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Dr. Grey AI

Condition

Hypoactive Sexual Desire Disorder

Hypoactive sexual desire disorder is persistently low sexual desire that causes personal distress, shaped by brain signaling, hormones, mood, and stress. Bremelanotide has the strongest evidence: two large trials of about 1,200 women found improved desire scores compared with placebo across all subgroups. Maca and DHEA have moderate evidence, but tribulus and other options are limited, and a small nicotine trial found no clear difference in libido.

Sources: PMID 29995725; PMID 33835907

Supplements studied
2
Medicines and peptides
1
Graded outcomes
6
Trials
2
People studied
208

Evidence by supplement

  • Strong
  • Moderate
  • Limited
  • Very limited

2 supplements

Tribulus Terrestris

Tribulus Terrestris: outcomes studied for Hypoactive Sexual Desire Disorder
GradeOutcomeEffectSizeStudiesPeopleStudies list
Erections

Small Increase

Improves (the measure goes up)Small effect4 studies180 people

Studies that measured erections

and 1 more on the Tribulus Terrestris page

TestosteroneImproves (the measure goes up)3 studies180 people

Studies that measured testosterone

Low-density lipoprotein (LDL)Improves (the measure goes down)1 study180 people

Studies that measured low-density lipoprotein (ldl)

Free TestosteroneImproves (the measure goes up)180 people
High-density lipoprotein (HDL)Improves (the measure goes up)180 people
Serum DHEAImproves (the measure goes up)180 people
Sex Hormone Binding GlobulinImproves (the measure goes up)180 people
Total cholesterolImproves (the measure goes down)180 people
TriglyceridesImproves (the measure goes down)180 people

Nicotine

Nicotine: outcomes studied for Hypoactive Sexual Desire Disorder
GradeOutcomeEffectSizeStudiesPeopleStudies list
Libido

No effect

NoneNo effect1 study28 people

Studies that measured libido

Penile GirthImproves (the measure goes up)28 people

Prescription medicines and peptides studied, for context

These are not supplements. Most need a prescription, and some are research compounds with no approved use. They are listed so the supplement evidence above can be read against them.

1 medicine or peptide

PT-141 (Bremelanotide)

  • Sexual Desire (FSDS-DAO): improves
  • Sexual Distress: improves
  • Sexually Satisfying Events: improves
PT-141 (Bremelanotide): outcomes studied for Hypoactive Sexual Desire Disorder
GradeOutcomeEffectSizeStudiesPeopleStudies list
Sexual Desire (FSDS-DAO)

Two Phase 3 RECONNECT trials (n=1202) showed bremelanotide significantly improved desire scores on the FSDS-DAO (Female Sexual Distress Scale-Desire/Arousal/Orgasm) compared to placebo across all subgroups.

Improves (the measure goes up)Moderate effect37 studies
Sexual Distress

Bremelanotide significantly decreased distress associated with low sexual desire in premenopausal women with HSDD in two Phase 3 randomized controlled trials.

Improves (the measure goes down)Moderate effect37 studies
Sexually Satisfying Events

Sexually satisfying events increased by 0.7 per month with bremelanotide vs 0.2 with placebo in a 12-week dose-finding trial of 293 premenopausal women.

Improves (the measure goes up)Small effect33 studies
Long-Term Efficacy

During the 52-week open-label extension of RECONNECT, sustained improvements in HSDD symptoms were maintained with no new safety signals observed.

Improves (the measure goes up)Moderate effect29 studies

Key findings

  • ErectionsTribulus TerrestrisImproves (the measure goes up)
  • LibidoNicotine

The Hypoactive Sexual Desire Disorder Support protocol

2 primary supplements · 4 supporting supplements

  • Maca Root1.5–3 g daily
  • DHEA25–50 mg daily (under medical supervision)

See the full protocol

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Studies cited

67 studies from PubMed

  1. Female Sexual Desire, Arousal, and Orgasmic Dysfunctions: A Systematic Review and Meta-Analysis of Treatment Options.Journal of minimally invasive gynecology, 2026 · PMID 40543759
  2. 2024 SOGC, 2024 NCCN, 2022 ESO-ESMO, and 2018 ASCO: a comparison of female cancer survivorship guidelines for the management of sexual health concerns.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2025 · PMID 40518469
  3. Practical considerations and emerging approaches for the management of vasomotor and sexual symptoms in breast cancer patients on endocrine therapies.Expert review of clinical pharmacology, 2025 · PMID 41088800
  4. Intravenous peptides and amino acids for erectile dysfunction: a narrative review of current applications and future directions.Expert opinion on pharmacotherapy, 2025 · PMID 40069591
  5. A Comprehensive Review of Novel FDA-Approved Psychiatric Medications (2018-2022).Cureus, 2024 · PMID 38646400
  6. Prespecified and Integrated Subgroup Analyses from the RECONNECT Phase 3 Studies of BremelanotideJ Womens Health (Larchmt), 2022 · PMID 35230162
  7. An evaluation of bremelanotide injection for the treatment of hypoactive sexual desire disorderExpert Opin Pharmacother, 2022 · PMID 36242769
  8. Safety Profile of Bremelanotide Across the Clinical Development Program.Journal of women's health (2002), 2022 · PMID 35147466
  9. Management of Hypertension with Female Sexual Dysfunction.Medicina (Kaunas, Lithuania), 2022 · PMID 35630054
  10. Effect of bremelanotide on body weight of obese women: Data from two phase 1 randomized controlled trials.Diabetes, obesity & metabolism, 2022 · PMID 35170192
  11. The neurobiology of bremelanotide for the treatment of hypoactive sexual desire disorder in premenopausal womenCNS Spectr, 2021 · PMID 33455598
  12. BremelanotideLiverTox, 2021 · PMID 34436837
  13. Failure of a Meta-analysis: A Commentary on Glen Spielmans's "Re-Analyzing Phase III Bremelanotide Trials for 'Hypoactive Sexual Desire Disorder in Women'".Journal of sex research, 2021 · PMID 33835907
  14. Bremelanotide: New Drug Approved for Treating Hypoactive Sexual Desire DisorderAnn Pharmacother, 2020 · PMID 31893927
  15. Bremelanotide for the Treatment of Hypoactive Sexual Desire Disorder: Two Randomized Phase 3 TrialsObstet Gynecol, 2019 · PMID 31599089
  16. Long-Term Safety and Efficacy of Bremelanotide for Hypoactive Sexual Desire DisorderObstet Gynecol, 2019 · PMID 31607241
  17. Bremelanotide: First ApprovalDrugs, 2019 · PMID 31429064
  18. Long-Term Safety and Efficacy of Bremelanotide for Hypoactive Sexual Desire Disorder.Obstetrics and gynecology, 2019 · PMID 31599847
  19. Responder Analyses from a Phase 2b Dose-Ranging Study of Bremelanotide.The journal of sexual medicine, 2019 · PMID 31277966
  20. Bremelanotide for the Treatment of Hypoactive Sexual Desire Disorder: Two Randomized Phase 3 Trials.Obstetrics and gynecology, 2019 · PMID 31599840
  21. Female Sexual Dysfunction and the Placebo Effect: A Meta-analysis.Obstetrics and gynecology, 2018 · PMID 29995725
  22. Phase I Randomized Placebo-controlled, Double-blind Study of the Safety and Tolerability of Bremelanotide Coadministered With Ethanol in Healthy Male and Female Participants.Clinical therapeutics, 2017 · PMID 28189361
  23. Usefulness of ambulatory blood pressure monitoring to assess the melanocortin receptor agonist bremelanotide.Journal of hypertension, 2017 · PMID 27977473
  24. RETRACTED: Evaluation of the safety and efficacy of bremelanotide, a melanocortin receptor agonist, in female subjects with arousal disorder: a double-blind placebo-controlled, fixed dose, randomized study.The journal of sexual medicine, 2008 · PMID 18179455
  25. Gateways to clinical trials.Methods and findings in experimental and clinical pharmacology, 2008 · PMID 18806898
  26. Gateways to clinical trials.Methods and findings in experimental and clinical pharmacology, 2008 · PMID 19088949
  27. Melanocortins in the treatment of male and female sexual dysfunctionCurr Top Med Chem, 2007 · PMID 17584134
  28. Bremelanotide: an overview of preclinical CNS effects on female sexual functionJ Sex Med, 2007 · PMID 17958619
  29. Gateways to clinical trials.Methods and findings in experimental and clinical pharmacology, 2007 · PMID 18040531
  30. An effect on the subjective sexual response in premenopausal women with sexual arousal disorder by bremelanotide (PT-141), a melanocortin receptor agonistJ Sex Med, 2006 · PMID 16839319
  31. Gateways to clinical trials.Methods and findings in experimental and clinical pharmacology, 2006 · PMID 17235418
  32. Gateways to clinical trials.Methods and findings in experimental and clinical pharmacology, 2005 · PMID 16082427
  33. Gateways to clinical trials.Methods and findings in experimental and clinical pharmacology, 2005 · PMID 16179960
  34. Gateways to clinical trials.Methods and findings in experimental and clinical pharmacology, 2005 · PMID 16395422
  35. Double-blind, placebo-controlled evaluation of the safety, pharmacokinetic properties and pharmacodynamic effects of intranasal PT-141, a melanocortin receptor agonist, in healthy males and patients with mild-to-moderate erectile dysfunctionInt J Impot Res, 2004 · PMID 14963471
  36. Evaluation of the safety, pharmacokinetics and pharmacodynamic effects of subcutaneously administered PT-141, a melanocortin receptor agonist, in healthy male subjects and in patients with an inadequate response to Viagra.International journal of impotence research, 2004 · PMID 14999221
  37. Gateways to clinical trials.Methods and findings in experimental and clinical pharmacology, 2004 · PMID 15319808
  38. Gateways to clinical trials.Methods and findings in experimental and clinical pharmacology, 2004 · PMID 15349141
  39. Gateways to clinical trials.Methods and findings in experimental and clinical pharmacology, 2004 · PMID 15672123
  40. The inhibitory effects of nicotine on physiological sexual arousal in nonsmoking women: results from a randomized, double-blind, placebo-controlled, cross-over trialJ Sex Med · PMID 18331269
  41. Effects of intravenous cocaine and cigarette smoking on luteinizing hormone, testosterone, and prolactin in menJ Pharmacol Exp Ther · PMID 12893845
  42. Nicotine treatment of mild cognitive impairment: a 6-month double-blind pilot clinical trialNeurology · PMID 22232050
  43. Nicotine increases neural response to unpleasant stimuli and anxiety in non-smokersAddict Biol · PMID 20731637
  44. Nicotine differentially modulates antisaccade performance in healthy male non-smoking volunteers stratified for low and high accuracyPsychopharmacology · PMID 22038536
  45. Acute effects of nicotine on physiological and subjective sexual arousal in nonsmoking men: a randomized, double-blind, placebo-controlled trialJ Sex Med · PMID 17971108
  46. Acute effects of nicotine on serum glucose insulin growth hormone and cortisol in healthy smokersMetabolism · PMID 15131760
  47. Nicotine infusion acutely impairs insulin sensitivity in type 2 diabetic patients but not in healthy subjectsJ Intern Med · PMID 11422660
  48. Preliminary findings on the interactive effects of IV ethanol and IV nicotine on human behavior and cognition: a laboratory studyNicotine Tob Res · PMID 22180582
  49. Effect of chewing gum containing nicotine and caffeine on energy expenditure and substrate utilization in menAm J Clin Nutr · PMID 12791621
  50. The effects of acute doses of nicotine on video lottery terminal gambling in daily smokersPsychopharmacology · PMID 21904819
  51. Efficacy of Tribulus Terrestris Extract on the Serum Glucose and Lipids of Women with Diabetes MellitusIran J Med Sci · PMID 27840471
  52. Tribulus terrestris versus placebo in the treatment of erectile dysfunction and lower urinary tract symptoms in patients with late-onset hypogonadism: A placebo-controlled studyUrologia · PMID 30253697
  53. Pilot Study on the Effect of Botanical Medicine (Tribulus terrestris) on Serum Testosterone Level and Erectile Function in Aging Males With Partial Androgen Deficiency (PADAM)J Sex Marital Ther · PMID 25849625
  54. Prospective Analysis on the Effect of Botanical Medicine (Tribulus terrestris) on Serum Testosterone Level and Semen Parameters in Males with Unexplained InfertilityJ Diet Suppl · PMID 27337519
  55. Short term impact of Tribulus terrestris intake on doping control analysis of endogenous steroidsForensic Sci Int · PMID 18282674
  56. Dietary Supplements for Erectile Dysfunction: Analysis of Marketed Products, Systematic Review, Meta-Analysis and Rational Use.Nutrients · PMID 37686709
  57. Evaluation of the efficacy and safety of Tribulus terrestris in male sexual dysfunction-A prospective, randomized, double-blind, placebo-controlled clinical trialMaturitas · PMID 28364864
  58. The aphrodisiac herb Tribulus terrestris does not influence the androgen production in young menJ Ethnopharmacol · PMID 15994038
  59. Effect of oral administration of Tribulus terrestris extract on semen quality and body fat index of infertile menAndrologia · PMID 27401787
  60. Clinical study of Tribulus terrestris Linn. in Oligozoospermia: A double blind studyAyu · PMID 23723641
  61. Anti-hypertensive effect of Gokshura (Tribulus terrestris Linn.) - A clinical studyAnc Sci Life · PMID 22556936
  62. Tribulus terrestris for treatment of sexual dysfunction in women: randomized double-blind placebo - controlled studyDaru · PMID 24773615
  63. Efficacy of Tribulus terrestris for the treatment of hypoactive sexual desire disorder in postmenopausal women: a randomized, double-blinded, placebo-controlled trialMenopause · PMID 27760089
  64. Efficacy of Tribulus Terrestris for the treatment of premenopausal women with hypoactive sexual desire disorder: a randomized double-blinded, placebo-controlled trialGynecol Endocrinol · PMID 29172782
  65. Clinical Assessment of Tribulus terrestris Extract in the Treatment of Female Sexual DysfunctionClin Med Insights Womens Health · PMID 25574150
  66. The effects of Tribulus terrestris on body composition and exercise performance in resistance-trained malesInt J Sport Nutr Exerc Metab · PMID 10861339
  67. The effect of five weeks of Tribulus terrestris supplementation on muscle strength and body composition during preseason training in elite rugby league playersJ Strength Cond Res · PMID 17530942

Supplement stack for Hypoactive Sexual Desire Disorder