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

13:41Cindy Eckert:And they published this result. And it was like the room was looking at this brain scan imaging. And it was as if in a collective, all of us went like, holy shit, it's biology. And exactly at that moment, like, it's almost so absurd that we hadn't considered it before, that everything we had told women who were struggling with this issue was something rooted in her emotion. Relax, schedule date night, you're stressed. Like, those things may all be true. Right. But also, of course, we're wired biologically to have sex drive. And so the room looked at it, and that is what really lit me up. So when we took on the science, you know, the fun was like, what do you do?

14:23Cindy Eckert: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.

14:41Dr. Mary Claire Haver:So let's back up a little bit. Walk our listeners through what is Addy? So what is this drug? How does it work? Yeah, Addy. Do you rub it on your vagina?

14:51Cindy Eckert:That's such a great, great question. We are brain flow, not blood flow. I think this is the beginning of all of this.

14:59Dr. Mary Claire Haver:Yeah, because this is where desire ignites. Female Viagra is a misnomer.

15:02Cindy Eckert:Totally.

15:03Dr. Mary Claire Haver:Right, because there's arousal. Totally. And then there's desire. Totally. Viagra is for arousal. Yes. And it actually works in women. Yes, for sure. And desire is where most women complain.

15:13Cindy Eckert:That's right. Addy's a mood drug. So it's got a fun origin story. You know, so does Viagra. Viagra is a blood pressure drug with a really interesting side effect of directed blood flow. And when they found that observation, by the way, this is common in like medications. This is the story of Botox, which was being used for, you know, helping folks with 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 Adi was a mood drug that happened to have this really interesting effect in that it promoted sex drive.

15:49Cindy Eckert:And once they saw that, like that was its it factor.

15:53Dr. Mary Claire Haver:I wonder, like, that's not a standard questionnaire question where women just like, hey, not only am I happier, but I want to have sex.

16:02Cindy Eckert:You know why it was found? because actually every other mood drug we have like on market today, so classically like an antidepressant, decreases sex drive. 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. And in this case, all the scores went the other way. And they were like, ooh, what? And then they changed the course of study right then and there. And they were looking at desire, as you said, desire specifically, because that is women's most common issue. Actually, what's interesting, even in our data, is once you ignite that desire, actually those other variables of sex, arousal, orgasm, everything improves.

16:46Dr. Mary Claire Haver:Right, because the neurotransmitters increase blood. I mean, you know, it all works together.

16:50Cindy Eckert:It's like I say it my non-Dr. Mary Claire Haver way is you get the party started. The party starts in the brain. When you start the party in the brain, 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.

17:07Dr. Mary Claire Haver:So, yeah. Awesome. Okay. So we have this medication. Women have increased desire when they're taking it. Yeah. You're reading the studies. You know there's a biological component to this. And female desire is complicated. I describe it like a traffic circle. There's several things that kind of feed into it. But, you know, for the patients who have a great partner, a great relationship who used to have desire, and then now it suddenly is gone without like an environmental factor causing it. And they can orgasm. They don't have any issues with arousal. Yeah. This is a medication that may be helpful for them.

17:43Dr. Mary Claire Haver:A hundred percent. So if a woman hears this. Yes. And says, I feel like this is me. And I feel like I would like to try Addy. This may be something I'm interested in. Where does she go? How does she find it? Walk me through.

17:55Cindy Eckert: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, OBGYNs, family practice, all of the above in which a woman has really led this. And what they can expect is, look, you need to talk to your doctor directly and whether or not this is right for you. Let me say that. But it's just a return of that drive. 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.

18:28Cindy Eckert: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. 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 to hear it. But it's that percolating of interest and desire. And then we see them being receptive to their partner, where they probably were going to bed early and avoiding sex. And then they're initiating themselves. And that's really the progression.

19:02Dr. Mary Claire Haver:How long, when you start the medication, would you expect? It works on neurotransmitters.

19:07Cindy Eckert:So just like other drugs, wait. We basically say, if at eight weeks you haven't seen a result, you're not going to, so you can stop taking it. But there's a climb. Like it's not zero to 60. You're not taking home the hot waiter tonight. Sorry, ladies. You are waiting because it's building in your system over time. And it's those little things that percolating that you start to notice and get back to that place where you were happy with your desire. It's very similar to all other mood drugs in that regard, right? If we took an antidepressant, we wouldn't expect to be euphoric the next day, right?

19:41Cindy Eckert:It's going to take a little bit of time. And it's not that you're going from depressed to euphoric. Same with Addy, right? You're not going from never having sex to nymphomania. You're coming back to that place that you were happy with, that was your normal. Okay. I actually spent a year just talking to women with this condition before I ever pursued it because I wanted to see like, what was the there there? And like, at that time, I knew all of these amazing sex researchers in the world who'd built like, you know, the house of Viagra, so to speak, like all of those researchers. And I'm like, are you seeing female patients?

20:15Cindy Eckert:Can I talk to them? And what's so funny that you just said that triggered me is every single one of them started the conversation like this with me. I love my partner. They wanted to make sure I knew like it. I love my partner, but like something's changed. Like it's like the switch went out. I heard it over and over and they were different walks of life, different ages, different back, different relationship status. Every single one of them told me the same story. And when I've been told that story over and over again for a year, I'm like, there is something there. And while I will concede that humans are complicated, this is what I do take issue with.

20:52Cindy Eckert:Women aren't uniquely complicated. Like we're not uniquely complicated when it comes to sex. Men are complicated, actually, when it comes to sex too, right? So I think that's a bit of it. I mean, men in the Viagra trials get an erection on placebo. True. So like there is like this whole, you know, biopsychosocial thing going on. But I think that we've sort of allowed women to be so complicated that we didn't have to bother to fix it.

21:15Dr. Mary Claire Haver:I was taught that women tend to somaticize psychological conditions. So and that her decreased libido is probably a side effect of that. And there's not much we can do for that. That's the basis of my training. Okay, so you've got this drug. The whiny women. You know, preliminary studies are showing that, you know, it should work. Yeah. Now you go to the FDA. Well, you don't know, right?

21:38Cindy Eckert:FDA, yeah, I go to the FDA. They give the roadmap and we did the work. Like we went out and we did these studies. What does the roadmap look like? So there were three things we had to prove. So in clinical trials, not one thing, three things. We had to prove that women who took the product had more interest in having sex, more desire for it. That when they had sex, it was more satisfying for them. and that it actually decreased the distress they were feeling because of this issue. Because look, if you're not having sex and you don't care, you would never take a product for it. I mean, actually, I think what we miss because we joke about sex or we minimize it is people are really struggling with this.

22:13Cindy Eckert: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.

22:28Dr. Mary Claire Haver:And I was so excited because you don't know. How many patients had you put through the trials? And how much does this cost? Oh my God. Okay.

22:37Cindy Eckert:So first of all, I'm very proud of this. We are the largest ever studied drug in women submitted to the FDA. 13 ,000 patients in our clinical trials. That is not the norm. The norm is when you include rare disease in there, it's like just a little over a thousand. But as you know, let's use Viagra as the comparator. They had about four thousand. OK, so look at that like that difference, right? Three times as many patients worth of data. And it cost hundreds of millions of dollars. I mean, I went out and by the way, VCs laughed me out of the room. OK, so

23:13Dr. Mary Claire Haver:what's VC? Venture capitalist. Right. So you have this drug. Yes. And you're like, I need to raise money to get people to invest in this so we can do these studies. Because you're not... Because you're not... Because you're not... Because you're not... Because you're not... Because you're not... Because you're not... 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.

23:35Cindy Eckert:No, and let me just remind you, I'd sold a company already with a male sexual health drug for hundreds of millions of dollars. And yet, I remember presenting at the biggest healthcare conference, like the biggest banking conference where companies like me get to go showcase and you might get investors. And I started to talk about it and the whole room broke into laughter. Laughter. And I thought, you're joking me. And I can remember, like I had a countdown clock, you know, I was watching it, like this is your shot and you're losing this time. And I can remember, I like fast forwarded my slides as fast as I could to the brain scan imaging of women.

24:14Cindy Eckert: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 a hundred million dollars 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.

24:45Dr. 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. Yes. And you, the numbers are in your favor. You're so excited.

24:58Cindy Eckert:So excited.

24:59Dr. Mary Claire Haver:Then what happened?

25:00Cindy Eckert:They, they say no. And I really like, I couldn't believe it. How? How could they say no? Because they're the FDA and they get to make the decision ultimately. And really what they said, and this is the tell, is they said, well, the benefit is only modest and therefore no risk would be worth it. And I think really what you have to look to there is if we assign no value to the benefit of something, then sure, any risk would be too great. And were we really just saying that we don't think women need this? Because we 26 times we looked at medications for men that have benefits and risks. And we said, yeah, here you go.

25:44Cindy Eckert:Make the decision with your doctor. But we wouldn't do this. And it became like this media frenzy of like, oh, well, how many more times do they have sex a month? And how many more times is the right amount of times? And my answer to that is go ask the woman struggling with it. Go ask her if going from not having sex to having satisfying sex even once a month is meaningful. You ask her. Because in our trials, by the way, we also had to use an index. It's called the Patient Global Impression of Improvement. Just nerd terms for, does it matter? And they said yes, with statistical significance. And so data was on our side.

26:23Cindy Eckert:I mean, when we got the news that FDA rejected us. I got to tell you, that was, I was blindsided by it. I couldn't, I couldn't believe it. You did everything right. We did the work. You, you defined success and we made it with statistical significance. And now we're going to debate the merit of like, how much is enough for her to deserve it? That was brutal. And really, I thought the end. I mean, I can remember the day I got the news. I happened to be flying in. I'm based in Raleigh. I'd been in New York. And my assistant called me right when I got off the plane, like, oh, no, I need to tell you this because they'd sent it through.

27:00Cindy Eckert:And I went to the office and I basically gathered everybody around the table and really to set the mood, like the champagne was chilling because we knew the results of the trials at that point. We'd broken the blind and like everybody came to the table, like here's Cindy is, here's the great news. And I said, go home and work on your resumes. it's over. And I took that weekend and I swear this is a bit of like women have always been the people who've directed me. Right. Right. A woman who'd been watching the results. Nobody knew this tiny little company doing this at this point. Right. No, the media frenzy hadn't even begun.

27:36Cindy Eckert: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 D.C., sat with her, and I was reminded of why I did it in the first place. Like, it was for her. It was for her. It was the validation. And I went back on Monday morning. I gathered my team around the table and I said, we're going to fight the FDA. And my IT guy said, can you do that? I'm like, we're about to find out. And that really, the next day, he put a pair of boxing gloves on my desk and they've been there ever since.

28:09Cindy Eckert:So walk us through the fight. It was brutal in that like the minute we did that, Nightline shows up, right? Like here's this tiny little company rally, knock, knock. Hi, you're fighting the FDA. And then it just, everyone was coming and commenting. And what was really happening was the great cultural debate of does it matter for women to have pleasure? And we were maligned and smeared and you were, I had this, this is the

28:37Dr. Mary Claire Haver:part I remember as a young practicing physician with this new medication. It really doesn't help that much.

28:43Cindy Eckert:The very first headline, like I still remember, was female Viagra. Isn't that jewelry? I mean, that's not that long ago. And so it just started coming. I mean, there were the things that were printed, the photographs of me where I'm red like the devil. My brother still has it as a screensaver on his phone when I call him, because what would a big brother be if not doing that to you. I look back on it. And at that moment, I just built an armor of pink, right? Like I was going to, we were going to have this conversation. Go ahead, come for me. Let's talk about it. Because in the end, I have the data and science cures bias.

29:22Cindy Eckert:I'm not backing down. And that was really the, with the FDA as well. You know, being in that room, my pink kept getting brighter and brighter and brighter because this was the conversation we were going to have that you minimize, view it as weakness. You know, go ahead, honey, just have a bubble bath. It'll be okay. No, no. I think, you know, progress begins when somebody says no out loud. And so it was a wild ride, a lot of smear. And the FDA, to their credit, opened their doors to the public. And this is actually their mandate. We pay for them with our taxpayer dollars. And their mandate is to put patients at the center of conversations.

30:02Cindy Eckert:It's called patient-focused drug development. Who should we be talking to if not the people that are affected by the condition? And so to their credit, they had all these public meetings that were like a three-ring circus of media and picketers. And it's crazy. Because why? Because we so don't want women to have a medical option, an FDA-approved medical treatment that is proven safe and effective to the standards of the FDA for a medical condition that was first characterized in 1977. So ultimately we won fair and square on science, but women won.

30:35Dr. Mary Claire Haver:But you brought the patients into the FDA. Yes.

30:38Cindy Eckert: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, took time off work.

30:50Dr. Mary Claire Haver:And got up and told probably some embarrassing stories.

30:53Cindy Eckert:You're at a federal agency and you're like opening the doors of your bedroom to tell your most private struggles. And they did it because they knew if I don't say it, it never changes. And like, they're my heroes. I'm going to get emotional. I sat in the audience with them, you know, watching them up there. And they were mocked, ridiculed, berated. Stories were written about them in the press. And there was one moment in particular where a woman had just gotten up and said, like, really, this had caused the demise of her relationship. It wasn't sex alone. But once they stopped having sex, like all the resentment started to build.

31:29Cindy Eckert:And she was on the brink of divorce. And somebody got up and they said, hey, I have something you can do for this. Eat chocolate. And I just just sat there like gritting my teeth. Like, I cannot believe we talk to women this way about a medical condition.

31:46Dr. 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. Which have been repeated all over the world now.

32:01Cindy Eckert:Like Stanford did big work in the United States. It was discovered in the Netherlands. Like this is unequivocal.

32:06Dr. Mary Claire Haver:But that didn't trickle down.

32:08Cindy Eckert:I know. But it's really so much about what is so deeply embedded culturally about our right to desire.

32:16Dr. Mary Claire Haver:So, you know, no one owns this in medicine. So OB-GYN barely covers it. Totally. At least until 2018, I was a program director. Yeah. We didn't touch on desire, just barely. Right. And I got zero in my training. Yeah. And urology, they get tons for men and almost nothing for female. You know, family medicine, all the primary care docs. But OBGYN, really, there's not a female sexual specialty. I mean, there's organizations that you can join after you finish your training. That's right. Like IshWish. Sure. But no one really owns this part for women. They do for men. It's urology.

32:56Cindy Eckert:Absolutely right. That's right. Yes.

32:59Dr. Mary Claire Haver:But usually it falls under psychiatry. I know.

33:02Cindy Eckert: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.

33:25Dr. 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, it's outside of the bikini, the breast, the uterus, you know, the part of the body covered by the bikini. You are a man with, you know, like Miss Potato Head. You just pop on the breast and pop in the uterus and ovaries. and that what we're understanding now and what I'm pushing is actually every cell in our body is different. Yeah. And it's going to respond differently. Yeah. To different medications. All right. So you go and you fight. Yes.

34:01And when did it get approved?

34:03Cindy Eckert: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.

34:41Cindy Eckert:ED is erectile dysfunction. Yes. So if you think about that, right, like more women struggle in the bedroom than men. Now there is for the first time ever an FDA approved treatment option for it. And I went up to do the morning shows and it doesn't change. The questions they asked, like a very famous broadcaster had me on to talk about the big news. And he's like, yeah, but but it has side effects. I'm like, does the blue pill you take have any side effects? Because I'm pretty sure there was death in the clinical trials. but not likely to happen in real life. These are clinical trials. You test extremes to understand.

35:18Cindy Eckert:And yet it's that it's exactly the dismantling of WHI. It's the fear mongering that when something exists for a woman, we lead with the risk. And when something's for a man, we lead with the benefit. Time magazine put Viagra on the cover of Time magazine. It was it was the world's like the biggest invention of its time. How long did it take for Viagra to make it through the FDA approval?

35:41Dr. Mary Claire Haver:process.

35:41Cindy Eckert:Oh, I love this question. Okay, let's do a tale of two sexes, pink pill, blue pill. Blue pill is deemed to meet such an important unmet medical need, a national emergency, if you will, that it was fast-tracked for approval in six months. Six months. Men getting erections was that important. Pink pill, six years, two rejections, public meetings, and we had three times as many patients' worth of data. There's more data. This is a great news story, but I do you think it's missed? Because we often talk about in women's like sexual health, even we need more research and we need more research. Let's not miss that there's more research in a product for women's sexual health than any product for men's.

36:22Cindy Eckert:We have research actually. Now we're finally having the conversation. Yeah.

36:27Dr. Mary Claire Haver:Then you get approved and then you sell. I did. That was always the goal, right? Well, the goal, we were 34 people.

36:35Cindy Eckert:I think nobody knows that. We were like this tiny little band of 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 a year of condition that affects, you know, first of all, half the population. The recent Mayo Clinic data said 50 percent of women over 50 have this 50 percent of women. OK, so huge prevalence were 34 people. This deserved the attention of a big company to globalize it, to do the education, to have the Super Bowl commercial with Bob Dole. I can think of like more interesting women than him on both of my hands that are, you know, on Addy.

37:13Cindy Eckert:Like it was really that opportunity to scale. That was the dream. And then they didn't do it.

37:19Dr. Mary Claire Haver:Walk me through how you felt when you like they bought it and you're like, OK. Yeah. And they put it on a shelf.

37:25Cindy Eckert: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.

38:00Cindy Eckert:and they couldn't get it. And I was crushed. Like I felt like I had let my team down, the medical community down and those women down. It was brutal. But you got the company back. Hell yes. At some point, wallowing in my, like I said, progress begins when somebody says no out loud. I thought, not on my watch. No. And I picked myself up. They had at the time changed the CEO. And I asked the new CEO if he'd have breakfast with me in New York. And he sat down and I said, give it back. And he looked at me and he's like, what? Like, we've paid you a bunch of money for it. Like we own it. And I'm like, yeah, but women can't even get it.

38:40Cindy Eckert: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 to be unable to launch it on our own terms. Still a tiny company.

38:56Dr. Mary Claire Haver:What's the hardest lesson you learned through this whole thing?

38:59Cindy Eckert:That no matter what, the smear still comes. You just have to stay the course in issues like this where we've deemed them taboo or stigmatized or we feel no personal accountability for putting our opinion on somebody else's suffering. Yes. That is extraordinary to me. I do think it's breaking, but I do think it has taken a really long time. And I still sit with physicians who I love who have no idea how this even works. No idea. Nor would they bring up the conversation. And it's like bit by bit. You just keep going and you've got to build whatever that armor is that allows you to do that.

39:43Dr. Mary Claire Haver:What are the plans for Addy in the future?

39:45Cindy Eckert: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.

40:22Cindy Eckert:And like we've had to change meta policy and this, it's just been a long, a long road.

40:27Dr. Mary Claire Haver:Yeah, a long road.

40:28Cindy Eckert:But what's great is that once you change it, you change it for everybody else who's coming behind you too.

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44:11Dr. Mary Claire Haver:What advice would you give to, I know you, you mentor, you coach and you fund a lot of female tech and female entrepreneurs. Talk a little bit about that. That was the value of keeping the

44:23Cindy Eckert:money that the big pharma company paid me. So even though I got it back, I kept their money and, 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, you know, step on? And so we've done everything from, you know, infant formula made to standards that are better than what the FDA standards were at the time. Like, they've improved them. And, you know, an epidural that's more comfortable for women. Like, those are the things I love when it's women's health and it's disruptive.

45:00Cindy Eckert:A date break drug? Yes, that was to detect, basically, I could stick my finger in this and see if there's a date break drug. It was a nail polish. Yeah. Yeah, that was so cool.

45:09Dr. Mary Claire Haver:For the Rohybnal. So if someone comes to you and is pitching something, like, how do you mentor and coach those women?

45:18Cindy Eckert: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.

45:54Cindy Eckert:Like, I think if you keep that open, you don't hold on to that. You actually allow them to change with you. And, but we were sitting in a room and a woman came in and I can remember she presented in the middle of the pitch, she started to cry. And we walked out of the room and it's funny, they looked at me and they were like, why didn't you say to her, like, listen, you know, there's no crying in baseball 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 putting money in. Because I could see in her all of that emotion, all that passion that she's going to wake up every day and work on this tirelessly until she sees it through.

46:38Cindy Eckert:Win or lose, she's going to put it all in the field. And like that was such a, and they were like, God, I've never thought about it that way. So, you know, I coach them to be authentically themselves. That's the truth, right? That is, that's the best lesson is show up in pink, right? Show up in pink and be you. And like, it's going to piss some people off. If you're changing something, 100 % it will. But you just, you can never allow that to push you back or to tone you down. Yeah.

47:06Dr. Mary Claire Haver:I have, of course, my husband and I, me first, but then he's jumped in to help. You know, we have a company, we have self-funded, we've built this company from scratch. And, but we have through the years had VC and private equity come to us looking to perhaps invest. And so, you know, we take all the calls because I want to hear what they have to say. And we've never accepted any, but there's this theme. And so, of course, I have a menopause company and it's always, almost always a man. Yep. And he has to start the conversation with his mother or for his daughters and why he wants to do this. And I know he seems sincere, but it's like, isn't this just a good fucking idea?

47:53Dr. Mary Claire Haver:Yes, it is. Exactly. You know, like, do you have to feign interest in women's health? It's like when Viagra, when they were looking for investors in an erectile dysfunction, did they talk about the health of their son's penises? Right. Exactly. You know, or their son's sex life. This is a goddamn good idea.

48:10Cindy Eckert: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 - I'm just so sick of people sleeping on women's health.

48:19Dr. Mary Claire Haver:Yeah. And like, this is real. Totally. And women are ready to invest in their own health.

48:25Cindy Eckert:Of course. They will rue that day. If you look at the control of wealth and everything else, the wealth transfer to women, etc. Like, you are really out of touch if you're not looking at these opportunities right now. Yeah.

48:36Dr. Mary Claire Haver:And we still get the calls and we just kind of laugh.

48:38Cindy Eckert:Yeah.

48:38Dr. Mary Claire Haver:Okay. Yep. Sure. How do you think, like, women's sexual health, you know, you've been in it. You've seen it from the men's side. Sadly seen it from the women's side. But I feel like things are changing. I do too. I'm new to the party. Yeah. So, but how do you see this changing?

48:53Cindy Eckert: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 I think that people understand, like, it is my responsibility. I mean, look, this is my favorite thing of all. At this point, you can't become a board-certified OBGYN, internal medicine, urologist, or family practice physician without answering a question about HSD and ADDIE. That's huge. That's how it changes, right? Once it becomes embedded in the education system.

49:30Cindy Eckert:But I think even like in practice, I didn't get it in medical school. You feel it. Like you can feel this right now.

49:36Dr. Mary Claire Haver:A significant percentage of my non-pregnant patients complained about this. Yes. and I was a deer in the headlights, Cindy. I was like, I remember walking out to my boss at the time. You know, we'd go to our more seasoned wisdom, you know, older people and who happened to be a man. I don't want to, you know, make this about being, you know, sexist. And he would say, oh, tell her to have some wine, you know, just very dismissive, very platitudes. And that there was nothing, nothing to do. and these poor women. And like you said, I love my husband. Yes. Always. And so I started reading on my own and I found Venus and Mars in the bedroom.

50:19Dr. Mary Claire Haver:Do you remember that book? Yeah, I do, of course. 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. So, you know, you telling that story as I had no idea what you were going to say, you were just a business owner talking about this business. And as an OBGYN, I was just sitting there like, and I remember standing up and just like, I think it was a little teary and being like, hi, I'm an OBGYN.

50:52Dr. Mary Claire Haver: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.

50:58Cindy Eckert:So I love that so much. I remember that. I remember that meeting in 2016. I think it was so many years ago. Look at this. We're almost at a decade from there. And it's just, but it is thanks to people like you. Like, I can't go. I write you. I send you little texts 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. 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.

51:35Dr. Mary Claire Haver:There's so much that is good and bad about social media. But one of the good things, I think, is that stories of women that were kept behind locked doors. Yes. That women had begun sharing these things and everything from, you know, their sexual function to libido to, you know, how to make a chicken. Right. But it's this feeling of, oh, my God, that happened to me. And I don't want to say me too, but, you know, I'm not alone. Wow. I mean, one of my most viral videos, frozen shoulder, palpitations, you know, things that no one had connected in the past on a larger scale with menopause. And I think people being honest and sharing their stories of their sexual function and their frustration and, you know, this real thing about libido.

52:24Dr. Mary Claire Haver:I think social media has allowed women to realize they're not alone and that there's stuff that they can do for it. They don't have to suffer.

52:31Cindy Eckert:Agreed. And I think there's been a dismantling of other even stigmatized conditions. Like I'm very interested in, I would be interested in your take, like the conversation around obesity. I got to speak in LA. So I asked this question to the audience. I'm like, by a show of hands, how many of you have ever tried a fad diet? Right. And like the whole thing, right. The whole audience raised their hand. And I'm like, but there were people we've always known who like, no matter what they did, they couldn't get like the weight off. Like there was something. And it's as if we're just now being like, sorry, it might also be genetics.

53:04Of course.

53:05Cindy Eckert:And I think so too will the story go around sex for women that like, why would we not even consider that it would also be a biological issue? Like, it doesn't mean it always is. If you're in a bad relationship and that's why you don't want to have sex. That's the first question I asked. No pill is going to fix it.

53:21Dr. Mary Claire Haver: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. We can't fix that, right?

53:28Cindy Eckert:But I think that it's just like thinking about us, like if women could be considered, which you say, and it just makes me like, you know, the hair on the back of my neck stand on it every time you talk about the whiny woman, like the WW in the medical chart, like if we could just consider them like biological beings, and if we would start there in science, in a scientific interaction, we'd be so much further along.

53:53Dr. Mary Claire Haver: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?

54:06Cindy Eckert:They were, so FDA criteria was that they had to be in long-term relationships, and this had to have been going on for some period of time. That said, the measure of satisfying sex could also be masturbation. Okay. So it could be unpartnered. So what's the masturbation data say? It's good. I mean, more satisfying sex. And that might have been, for some of them, like their own masturbation, not partnered sex. So I think that was part of what was looked at. But like the enrollment criteria was long-term partnered, long time. Like women had been struggling with this for at least five years during the trials.

54:42Dr. Mary Claire Haver:You didn't have to, you know, if the FDA was not in the picture, how would you have designed this study?

54:47Cindy Eckert:Oh, interesting. This is going to be the craziest thing that anybody has ever said designing a clinical trial. But I would have actually started with women who had survived breast cancer. And here's why. Because this is non-hormonal. And because I think we might have gotten out of our own goddamn way and had a little bit of compassion. And if you think about a woman who goes through that and has struggled and survived, and she's now given a life sentence of like a lack of libido and a lack of that intimacy. you would actually not be arguing about, like, does it matter if she has it? Like, that's honestly what I would have done.

55:24Cindy Eckert: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.

55:34Dr. Mary Claire Haver:They are very loud right now, which is great, about our needs are not being met. Like, okay, you've cured my cancer, but you've left me with this armamentarium of side effects. And my quality of life is so poor.

55:49Cindy Eckert: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 the greatest thing I had in my back pocket is that I had built a company in male sexual health and I knew what happened there and what the trials looked like. And, you know, suddenly I started getting asked all different questions that I'd ever been asked before. But like when men survive prostate cancer, one of the outcomes of surgery might be that they become impotent or they have erectile dysfunction.

56:26Cindy Eckert: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.

56:53Cindy Eckert:Why have we asked our contractor we found on Angie.com to be our kid's legal guardian? Because he took such good care when redoing our basement that we knew we could trust him to care for our kids, all eight of them, should something happen to us. Are you my dad now?

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58:20Dr. Mary Claire Haver:What would you tell your younger self walking into those all-male meetings in your pink outfit? What makes you think that they know better?

58:29Cindy Eckert:they may sit there they may you know criticize your idea um they may marginalize it they may tell you it can never be done but why do you think they know better than you do so it's out

58:41Dr. Mary Claire Haver:we prescribe it in our clinic um our patients are sometimes struggling to get it filled or covered

58:46Cindy Eckert:yeah you have a good story i want you to share oh man i gotta tell you this is also like this is where it never ends, right? And like, who bears the responsibility for this? Like, what journalist, 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.

59:24Cindy Eckert:So the story from denial. So listen to this. An insurance company sent a basically prior authorization, which is the hoop jumping that insurance companies tried to deny. And so a woman who'd been like diagnosed with HSTD, been prescribed Addy by her physician. It's the, you know, one of the FDA approved drugs. She gets it. They send a prior out and they say, well, first she has to try marriage counseling.

59:56Dr. Mary Claire Haver:Just to fail marriage counseling.

59:58Cindy Eckert:Fail it. What does that look like? Yeah. I don't know. If she sends her a divorce certificate, does she get the medication then? Is that what it looks like? This is a huge national insurer. Are you kidding me? You must first fail marriage counseling, please. So of course, you know me. I'm like, well, please show me a time in which you have required that a man fail marriage counseling before he gets Viagra, Cialis, any other medication. Because if you don't, I'm printing it on the front page of the New York Times. Like, this is the thing. It's unacceptable. We have to be thoughtful about what our responsibility is in that if we position this for women as just an emotional thing.

1:00:41Cindy Eckert:Because then they can get away with saying it. I think that's, by the way, let me be a little optimistic here. I think that's the next domino to fall, that actually insurers are going to cover the things that are approved for women. That's the next domino to fall, that actually, you know, because we talk a lot and, you know, we have this conversation as well about, we can talk a lot about women need more funding, we need more research, we need more of those things. Yes, but for the things that do that, right, that get the research, get the approval, then they can't access them anyway. So what is the incentive for anybody to go here and do that?

1:01:17Cindy Eckert:And like, that's the thing that has to crack. I talk to rooms of friends who like have a perception like, well, there's nothing for women. I'm like, well, actually look at this page I have of all of these different things 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.

1:01:40Dr. 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. Yeah. And some of the, you know, feedback, does your husband know you're on this? And, you know, from that I've heard from patients coming back of just how lots of people not in the relationship feel like they need to weigh in from pharmacists down to their insurance coverage. Unbelievable. And they don't see that when their husbands go get vasectomies or Viagra. Yes, right. But when you get your tubes tied or when it's your health, your right, your choice, you know, again, this is a bigger conversation.

1:02:21Cindy Eckert:And let's just say this here. Don't mistake that paternalism is only male. Oh, God. Yeah. So many women are so paternalistic about this, And I think they're blinded by their own superiority.

1:02:36Dr. 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, it's less. If you are an academician who is not actually seeing patients, sitting there getting the emotional waves of this coming off of a patient, it's a lot easier for you to dismiss this and dismiss, you know, what this medication could do for the patient. I also think there is a definite generational thing where maybe this generation of scientists was not in their own socio, you know, psychological and socio-biopsychosocial development.

1:03:19Dr. Mary Claire Haver:This was not a thing. They were expected to serve and fade and not to embrace their own sexuality. Now, Lauren Stryker is not like that. You know, I had just had her on the podcast. She's, you know, a little bit older than me and definitely has been training a lot longer. I was a geologist before, so I have a little gap. But, you know, it's not all. I certainly don't want to generalize this by age. But I do see, you know, if you're at the bad side, if you're actually treating patients and if you tend to be have been brought up with this biopsychosocial sex is a good thing, you deserve to have pleasure.

1:03:54Dr. Mary Claire Haver:Yes. Then you're a lot more easy to embrace. Yes. There's just so much we have to dismantle.

1:03:59Cindy Eckert:so much dismal 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?

1:04:39Cindy Eckert:That is a crazy thing. And I will just say, because I'm a little less forgiving than you are for all of the, you know, excuses I have heard through the years of, well, I just wasn't trained on it. You know, I too was not trained on Microsoft Excel, and yet I've had to learn how to do it to be a CEO. And so I feel like there's also just a requirement in this world, right, to keep learning and evolving so that you can take the best care of people. What's one myth about women's sexual health you want to retire forever? Okay, right here, right now, we're doing this. It's men's right to receive pleasure, and it's women's to deliver pleasure.

1:05:17Cindy Eckert:Good job. Own your pleasure in the bedroom, in life, in the boardroom, wherever it is, own your pleasure.

1:05:25Dr. Mary Claire Haver:Awesome. All right, what is the documentary, The Pink Pill, Sex, Drugs, and Who Has Control? Oh my God. Tell me the story. Like you were sitting at home one day and the phone rang.

1:05:35Cindy Eckert: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.

1:06:12Cindy Eckert:Just keep going. Just keep going. We're going to make progress. And we have made so much progress that I didn't want to go backward and basically 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.

1:06:45Cindy Eckert:So I have no involvement, like no editorial control, nothing. Right. So it was very scary. Like it's very scary for me 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 of the women in the room that day who stood very bravely and, like you said, told their most personal struggle to change it.

1:07:23Cindy Eckert:In front of a bunch of strangers. 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. I believe that.

1:08:02Cindy Eckert: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 a straightforward process.

1:08:21Dr. Mary Claire Haver:I mean, Cindy, you could have taken your big fat check. paid off your people and gone off into the sunset. You didn't have to work again, I'm guessing. I mean, you know. It's true. So like you're always working.

1:08:34Cindy Eckert:I'm always working. What is it? I know it's because this is my passion. And like I'm not, I won't stop working until it's done. And when it's done is when we're not having these nonsense conversations. We're really treating women equally when it comes, not differently, equally. Like, again, with the FDA, I never asked that we get special consideration. I asked that we got equal consideration. Same standard. That's it. That's all I asked for. And that's what I hope we get to in women's sexual health. I think it's the next frontier.

1:09:08Dr. Mary Claire Haver:All right. So why do you keep doing this? What is driving you right now? I've decided I'm allergic to hypocrisy. That is awesome. 2016 I sat in a room and you were the first person in all of my training and all of my years who made me look at how we treat women's sexual desire as a medical condition and you changed my life and therefore you changed the life of all of my patients and now millions of followers so thank you I adore you thank you you can find Cindy on Instagram at Cindy Pink CEO and through Addy's website at addy.com. I'd love to hear from you about this topic and anything else that's on your mind.

1:09:55Dr. Mary Claire Haver:You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepawslife.com. My upcoming book, The New Perimenopause, is available for pre-order at Amazon. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr.

1:10:30Dr. Mary Claire Haver: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.

1:11:10Cindy Eckert:Irish flute or those calligraphy pens or that daunting Beef Wellington recipe card and leave the laundry to us. Rinse. It's time to be great.