?

  We didn't touch on desire, just barely.

• 30:24Speaker 01

  Right.

• 30:25Dr. Mary Claire Haver?

  Um, and I got zero in my training.

• 30:27Speaker 01

  Yeah.

• 30:27Dr. Mary Claire Haver?

  And. Urology, they get tons for men and almost nothing for female. You know, family medicine, all the primary care docs, like, but OB-GYN, really, there's not.

• 30:40Speaker 01

  No.

• 30:40Dr. Mary Claire Haver?

  You know, a female sexual specialty. I mean, there's, there's organizations that you can join after you finish your training.

• 30:47Speaker 01

  That's right.

• 30:48Dr. Mary Claire Haver?

  Like Ishwish.

• 30:49Speaker 01

  Sure.

• 30:49Dr. Mary Claire Haver?

  But no one really owns this part for women. They do for men. It's urology.

• 30:54Speaker 01

  Absolutely right. That's right. Yes.

• 30:56Dr. Mary Claire Haver?

  But usually it, it falls under psychiatry.

• 30:59Speaker 01

  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.

• 31:23Dr. Mary Claire Haver?

  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 outside of the bikini, the breasts, the uterus, you know, the part of the body covered by the bikini.

• 31:38Speaker 01

  Yes.

• 31:39Dr. Mary Claire Haver?

  You are a man with, you know, like Miss Potato Head. You just pop on the breasts and pop in the uterus and ovaries. And, and that, what we're understanding now and what I'm pushing is actually every cell in our body is different.

• 31:51Speaker 01

  Yeah.

• 31:52Dr. Mary Claire Haver?

  And it's going to respond differently.

• 31:53Speaker 01

  Yeah.

• 31:53Dr. Mary Claire Haver?

  To different medications. All right. So you go and you fight.

• 31:57Speaker 01

  Yes.

• 31:58Dr. Mary Claire Haver?

  And when did it get approved?

• 32:01Speaker 01

  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 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? 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.

• 32:38Dr. Mary Claire Haver?

  ED is erectile dysfunction.

• 32:40Speaker 01

  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 ask, like a very famous broadcaster had me on to talk about the big news. And he's like, yeah, but, but it has side effects. I'm like, does the blue pill you take have any side effects? Cause 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 WHI. It's the fear mongering that when something exists for a woman, we lead with the risk.

• 33:25Speaker 01

  And when something's for a man, we lead with the benefit. Time Magazine put Viagra on the cover of Time Magazine. It was, it was the world's, like, the biggest invention of its time.

• 33:34Dr. Mary Claire Haver?

  How long did it take for Viagra to make it through the FDA approval?

• 33:38Speaker 01

  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-tracked for approval in six months.

• 33:51Dr. Mary Claire Haver?

  Six months.

• 33:52Speaker 01

  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, and 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.

• 34:24Dr. Mary Claire Haver?

  Yeah. Then you get approved and then you sell.

• 34:28Speaker 01

  I did.

• 34:29Dr. Mary Claire Haver?

  That was always the goal, right?

• 34:30Speaker 01

  Well, the goal, 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, this is

• 34:46Dr. Mary Claire Haver?

  Years.

• 34:46Speaker 01

  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.

• 35:16Dr. Mary Claire Haver?

  Walk me through how you felt when you, like, they bought it and you're like, okay.

• 35:20Speaker 01

  Yeah.

• 35:21Dr. Mary Claire Haver?

  And they put it on a shelf?

• 35:22Speaker 01

  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

• 36:07Speaker 01

  down. It was brutal.

• 36:08Dr. Mary Claire Haver?

  But you got the company back.

• 36:10Speaker 01

  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 had 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.

• 36:54Dr. Mary Claire Haver?

  What's the hardest lesson you learned through this whole thing?

• 36:57Speaker 01

  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.

• 37:16Dr. Mary Claire Haver?

  Mm-hmm. Yes.

• 37:18Speaker 01

  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, 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.

• 37:40Dr. Mary Claire Haver?

  What are the plans for Addy in the future?

• 37:43Speaker 01

  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.

• 38:25Dr. Mary Claire Haver?

  Yeah, a long road.

• 38:25Speaker 01

  But what's great is that once you change it, you change it for everybody else who's coming behind you too.

• 38:34Dr. Mary Claire Haver?

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• 39:52Speaker 04

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• 40:01Speaker 03

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• 40:12Speaker 05

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• 40:49Dr. Mary Claire Haver?

  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.

• 40:59Speaker 01

  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. Like, they've improved them. And epidural that's more comfortable for women. Like, those are the things I love, when it's women's health and it's disruptive.

• 41:38Dr. Mary Claire Haver?

  A date rape drug?

• 41:40Speaker 01

  Yes, that was to detect, basically, I could stick my finger in this and see if there's a date rape drug.

• 41:45Dr. Mary Claire Haver?

  Yeah, that was so cool for the Rohibnol. So if someone comes to you... And is pitching something like, how do you, how do you mentor and coach those women?

• 41:56Speaker 01

  It's 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, 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. 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.

• 42:38Speaker 01

  And, um, 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. Cause I could see in her all of that emotion, all that passion, that she's gonna wake up every day and work on this tirelessly until she sees it through. Win or lose, she's gonna put it all on the field. And like, that was such, and they were like, "God, I've never thought about it that way."

• 43:21Speaker 01

  So, you know, I coached 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 gonna 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.

• 43:43Dr. Mary Claire Haver?

  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.

• 43:54Speaker 01

  Yeah.

• 43:54Dr. Mary Claire Haver?

  Built this company from scratch. And, but, we have through the years had VC and private equity come to us looking to perhaps invest.

• 44:04Speaker 01

  Sure.

• 44:04Dr. Mary Claire Haver?

  And so, you know, we take all the calls because

• 44:07Speaker 01

  Why not?

• 44:07Dr. Mary Claire Haver?

  I want to hear what they have to say. And, um, 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.

• 44:17Speaker 01

  Yep.

• 44:18Dr. Mary Claire Haver?

  And he has to start the conversation with his mother.

• 44:22Speaker 01

  Yes.

• 44:23Dr. Mary Claire Haver?

  Or for his daughters and why he wants to do this. And I know he's, he seems sincere, but it's like, isn't this just a good fucking idea?

• 44:31Speaker 01

  Yes, it is. Exactly.

• 44:32Dr. Mary Claire Haver?

  You know?

• 44:33Speaker 01

  Yes.

• 44:33Dr. Mary Claire Haver?

  Like, do you have to feign interest in women's health?

• 44:36Speaker 01

  Yeah.

• 44:37Dr. Mary Claire Haver?

  It's like, when Viagra, when they were looking for investors in erectile dysfunction, did they talk about the health of their son's penises?

• 44:43Speaker 01

  Right.

• 44:44Dr. Mary Claire Haver?

  Exactly. You know, or their son's sex life? This is a goddamn good idea.

• 44:48Speaker 01

  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

• 44:54Dr. Mary Claire Haver?

  I'm just so sick of people sleeping on women's health.

• 44:57Speaker 01

  Yeah.

• 44:57Dr. Mary Claire Haver?

  And like, this is, this is real.

• 44:59Speaker 01

  Totally.

• 45:00Dr. Mary Claire Haver?

  And women are ready to invest in their own health.

• 45:03Speaker 01

  Of course. They will rue that day. If you look at the control of wealth and everything else, the wealth transfer to women, et cetera, like, you are really out of touch if you're not looking at these opportunities right now.

• 45:13Dr. Mary Claire Haver?

  Yeah. And we, we still get the calls and we just kind of laugh.

• 45:16Speaker 01

  Yeah.

• 45:16Dr. Mary Claire Haver?

  Okay.

• 45:17Speaker 01

  Yep, sure.

• 45:18Dr. Mary Claire Haver?

  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.

• 45:27Speaker 01

  I do too.

• 45:27Dr. Mary Claire Haver?

  I'm new to the party.

• 45:28Speaker 01

  Yeah.

• 45:29Dr. Mary Claire Haver?

  So, but where, how do you see this changing?

• 45:31Speaker 01

  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, um, 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 OB-GYN, internal medicine, urologist, or family practice physician without answering a question about HSD and Addy. That's huge. That's how it changes, right? Once it becomes embedded in the, in the education.

• 46:06Dr. Mary Claire Haver?

  In the education system.

• 46:07Speaker 01

  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.

• 46:14Dr. Mary Claire Haver?

  A significant percentage of my non-pregnant patients complained about this.

• 46:19Speaker 01

  Yes.

• 46:19Dr. Mary Claire Haver?

  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, 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, but, and he would say, oh, tell her to have some wine, you know, just, just very dismissive, very platitudes.

• 46:42Speaker 01

  Yep.

• 46:43Dr. Mary Claire Haver?

  And that there was nothing, nothing to, to do and these poor women, and like you said, I love my husband.

• 46:51Speaker 01

  Yes, always.

• 46:52Dr. Mary Claire Haver?

  And so I started reading on my own and I found Venus and Mars in the bedroom. Do you remember that book?

• 46:58Speaker 01

  Yeah, I do, of course.

• 46:58Dr. Mary Claire Haver?

  And so I read it and I took notes from it. This, this, of all things, this was the only like 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.

• 47:14Speaker 01

  Exactly.

• 47:14Dr. Mary Claire Haver?

  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 OB-GYN, I was just sitting there like, and I remember standing up and just like, I think I was a little teary and being like, hi, I'm an OB-GYN 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.

• 47:35Speaker 01

  Oh. So. I love that so much. I remember that. I remember that meeting in 2016, I think it was.

• 47:41Dr. Mary Claire Haver?

  Yeah.

• 47:41Speaker 01

  So many years ago. Look at that, we're almost at a, 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, I send, I send you a 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 Claire Haver? 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.

• 48:05Dr. Mary Claire Haver?

  Yeah.

• 48:05Speaker 01

  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.

• 48:13Dr. Mary Claire Haver?

  There's so much that is good and bad about social media.

• 48:16Speaker 01

  Mm hmm.

• 48:17Dr. Mary Claire Haver?

  But one of the good things, I think, is that stories of women that were kept behind locked doors.

• 48:24Speaker 01

  Yes.

• 48:25Dr. Mary Claire Haver?

  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.

• 48:36Speaker 01

  Right.

• 48:36Dr. Mary Claire Haver?

  But, but it's this feeling of, oh, my God, that happened to me.

• 48:39Speaker 01

  Yes.

• 48:40Dr. Mary Claire Haver?

  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, frozen shoulder.

• 48:47Speaker 01

  Yes.

• 48:47Dr. Mary Claire Haver?

  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, 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, there's stuff that they can do for it. They don't have to suffer.

• 49:09Speaker 01

  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 in 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, of course. And I think so too, will the story go around sex for women?

• 49:46Dr. Mary Claire Haver?

  Mm hmm.

• 49:47Speaker 01

  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're in a bad relationship and that's why you don't want to have sex.

• 49:56Dr. Mary Claire Haver?

  That's the first question I asked.

• 49:57Speaker 01

  No pill is gonna fix it.

• 49:58Dr. Mary Claire Haver?

  Is, I was like, do you love your partner? I absolutely hate him. I'm like, well, I, you know, we, you need a new partner.

• 50:05Speaker 01

  We can't fix that, right? Like, but I think that it's just like thinking about us, like if women could be considered, which you, you say, and it, it just makes me like, you know, the hair on the back of my next hand. And then every time you talk about the whiny woman, like the WW in the, 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. And 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

• 50:48Speaker 01

  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 unpartnered. What's the masturbation data say? Yeah. It's good. 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 during the trials. So if 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

• 51:30Speaker 01

  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, 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 to look at.

• 52:12Speaker 01

  Right, and they are very loud right now, which is great about our needs are not being met. Like, okay, you 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. 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.

• 52:57Speaker 01

  But like when men survive prostate cancer.

• 52:59Dr. Mary Claire Haver?

  Yeah.

• 53:00Speaker 01

  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.

• 53:34Dr. Mary Claire Haver?

  What would you tell your younger self walking into those all male meetings in your pink outfit?

• 53:40Speaker 01

  What makes you think that they know better?

• 53:44Speaker 01

  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?

• 53:54Dr. Mary Claire Haver?

  So it's out. We prescribe it in our clinic. Our patients are sometimes struggling to get it filled or covered.

• 54:01Speaker 01

  Yeah.

• 54:01Dr. Mary Claire Haver?

  You have a good story. I want you to share.

• 54:04Speaker 01

  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?

• 54:12Dr. Mary Claire Haver?

  And how many journalists?

• 54:14Speaker 01

  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.

• 54:39Dr. Mary Claire Haver?

  So the story from denial.

• 54:42Speaker 01

  So listen to this. An insurance company sent a, a basically prior authorization, which is the hoop jumping.

• 54:50Dr. Mary Claire Haver?

  Right.

• 54:50Speaker 01

  That insurance companies.

• 54:51Dr. Mary Claire Haver?

  Every single person listening knows what a prior auth.

• 54:54Speaker 01

  Right? Try to deny. And so a woman who'd been like diagnosed with HSD, been prescribed Addy by her physician. It's the, you know, one of the FDA approved drugs. She gets it. They send a prior auth and they say, Well, first she has to try marriage counseling.

• 55:11Dr. Mary Claire Haver?

  Just to fail marriage counseling.

• 55:12Speaker 01

  Fail it. What does that look like?

• 55:14Dr. Mary Claire Haver?

  Yeah.

• 55:15Speaker 01

  I don't know. What, what, if she sends her divorce

• 55:18Dr. Mary Claire Haver?

  Decree.

• 55:18Speaker 01

  certificate decreed, does she get the medication then? Is, 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.

• 55:56Dr. Mary Claire Haver?

  Mm hmm.

• 55:56Speaker 01

  Because then they can get away with saying it. I think that's the, 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, 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.

• 56:18Dr. Mary Claire Haver?

  All day.

• 56:19Speaker 01

  We need more of those things. Yes, but for the things that do that, right? That, that, that get the research, get the approval. Then they can't access them anyway.

• 56:28Dr. Mary Claire Haver?

  Right.

• 56:28Speaker 01

  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.

• 56:55Dr. Mary Claire Haver?

  I often say, where do they think the Viagra laden penises are going? You know, like, you can't treat half of a couple.

• 57:02Speaker 01

  Yeah.

• 57:03Dr. Mary Claire Haver?

  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 coverage.

• 57:20Speaker 01

  Unbelievable.

• 57:21Dr. Mary Claire Haver?

  And, and they don't see that when their husbands go get vasectomies or Viagra.

• 57:26Speaker 01

  Yes, right.

• 57:26Dr. Mary Claire Haver?

  You know, but when you get your tubes tied or, you know.

• 57:28Speaker 01

  That's right.

• 57:29Dr. Mary Claire Haver?

  When it's your health, your right, your choice, you know, again, this, this is a bigger conversation.

• 57:35Speaker 01

  And don't, and let's just say this here. Don't mistake that paternalism is only male.

• 57:41Dr. Mary Claire Haver?

  Oh, God.

• 57:42Speaker 01

  So many women are so paternalistic about this, and I think they're blinded by their own superiority.

• 57:50Dr. Mary Claire Haver?

  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 patients,

• 58:03Speaker 01

  Yes.

• 58:04Dr. Mary Claire Haver?

  they, 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.

• 58:18Speaker 01

  Yep.

• 58:18Dr. Mary Claire Haver?

  And dismiss, you know, what this medication could do for the patient. I also think there is a definite generational thing where

• 58:25Speaker 01

  Yeah, that's

• 58:26Dr. Mary Claire Haver?

  maybe this generation of scientists was not in their own socio, you know, psychological and socio-bio-psycho-social development.

• 58:34Speaker 01

  Yes.

• 58:34Dr. Mary Claire Haver?

  This was not a thing.

• 58:36Speaker 01

  Hmm.

• 58:36Dr. Mary Claire Haver?

  They were expected to serve and fide and not to embrace their own sexuality. Now, Lauren Stryker is not like that. You know, I had just had her on the podcast.

• 58:46Speaker 01

  Yeah.

• 58:46Dr. Mary Claire Haver?

  She's a, 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 bedside, if you're actually treating patients and if you, you tend to be, have been brought up with this bio-psycho-social sex is a good thing, you deserve to have pleasure.

• 59:08Speaker 01

  Yes.

• 59:09Dr. Mary Claire Haver?

  Then you're a lot more easy to embrace.

• 59:11Speaker 01

  Yes.

• 59:12Dr. Mary Claire Haver?

  There's just so much we have to dismantle.

• 59:14Speaker 01

  So much dismantle 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,

• 59:59Speaker 01

  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. Your job. Own your pleasure. In the bedroom, in life, in the boardroom, wherever it is, own your pleasure. Awesome. All right, what is the documentary?

• 1:00:42Speaker 01

  The Pink Pill: Sex, Drugs, and Who Has Control? Oh, my God. Tell me the story. Like, 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.

• 1:01:27Speaker 01

  We're going to make progress." And we have made so much progress that I didn't want to go backward and basically relitigate 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 I, she said, in order to earn your trust, I'll show you. So I have no involvement, like no editorial control, nothing, right?

• 1:02:02Dr. Mary Claire Haver?

  You just gave an interview.

• 1:02:04Speaker 01

  Very scary. Like, it's very scary for me.

• 1:02:06Dr. Mary Claire Haver?

  Yeah.

• 1:02:06Speaker 01

  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 it.

• 1:02:38Dr. Mary Claire Haver?

  In front of a bunch of strangers.

• 1:02:38Speaker 01

  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? The, 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.

• 1:03:15Dr. Mary Claire Haver?

  I believe that.

• 1:03:16Speaker 01

  But 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

• 1:03:33Dr. Mary Claire Haver?

  Because you could have taken your check.

• 1:03:35Speaker 01

  Straightforward process.

• 1:03:36Dr. Mary Claire Haver?

  I mean, Cindy, you could have taken your big fat check.

• 1:03:38Speaker 01

  Yeah.

• 1:03:39Dr. Mary Claire Haver?

  Paid off your people.

• 1:03:40Speaker 01

  Yeah.

• 1:03:41Dr. Mary Claire Haver?

  And gone off into the sunset. You didn't have to work again, I'm guessing. I mean, you know.

• 1:03:46Speaker 01

  It's true.

• 1:03:46Dr. Mary Claire Haver?

  So, like, you're always working.

• 1:03:49Speaker 01

  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.

• 1:04:16Dr. Mary Claire Haver?

  Yeah.

• 1:04:16Speaker 01

  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.

• 1:04:22Dr. Mary Claire Haver?

  All right. So why do you keep doing this? What is driving you right now?

• 1:04:26Speaker 01

  I've decided I'm allergic to hypocrisy.

• 1:04:31Dr. Mary Claire Haver?

  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.

• 1:04:55Speaker 01

  I adore you. Thank you.

• 1:04:58Dr. Mary Claire Haver?

  You can find Cindy on Instagram at Cindy Pink CEO and through Addy's website at addy, A-D-D-Y-I dot 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 thepauselife.com. My upcoming book, The New Perimenopause, is available for preorder 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.

• 1:05:43Dr. Mary Claire Haver?

  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.

• 1:06:07Speaker 06

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