Peptides/Sex and libido
Bremelanotide
Also sold as Vyleesi, PT-141
An approved medicine for low sexual desire in premenopausal women. It works on the brain rather than blood flow, and effects are modest.
At a glance
What people use it for
- Low sexual desire that causes distress, in premenopausal women
- Taken before sex rather than daily
- Used off-label by men for erectile difficulty
How it is taken
An injection under the skin of the thigh or stomach, using an auto-injector, around 45 minutes before sex.
Evidence
Mixed human evidence
Good to know
- Nausea, common enough that a significant minority stop because of it
- Flushing, headache and injection site reactions
- Temporary rise in blood pressure, so it is avoided in uncontrolled hypertension
- Darkening of the skin or gums with frequent use
Bremelanotide is genuinely unusual on this site: a peptide, approved by the US Food and Drug Administration, for a problem that had almost no good options. It was licensed in 2019 as Vyleesi for hypoactive sexual desire disorder in premenopausal women.
Most treatments in this area work on blood flow. This one works in the brain, on melanocortin receptors involved in sexual motivation. It addresses desire rather than mechanics.
What people take it for
Low sexual desire that is genuinely distressing and not explained by relationship problems, another medical condition or a medication. It is taken as needed, roughly 45 minutes beforehand, rather than every day.
It is also used off-label by men for erectile difficulty, particularly where the usual tablets have not worked.
What the evidence shows
The registration trials met their endpoints, which is why it was approved. Women on bremelanotide reported greater improvement in desire and less distress than those on placebo.
The honest caveat is size. The average improvement was modest, and the placebo response in this area is large. Approval means it works better than nothing to a statistically reliable degree; it does not mean it works dramatically for everyone. Reviews have been openly divided on whether the benefit justifies the nausea.
What to know before
Nausea is the main reason people stop. It is common, and for some it is enough to outweigh the benefit.
There is a limit on how often it can be used, and repeated use can darken skin or gums because of how melanocortin receptors work. That is the same mechanism that makes Melanotan II tan the skin.
It needs a prescription and a conversation, because low desire has many causes and a drug is not the right answer to most of them.
Last reviewed .