Welcome to the Dr. Gabrielle Lyon show where cutting edge science meets innovation and practical application for everybody In today’s episode I sit down with the incredible Cindy Eckert She is a serial entrepreneur and founder of Sprouts pharmaceutical Not only that She has brought Addie to market and maybe you haven’t ever heard of this or maybe you have but regardless There are things in women’s health specifically women’s sexual health and desire that you May not even know what you are up against this episode. I learned so much I have a tremendous amount of respect for Cindy Eckert. I know that you are going to find this extremely valuable whether you are someone who is suffering from PCOS or low libido or Fibromyalgia, you name it. I Guarantee you are going to come away with this conversation as a totally different person. Please enjoy my conversation with Cindy Eckert

Cindy Eckert

The truth is I knew that you’re gonna be wearing pink today I know it’s shocking it is shocking and you guys have to understand I am so excited to have this particular guest on the show Cindy you’re excited. I’m excited. I’m very excited. I’m not wearing pink. I should be you are extraordinary and your vision and your drive and your ambition to bring a voice to women women in medicine is second to none and I See it and I think the world sees it and I definitely definitely want our audience to see you know you and Just support what it is that you are doing. So welcome to the show. Thank you I think I go through life and my dad taught me this very young I I live by four words, which is how lucky am I and so I should say to you How lucky am I to be sitting here with you who I greatly admire for all of your work? And thank you for that introduction actually choked me up we need you and I need you now more than ever and I would love people if you guys know who Cindy Eckert, you know, the first time I saw you was on Shark Tank

Thinking myself about this woman this woman is amazing. But let me tell you my experience. I had never thought about the differences in Women’s health the differences in the research for women versus men. It never even occurred to me It never even occurred to me. That’s the dirty little secret, isn’t it? We don’t really think about it and yet I’ve lived the case study of the difference having built a company for male sexual health Right and seeing what that landscape is seeing how much that can make a difference in people’s lives How valued it is and then I dared to build a company in women’s sexual health and break through with the first treatment and the path Was radically different. I’ve literally my professional journey In sexual health has been a tale of two sexes. I mean it’s extraordinary and When I saw you on Shark Tank, it had put you in Obviously as an entrepreneur and there’s this whole story sure how You built this business and then you sold it for a billion dollars and they you bought it back for a sandwich or a dollar I am sandwich. Thank you and my leg. I always laugh by that reference But what is so extraordinary was and I and I speak for I think that the people that already know who you are Is that there was a mission behind it? Oh, yes, and I would love for you to share We will definitely talk about Addie the pharmaceutical the female Viagra but on the same Side of that coin or the opposite side sure is a true story about what the current landscape is for women’s health. Mm-hmm

This is has never been about a drug This was about evening a playing field that never should have been uneven to begin with That is who I am. That is how I’ve walked through my entire life I think even from my childhood it has been about looking at those things that are Don’t make sense and then challenging that so when I stood in the field of Male health and I ran a business in that and I looked at a plethora of options 26 at the time and not a single one for women I asked the most obvious question which is how can that be? When more women than men are struggling with this issue So for me the mission when lightning struck to do something about this It was about having the conversation that we obviously needed to be having That’s always I think in life I’m looking for those things where it just doesn’t make sense and then I want to ask the provocative question disrupt disrupt the Atmosphere tell me a little bit about your backstory for the listener you had started in Was it pharmaceuticals? Yeah, I worked for a big company. So right out of school I’m such a nerd. I wanted to work for the Fortunes most admired business. I was singular I they could have been in oil and gas or in Houston They could have been in anything they happened to be at the time Merck which was in Pharmaceuticals and I got into that company thinking I’m gonna go work for the best and I fell in love with the science I now worked for a company that changed people’s lives With what they did and I didn’t love doing that in a big environment I was just a number You know do they were were they doing at the time so much research and development like that was back in the day when big companies Really drove all the R&D what has transitioned like so many industries is it’s the little guys That are doing all the innovation the big guys come and gobble them up, but they don’t do that work And it’s really sort of those passionate mission driven Problem-solvers and those were the people I wanted to be with who were really solving Challenges that could be transformative in people’s lives if you track my career. I chased innovation I literally went so cool toward I ran toward those things where I would be learning I would be Making an impact I have two big brothers. They’ll tell you from the time. I was little I’d like to be I like to be heard I like for people to listen to what I have to say So naturally I was not a fit in a big kind of environment But you’re always driven by this desire to make a positive impact. I think impact success. You know success for me I’ve been very fortunate in my career people talk a lot about what were you chasing and you know I often say success for me Doesn’t look like money. It looks like impact It looks like change and that’s the thing I love to be some small part of And it looks like choice. It looks like freedom And so you know think the things I worked on were liberating people To live their best lives or take control of something that they had lost control of and so Naturally that leads me to sex. You know I come into of all the fields and actually the field of sexual health Relatively speaking in Scientifically is young you know there’s a lot of new discovery, and so it’s such a fascinating field because None of us would be here without sex, so it’s important don’t tell my Do not tell my human race and and I just loved

Even when I was on the male side Watching what a difference it made in people’s lives and then realizing that the score was uneven And that in fact women had nothing in their toolbox and that you know started an entire Lit something inside of me of what we needed to be talking You start seeing that and and basically you were looking at Viagra, and there were 26 different choices to treat Male sexual dysfunction male sexual and it could be that could be You know ED which is men’s most common issue that could be around testosterone Which is you know a milieu of different symptoms one of which is low libido It could be around peroni, so they’re all of these different things that men struggled within the bedroom Let’s just say that for that they had 26 different medical options to make it right Or to help them and if you look at the data more women than men actually struggle from sexual dysfunction, so Jam up 43 or Journal of American Medical Association 43% of women will struggle with some some form of sexual dysfunction 31% of men and So I’m looking at all of the prevalence data for years and years over the world that women are actually struggling disproportionately and Women have zero options, but men have more than 20 and you think well How can that be and you have to ask that question? And I think what you come up with is the answer that we don’t value pleasure for women

Did you have an aha moment was there a moment 100% do you remember what that was I do I was Standing at the sexual medicine society meeting there is one of those the best researchers. You know in the world That’s right the best and They presented data That was showing brain scan imaging of women who have this medical issue. It’s called HSDD hypoactive sexual desire disorder plain English low sex drive. That’s causing them frustration and distress They took a woman who had that medically took a woman who did not expose them both to porn their brains lit up totally differently the side-by-side contrast is stunning and basically, it showed hardware and I think I sat there and was looking at this and I thought biology and It was so obvious in that moment and yet we’d gotten away with up until that moment Saying well, we can’t see it. So it must not be real. It’s just psychology and I think that started the premise for me in women’s health forget just in this field in sexual health But pervasively in women’s health be it cardiovascular health or any of these other things that if we think of women as driven solely by emotion and therefore psychological beings We will completely overlook that. She is also a biological being and that Irritates me more than anything else

It probably festered right it began to fester it wasn’t I mean you had that moment you saw the brain images That was so like black and white to me the click like I see this everyone’s gonna everyone’s gonna see this we’re gonna start talking about this because there’s a biological basis that is out of can out of the control of these women who were patting on the shoulder and telling to Have a bubble bath and just relax and I think when that happened what then transformed is I Sat with it. And what I did is I just started talking to those women Diagnosed with it and I spent a year doing that. I just asked the best researchers in the world Can I spend time with some of your patients who have this issue? They had no solutions, but they were diagnosed with it Can I talk to them? and Think how lucky am I? That these women were willing to share their most private struggles with me things that were a lot of tearful exchanges and What struck me again was how consistent their story was? So they came from all different backgrounds different ages different experiences and what they would say to me is the switch one out I Don’t know what happened. I used to think about it. I don’t think about I love my partner That was like a Hallmark sign for me. They would make sure I knew before I left that room. I love who I’m with This isn’t about depression. This isn’t about any of those things It’s like I never think of it anymore, but I want to and what they were describing is what we were seeing in Those brain scans. So imagine for a second if you drove your car around With your foot on the brake You were just driving riding the brake. That’s what we’re seeing their brains just literally not activating with sexual cues and if you could just take your foot off the brake and Even better put it on the gas with some drive What would be different and they described to a person what we were seeing in the scans

It sounds so clear and Yet you wouldn’t think you know where I’m going at this, you know where I’m going with this it sounds tremendously clear and obvious and Yet here we are

When you had this moment and you saw these brain images, what was the next step where were you thinking? Okay everybody is gonna want to be able to make a Medication to fix this or was there some next step that you were going to find to solve this? Well, I want to go back to your first comment because to me it was an obvious truth The world has a history of denying obvious truths for a long time When it causes disruption or change and that should have actually been more obvious to me to me It was straightforward and so the next step was there was this great science being innovated in Germany So there was a product that they were looking looking at that worked on key neurotransmitters So what are we seeing in those brain scan studies? We’re seeing this difference in like activation or deactivation And that like not, you know taking your foot off the brake With with key neurotransmitters in the sex center or reward center of the brain

They were doing studies in this compound and when you look at things that work on these Neurotransmitters in the reward center all the things that have ever been on the market for them cause sexual dysfunction Right, so they lower your libido And so when you look at these products in trials you actually are required to administer a scale that says like how much am I harming? Sexual function well this compound in Germany they administered that scale and all the scores went the other way so Flabasterin yes, did I say right? Flabancerin, Flabancerin So I only know Flabancerin is adding. Yes much easier. It was under investigation as an antidepressant What you what you’re describing? Yes are the normal side effects the sexual side effects that typically happen when someone goes on Prozac or a Zoloft something that is utilized to improve brain function. Yes, essentially

But they found improved sexual function. Yes, so they were looking at it early days You know, it’s so many so many of the products that we know and love the blue pill Viagra, right? It was a blood pressure medication. Did you also did you work on Viagra too? I didn’t work on Viagra. I just worked in that space So I know all those fun stories of it of early days But you know it was it was being looked at or it was a blood pressure medication with a really interesting side effect And you can go through history and there’s lots of different products that are discovered that way and similarly this product so interesting here it is looking at its effect on mood and Yet, it’s in fact improving sex drive as opposed to pushing it down really what’s happening with those antidepressants I keep going back to this analogy, but it’s really further inhibiting you Mm-hmm, and that’s why you’re having that reaction where it’s harming sex drive and this one is again

Disinhibiting so it’s it was spectacular and to me that was the science How did you find it? It was being talked about I mean this was so excited like such exciting discovery And the best researchers in the world again out or Erwin Goldstein Erwin Goldstein Was the principal investigator on the key pivotal trial that got very famous very famous position yeah prolific study, you know prolific publications in the field of sexual health and and he he knew obviously had been working on some of these research trials and So that was that was the first place to go and and and then it was to me so straightforward You you get the compound you do the studies you sit with the FDA you say what are the endpoints? We have to prove in clinical trials to prove efficacy or you know effectiveness Of this product and I just went out and I set on that path and what I didn’t anticipate Was the resistance that was coming? I didn’t because it was such it was such an obvious truth and But again in the world Change and humans are resistant to that and so what I hadn’t anticipated is just how deeply people would feel about women’s sexuality

Basically what you’re saying is you? found this solution for Women’s sexual dysfunction and you know for the science people out there There are and will link to some of these studies four types of considered four types of female sexual dysfunction orgasmic disorder sexual interest arousal disorder Genitope pelvic pain penetration disorder substance medication do sexual dysfunction a whole host of Disorders that are not Psychology they are not they are I’m looking at the four types of female sexual dysfunctions and these are biology Correct and that is that is also the lightning rod so the lightning rod is it is biology and then the fight is how do we take a woman and Reduce her to emotion and psychology alone and yet we both know that’s deeply rooted in medicine deeply rooted Hysteria is still actually alive and well. I I have a couple statistics and a few pieces of background and this is So this was a quote it says even Hippocrates believed that the womb traveled throughout the body causing hysteria a Psychological diagnosis that was only removed with the updated DSM 3 in 1980

Women were not required to be in clinical research. That’s until 1993

Again, you had mentioned 43% of women experienced sexual dysfunction 28 FDA approved sexual Dysfunction medications for men and only one for women But what I do think is important and you and I were talking before we were podcast. Yes, we are not anti men We are not this is not a feminist conversation this is about finding solutions

For women because women’s health just like men’s health just like child children’s health. Yes equally as important exactly and

There seems to be a bit of gaslighting in health and wellness in the health space that when And you know you sent me an amazing book an amazing book that went through Some of the data that a woman will go multiple times to a physician to be diagnosed with I Don’t know even PCOS. Of course. I think it was 13. Yeah visits was it somewhere around that the data for example There’s a great study where if a woman walks into an ER She describes the symptoms of a heart attack

They she actually waits seven minutes longer in the waiting room than a guy Because we have an initial whether conscious or not We have a deeply embedded belief that she might just be freaking out

If you Could have the result of your mission. Mm-hmm. You are very mission driven. Yes. What would that look like if you? advocated for what you believe in where would we be women deserve proof in medicine That would be where we are. We would believe that women are biological beings We would lead our conversations with them with that premise. We wouldn’t do that to the exclusion of exploring psychology lifestyle any of those things but our first foot would be that she is a Biological being and I will therefore take seriously The things that she is saying and we will explore that first and then we’ll layer in the rest and we have the opposite that happens Today tell me tell me we lead with she is a psychological being Rooted in emotion and therefore I am going to take what she’s saying and I’m going to

Dismiss a good bit of it not because I’m a bad person But because I have been conditioned to do so so I think about all of those women I talked to who’d raised their hand they’d said hey, can you help me? You know tearfully in the doctor’s office and what had we prescribed them?

Have a bubble bath. Okay Do better do you schedule date night and what what we almost don’t hear in that is that we are Putting a blame on her for something that is rooted in biology For which we have proven, you know science that would tell us we could help her and we create this Hopelessness there that’s so very unfair to me. She doesn’t ever have to take a Medicaid Let me say that very clearly but she deserves to have the conversation of what we know medically So if I could wave my magic wand, we would lead all conversations around women’s health with evidence. Hmm

When you went to get this drug approved by the FDA, did you get the same experience? So you felt like

Okay, here is the need

We’re gonna make this happen There’s a ton of data to suggest and evidence So one of the big things that you had mentioned was it’s all about the evidence it is That this matters for women. Yes What happened after that? Well, we got stuck in all medications Maybe all decisions we have in life are risk benefit, right? That’s what we’re coming down to and that’s the obligation a company has to say these are all the benefits that we prove It’s effective and this is it balanced against the risks and what we got to is is there any benefit to women having more sex? Because if there’s no if you don’t actually that’s also easy, but that is a subjective so the evidence shows that this is helpful totally and It’s almost an arbitrary decision if for somebody else to say Should they be having more sex or not, right? It’s not it’s not anybody’s decision It was literally the entire basis of the discussion was how much sex is enough for women to deserve to have it Which is an absurd premise. What’s just a ridiculous question? It’s a ridiculous question and we’d proven it against all the endpoints at the FDA Required which is we had to prove in clinical trials women had more desire for sex as measured by the medical instrument They had more satisfying sex when they had it and they were less stressed about it Remember this is going on in that right at that center of the brain So it’s causing them profound distress if this is out of whack and it just was an amazing

Amazingly absurd discussion. I always like to flip the script like I always like to say and if we asked a man This quite if we if the premise of Viagra was like, yeah Well, how many more time if we give men a pill how many more times should they have sex to deserve it?

Matt what do you think?

There you go. I mean, it’s so of course It’s so like that was really the basis of it and that was the idea of like Marginalizing I think effectiveness was talking about like yeah, but it’s just this many it’s just in its It’s funny how that happened. So just cliff notes Viagra got approved in 1998 It was deemed to meet such an important unmet medical need Erectile dysfunction got Pat didn’t move through in like six months six months Fast-track status. Yeah, because that was such an interaction. They need those erections. It’s a medical emergency Yes My husband would definitely say that and for women it took us six years We had three times as many patients worth of data in our clinical trials at the time We submitted would someone say what someone listening to this say that there was some other criticism like maybe There was some other reason why it didn’t get approved or didn’t get fast-tracked I think what if anybody were to say that they would say well Well, how well does it work and they would be back in the stuck in this argument of it’s not what how are you defining? It and I think that they say that and I think that is really what came to the door is this

Really? It wasn’t a debate about a drug It was a debate about whether or not women should get treatment for this thing pleasure that we don’t necessarily value for her and That was really the crux of it I mean when you looked at the data and ultimately obviously we got FDA approved So we proved it to the highest standard right to the to the scientific bar the highest scientific bar of safety and efficacy To win FDA approval and we’ve been approved in other places across the world But if you look at the criticisms You’re gonna realize what we’re really talking about is do we think this matters? And then we’re going to be doing that risk benefit and we’re gonna be talking about things like risks all Medications have side effects. Let’s be clear including those that you buy over the counter at the drugstore so all of them do anything you’re putting into your body and So what what we do is if we don’t value anything we talk about all these things out here risks

And we do that Disproportionately because we’ve we don’t place any value on the benefit of it And so I think that’s really a lot of our story and it’s it’s really fascinating because Flabastron or Addie is something we use in the clinic all the time. Yeah, I’ve taken it myself and There are other things in terms of benefits. So We might hear about the risks which I mean are so minuscule for In particular even this medication will just say but there are some great papers about Addie and Body weight changes. Yes weight loss. Yes also like interesting scientific theory, right around that reward center of the brain Let’s talk about it. What are the trade-offs there of like, why do you see that in clinical trials? and and so really I think the thesis would be like once I’m in that reward center of the brain that drive and I’m activating drive so sex drive But you know drive I think has implication beyond that is that the the correlation? Yeah, and if someone is interested, so basically

It acts on various receptors in the brain. Yes. So for the nerds out there over the physicians. I shouldn’t even say nerds Yeah, it’s 5HT it 1a 5h t2a you’ll be able to see it. Yeah, there’s a lot of good data and again this there’s the one study that I’m looking at is 24 week three 24 week double blinded placebo control trials of 100 milligrams each at bedtime. Yeah, and These women seemed to do really really well. They experienced weight loss better sleep. It wasn’t just even about Desire It’s not I think and you know for sure just to be clear our indication is for a hyperactive sexual desire disorder but I think what happens and this is Harold’s back to like talking to those women. It’s not about the sexual act So I don’t think and you would tell me differently that women specifically come in and they’re like dr. Lion I have sex two times a week and I’d really like to make it four I don’t think that’s not the language. Yeah, actually even if you look at like hierarchy of needs, yeah for women

Right in that hierarchy of needs before we ever get to self actualization You know on sort of mass love skill is is intimacy and its connection and love and I think in in a and I’m Stereotyping here, but in common female language we would talk about connection and intimacy in the top Three things that we need men would talk about it as sex. So I think it’s not the act. I think it is about that interest that intimacy that wanting to connect and then when that goes off when something biologically happens that Disrupts that what you do is you end up not only disconnected from the person you want to be the most connected to But I think you end up being quite disconnected from self and that shows up in a ton of data So I will say again

When I put patients on this medication, yes, we use it for clinical indication of Hyposexual desire disorder. Yeah, but it can also be used off-label for other things. Yes It and and that is obviously always in a doctor’s medical discretion with the patient, you know, I’m Sticking to our indication but honestly that’s that’s totally the discretion of and I think it’s much more

There’s a whole surround sound if you will to desire and drive I agree and if you’re listening to this, I would ask your physician about Flubancerin just they might not have even heard of it. They won’t have and and I will tell you that off-label uses it might be

Could help them sleep could help their body weight But what we have seen in clinical practice is there is this subtle effect on mood?

Definitely an increase in sexual desire definitely but also an increase in Drive in motivation. It’s almost as if you know again, it’s not a Antidepressant right but I will say from the accounts of my patient and also I’ve used in myself You feel more. I don’t know if the word is positive, but there is definitely More of a drive to do things we hear that and it don’t from patients. I think it’s libido is a mood You know that’s it’s actually right mood. So there’s a there is a mood correlation here And I think again once I’m in that neurochemistry That so many of us I think are most familiar with because of antidepressants because they’ve been around for so long You you realize that there’s that inhibiting effect from serotonin and Addie’s just this interesting twist on that where it’s Disinhibiting and so I do think you see that drive and I certainly I’m you know One of the reasons I fought so hard for Addie is I wanted it I Struggled with this and so is it I wanted a I will say and again. This is not a Sponsored episode this is this is I really wanted Cindy on because number one incredible advocacy for women in number two People have not heard of this medication and isn’t that an interesting story? I will tell you I was at an event signing books Yeah, and someone came and I’ve heard this over and over again a young woman Came to me and said, you know, you talk a lot about hormones, but I’m a breast cancer survivor and I’m 32 years old. Yeah, I cannot take hormones. Yeah, and she was telling me her story And nobody had said, you know, she was married and she was talking about her sex drive And I said have you ever heard of Addie? Yeah, and she had never heard of it. I know well look I’ll tell you the data it’s gonna make it makes me sad So, you know despite the fact that it’s more women than men suffer from sexual dysfunction, right? Here’s a solution to women’s most common issue It comes out Survey data last year less than 5% of doctors have ever heard of it less than 1% of women And I think what that tells us is We still are uncomfortable talking about women’s sexual health and pleasure and we’re still a far distance from value I think that’s changing. I want to be, you know optimistic and positive I’ve seen a massive shift culturally in the conversation and all the years I’ve been at it But it’s funny that you don’t know that story because I can’t go into a room I can’t go into a room anywhere across the world and say have you ever heard of the blue pill and not have the entire audience raise their hand Why do you think that is? I think it is again rooted in a discomfort in

Talking about from where though so for example hysteria, okay, I think it goes I think it’s biblical It’s so deep because if you go because you know one of the ways that physicians get their information is a drug rep A drug rep goes out and here is now I’ve heard about pepsin. Yeah, or I’ve heard about Whatever it is. Yeah, we go V. Yes

Is it that maybe we don’t have reps that are going out or what what is the What is the disconnect? Do you think in terms of are they calling the office and doctors offices are saying no We’re not really interested or

How is it not getting infiltrated women find their way to it all the time? Yeah, I mean so so in truth, you know Despite the fact that so few people know about it There are women who are getting on it all the time. And if you look at population size, it’s huge For how many women could be affected Mayo Clinic just put out 40% of women will experience HSDD in their lifetime That’s their data. Did you tell them about adding? Yeah, right. Exactly. I don’t know that they mentioned it. I think the reason is is that

When we dared to disrupt and the world was resistant to Disruption which it is probably in many many things The attack came I call it the fight of the first the fight of the first always gets bloody and basically So many shots were taken that became the truth and I still am in conversations today Even with physicians who when they tell me something they tell me something categorically about adding and I go but how does it work and they’re like I Have no idea because we haven’t really had that conversation and I think you hear about other things because we value there They’re already conditioned to be acceptable, right? Maybe it’s a conversation around. I don’t know peps it right gird reflux

Okay, my parents say this to me all the time Cindy could you have not done something in diabetes? Nobody has like a visceral reaction to it in sex we did and so we created a narrative and I was I’m I look at You know show me another category in medicine in which The medical professionals and the data Haven’t controlled the narrative. You can’t find it. There was there was a New York Times

No, not New York Times New England Journal of Medicine. Tell me tell me about this recent New England Journal of Medicine So many people sent it to me and it was about it. It was about hypoactive sexual desires or is about female sexual What was it it was a Publication on how important this was to address it actually had great data in it about the impact this can have in women’s lives So I think it was doing its part to say we should value this in women. We should be talking to women about this and then it did the thing that I think we repeatedly do which is and what we should do is we should just lead with only psychology and Psychological intervention because I think the you know that community has mostly control the narrative and I think there’s a wonderful place in that There’s a place for everything in the toolbox. So so alright this matters the first thing we do is we examine all of the relationship lifestyle all of those things if We decide they we treat them the products that are approved. There’s two Addy and Vileacy, right? There’s more than one in this category. They are like do they work and are they safe? Because that’s the narrative and then we go back to say but it really matters And like this is what we’ve missed in that whole train We’ve basically ignored biology again Even though this is a medical condition because we’ve said don’t lead with that and we said but if we have to do that Well shoot, here’s these things That we now don’t represent the data, right? We represent risk not benefit weird And then we conclude by saying well, you know, it matters, but and I I think that is

It’s so disheartening for me to the women who are affected by this because do we accept then responsibility? for when an insurance company a Doctor writes appropriately for a patient Addy This woman is has this diagnosis. This is a product again proven safe and effective by the FDA She’s appropriate candidate the insurance company then says We’re not going to pay for it unless she fails marriage counseling

This is happening Do we accept responsibility does do the people who write the articles that say we must just do this thing with women first? We must sit them down have them go to thing Then you literally have taken a medical condition and you’ve said Don’t but don’t use the medicine. I don’t understand that wait We have to pause and you have to say this again because it’s so important because if it is happening with this It’s happening. It’s happening. I Don’t want to say across the board, but this is a representation of

Something happening that is potentially very subtle. Maybe not subtle for us but subtle infiltration within its PCOS It’s fibromyalgia. It’s you let’s keep going. It’s maternal health care. It’s Whether or not birth control has been covered it is it’s not just this. This is just a case study of this It’s pervasive. Okay, we’re gonna we’re gonna say this again because it’s so critical. Yeah basically women have Sexual desire disorder. Yes There are two medications that are approved. We are talking about Addie right now Flubanserin in order to get that a Covered by insurance because it’s expensive without I mean, I think that there’s ways around it now. Yes, but initially it was Very expensive per month if it was not covered under insurance, which by the way, it’s 20 dollars a month if it is right, so it’s $20 a month if it is the insurance companies will have the Patient submit a script or whatever it is. Yes, and they are then required

To go through and not take the medication first and try something else like marriage counseling before They get this medication approved for a medical condition for a medical condition That is like saying

Before you get this diabetic medication. Mm-hmm you need to go back and Continue to I don’t know Do whatever it is that you’re doing and continue on with diabetes Mm-hmm a known medical condition But diabetes matters and this doesn’t that is what we are This is the cycle we are still in that we must break and that’s why I get sad and I don’t think the intention again Of the author the intention the author was to say this actually matters But we’re but we are stuck and that just you know, I’m looking for it I’ll have to yeah, I’ll have to get it sent but this is a recent New England Journal of Medicine Do you remember the title of it? I don’t okay. We’ll We’ll find it on Hyposexual desire and it’s really on female sexual dysfunction So it’s more broad right all the to all of the different sort of dysfunctions a woman might experience but just like what we can’t be blind to in reading that is that we are in fact feeding a medical system to ignore Medical intervention and to say the only intervention is psychological intervention And so now I really do question like again, I’m gonna flip the script

Can you remember a time in which any male patient?

Who wanted to be on an ED medication? No was told you can’t have it You have to tell you fail marriage counseling. No, and not by the way, I don’t know what that looks like Is that a divorce certificate again? We’re in a we’re in a debate of Worthiness Is it work does she deserve

This medication and I mean I’m I’m it’s quite clear to me and again I don’t think it comes from so long as bias exists in the medical establishment conscious or unconscious women pay the price and I think it’s what you said about hysteria like hysteria is deeply embedded the premise that women are more likely to be psychosomatic that they’re more likely to come in and and be emotional about what they’re feeling is so deeply and culturally rooted That you’ve got to really punch your way through that and maybe give grace to the person on the other side of the table They’re not even conscious that they’re there But I think in an ideal world women will start to push through that and we will force a conversation to lead With the medical evidence and proof that’s so important to me, too And also what you’re saying is yes, there’s evidence for sexual dysfunction But also PCOS this totally that we are talking about sexual dysfunction. But what’s so fascinating is It is pervasive. Yeah and

How do you think that that is going to change from a real nuts and bolts So when you were going through to get this FDA drug approved Was it an older generation that was in power? What why was it so challenging because you clearly had the evidence? You know, why do you think and what is actually going to be the way forward? I do think a newer generation will not tolerate it. So I think that’s part of change, right? There’s wonderful thought leaders like you that so many people have access to now that is different than it was previously so I think we’re making better, you know more informed decisions and I think fundamentally though it is about all of us looking in the mirror and Deciding are we actually leading this conversation with proof and with data? And that’s the only way we actually change it is by demanding by women demanding better By demanding that the the conversation be led with that and not with the pat on the shoulder that comes from a place of good Intention but is in fact dismissive. Hmm. It is and how are you Advocating for this because I mean you’re here talking about it and I’m sure that you’re thinking about this all the time

All the time all the time. And so what does it look like? I think it’s in for me. I think it’s education I think it’s so simple. I think it’s actually just having the conversation So that I recognize the cues like the you know I see that obvious truth that sitting right in front of me when it’s being Dismissed or overlooked and I and I have the courage to just push back a little and say no hold on a minute Like this is not what I’m experiencing What could be going on here and and look there’s a? We do it obviously in through medical education, right? That’s one of the parts that I like to do is how do we change the questions that we ask women on women wellness exams things? Like that so that we are asking questions that provoke an evidence-based conversation But I think for everyone listening for women. I hope it just Nothing more than hearing this to say God I’ve heard these like case study after case study where it just doesn’t make a lot of sense That I’m not getting access to something that might be helpful and pushing on your behalf your own behalf that you deserve it I want to talk about that for a minute though because I think We’re talking big things right yeah, big things that are seismic shifts in culture and One of the outcomes I think you have to start looking at the top of the tree says or at the top of the pyramid says Okay, women are psychological men are biological We go solve

We take this one and we we start to Impose doubt on women when they when they say this symptoms or say the things so we stay stuck in this space and then we have folks who are See that there’s a need and then they prey on it and I think yeah Yeah is a whole nother piece of this equation part of the the problem is we’ve set up a cycle of saying Women are psychological so we don’t solve in medical treatment for them. We don’t include them in studies We don’t solve with solutions for conditions that uniquely affect them We’re not gonna bother with any of that because they’re just psychological and we’ve now had a we have a whole system That’s screwing us and then the opportunity Operative sneak in and they say yeah, but I’m gonna go sell you something that is a Very astute Observation and it is a new problem. By the way, I think that’s a new problem or at least I We’re seeing it so much more so much Basically what Cindy is saying for you guys listening is that there’s a real problem here Whether it’s sexual dysfunction, whether it’s PCOS. Totally. It’s you you Fill in mad lib fill in. Yeah. Yes the research is either a Being done has been done. We have a solution and or still needs to be done

But we might have a solution right and you pick whether it’s yeah again PCOS, you know, whatever it is on the same hand if women And women issues are not brought to the forefront and we don’t have language and we don’t have vocabulary It allows for predatory behaviors to come in to sell you things. Yes that Hey, you don’t need B. Cell you promises further dilute real meaningful Treatment. Yes that then totally destroy people’s health and and if we fall prey to it we’ve reinforced that then nobody ever wants to Invest the dollars to do the hard work and the research in the in the beginning like we’re in a vicious cycle here We’ve discredited sort of the medical need to study women

Women have now fallen prey and they have been trained to preferentially pick the things that are not medicine And I you have to help it you have to help me understand I am so fascinated by what you’re saying. I hope I Really really hope you listeners are out there and really feeling What we’re talking about because I see this all the time and I see women Spend decades suffering. Yes, and because they have been Fed a narrative that it’s in their head or that

They shouldn’t take medicine. Yes, and that’s all Predatory. Yeah, it’s predatory. How did you Come I don’t know. How did you put that all together? I just I watch it I watch so look I’m let me tell you the thing I’m most proud of we study this in more women than any other new drug application for women You said earlier the stat women weren’t even required to be included in clinical trials until 1993 You know what? I I believe I believe in evidence. I believe you have to do the hard work and prove the thing and you You are going to prove like these are the conditions in which you should use it in which you shouldn’t use it You literally do characterize all things because I believe that that’s what women deserve They deserve proof and evidence and real things So that’s who I am to my core and then I watch like so many friends who are like I don’t I don’t take medicine. I’m like that’s interesting. I know what do you what are you worried about? proof Like you can’t say I don’t like data What are you talking about you like data and then I look at them have a baggie Full of things that they take and I’m like, what are the studies and they’re like, I don’t know I’m like, but you put it in your body and that is not that’s not a sugar pill like it’s not benign Right. It might not be doing all those things, but it’s not benign and like to me. I would pick the thing That’s been I know the risks. I know the benefit. It’s clear like they’ve done the work But we choose this other lane because we’ve been conditioned to do it because again we’re not worthy of Evidence or being included or any of that and it’s such a vicious cycle and unfortunate cycle that we’re in I’ll have to tell you a story. So I was uh, I Think it’s not even a month ago. I was just sitting I went on social and I said I give up like Wave, I’m waving the white flag. I can’t did you really or did you say this publicly? Yeah and I can’t really I What happened that day is my My phone blew up Everyone was sending me there was a release of an article. There’s two new prescription medications for female sexual dysfunction and You know, I’m so in this field like I would know I’m always I’m always watching it I’m always excited. I would support them Like I think we have a long way to go to have our 26, right? We deserve many going so So I’m like, oh no, what is this because it’s probably I it’s not you right? So I spent a day on the phone with editors saying at Best you are misleading women at worst. You’re putting them in harm’s way. What was it? So it was a great, you know Silicon Valley Couple bros in the valley decide like hey man. Everybody’s talking about this. Let’s go put something together They put it in pretty packaging. It’s got a great name. They’re great at branding good for them Right, and it’s not that they they see the need they see the need and then they can find what was it? It’s a compounded medication. So they took existing prescription medications combined them and Said nobody, you know, nobody who’s taken it has had any side effects. Well All medications have side effects like those drugs that they combined all have risks and benefits And hey, by the way, once they combined them all they didn’t bother to study it in women They had zero studies So they’re going to go out there and say Wow, look at this great new shiny object that’s going to help all of you women who are starting and there are millions So here’s this thing that you can get that’s a new prescription medication, which it is not it is a combination of existing drugs That they’re putting together for which they’ve had no studies and for which nobody is overseeing them So I have a funny, you know, my story is a little funny with the FDA because I on one hand Pushed them really hard that the standards were uneven. Let me say this. I don’t want a world without the FDA, right? I want a world in which there is a body Oversee forcing companies to good be good citizens. Yeah, and do the work Yes, and by the way when you do that you agree I’m gonna spend millions and millions of dollars decades of research to come up with something to prove That it does work and that the risk benefit is there and then you’ve got this whole black market for women that just has a tiny print these claims have not been evaluated in like

That is that’s what we’re worth We’re worth these claims have not been evaluated like FDA come they they inspect our facilities They know what goes in we we all of our thing all of our promotional materials we put out there. We submit to them We talk we fair balance it we tell people don’t take this if you’re this person don’t take this we do those things to be good stewards of science and Really good stewards of medicine and then you’ve got this whole other thing and it’s so devastating to me because again at best I think it’s robbing or misleading women. It’s giving them false hope Because the claims are outrageous and they’re not vetted and at worst. It’s harming them those medications that they were combining Some of them are not even supposed to be combined you know you are Not somebody who takes things personally, and I think that you know when I first met you I recognized that you are not someone that is taking things personally and It’s so interesting You know from the perspective as a physician and people have to understand. This is not a mission

That you had thought about and planned out no right. I mean I think there are yeah I think that it’s valuable yeah to say that there are you know certain buckets of individuals or Cultures that are like okay. This is for women’s rights. Yeah, that was not What happened was is you saw this treatment you saw that there was Two divergent paths mm-hmm is that fair to say that this was not about Women when you were in in the science space you started with men it was beginning to unravel and see how This was beginning to affect everybody is that it was the double standard in medicine Okay, so I want a double standard in medicine I want people to understand where you’re coming from yeah that it was kind of like when I I don’t know I figured out

When I was doing my fellowship this wasn’t a body fat problem mm-hmm, and when I saw that I was like oh everybody I looked at me. I looked at fMRI’s I looked at images, and I was thinking Everybody’s gonna get this yes, and for the first. I don’t know Seven years of my career people I was begging to be on a podcast yeah, please I have to share this You know I have to share this message. Yeah, and I and I think that It it becomes important to understand where the

The core of someone’s mission comes from mm-hmm because social media yeah and out in the public I think that the core Intention behind it is important to understand where that I mean do you agree where that person is coming from it is 100% the double standard I mean I think about I had an unusual childhood I grew up part of my time in the Fiji Islands, and it was that yeah My dad is a huge adventurer, and I can remember Really like in the fourth grade I was sitting in a classroom, and it was a it was a society in which Social rank mattered right here I am this like American kid sitting there such an outlier so of course I was very privileged relatively speaking right and I’m sitting in this room, and I can remember on the first day of class the teacher Asked every kid to tell what their dad did and I was sitting next to a girl who was very nervous that this was coming to her like in the social structure again getting choked up her dad wasn’t you know like at the same rank and

And I can remember before when it got to me. I said how is this relevant?

Always a little bit this way I mean lucky again how lucky am I that I got an exposure at a very young age for something that was you know very Different to my world and like watch how things like this can happen in social structures in society Maybe I’m a student of that and so I can remember saying how is this relevant because I wanted to stop Right there before it got to the wild child sitting next to like I that was like That was in me, and that doesn’t make me special or anything else I just think that is in an advocate and I had to spend the rest of that semester in the principal’s office because I talked back But that is the same I think for why I did this When it was the obvious truth to me It needed to be said Somebody needed to say the thing and actually to me at the beginning I don’t think I even knew it was going to be met with such resistance and Then when it was met with resistance it was about you have to keep saying the thing You have to keep pushing and you can’t take it personally right actually the critics are as informative as the proponents Because you understand like what is that what am I uncovering and so in many ways? I think for this this has been a journey of Discovery even for me in like what how are we societally conditioned here? And when what the answer screams to me is women matter less medically I’m not gonna quit pushing

Well, we’re you know, we’re really lucky to have you and and frankly I Hadn’t even thought about this until I heard you talk. Yeah, and Well, I appreciate you saying that too. I mean it’s very fair I think most of our your listeners today won’t have like necessarily thought about it and that you know It’s it goes even beyond the medication. Yes, it just Thinking about how women are studied. Mm-hmm thinking about that. Maybe blood pressure drugs affect women differently Yeah, depending on who knows I’m just throwing this out there different pre menopausal or postmenopausal Well look at Ambien right and I’m in sleep drug where it hadn’t been studied in women And so actually when we looked at women typically lower BMI was different in terms of how it’s metabolized and therefore they were having Worse sort of hangover effect and accidents like that was actually a phenomenon at the time So you start to think about it shows up in so many ways, right? I say once we once we have accepted the premise right that women are Emotional beings ruled by psychology and men are ruled by biology and by the way we are I mean I was thinking about

Instinct motherhood instinct. Yeah, this idea of Mammals have instinct. Yeah, and that is true. Yeah, there is instinct that perhaps a female would have however, that absolutely doesn’t diminish the Biological nature Diagram it is it’s social factors. I mean this is bio psychosocial biology psychology social factors You just can’t take one of the circles and throw them away. You can’t do that You really can’t do that for men either right men aren’t only biological creatures. There’s also psychology at play So you maybe we’ve under served them and not actually more exploration of that But I think once you accept a premise that doesn’t allow for as much

Doesn’t demand proof for women you start to see it show up not only in a regulatory Queue of getting medications approved where there might be a double standard. I think to the FDA’s credit right they Yeah, listen to women and they they change it. So to their credit, right? We started there, but we didn’t end there. So they grew I think it’s a regulatory pathway I think it shows up in you know in a physician’s office with the language that’s used I think it shows up in insurers and what they might get away with in terms of covering or not covering things for women and even in advertisement and like how there’s a different standard even there for talking about certain things as it relates to women you know We’re well, of course like tell me hello are state, you know stigmas for women’s health are like You know, we don’t we don’t talk about that I mean in our case and now you know, meta is a good ally of ours at Facebook Instagram, etc You know, how do you get the word out on things like this? You go there Well, all of our ads were taken down. Was there a reason? Yeah, cuz we say sex But what about what about the condition it says a right tile dysfunction? Oh, this is but but is that true or is it really just that it’s female like but also why couldn’t he say sex? I mean, but you know, it’s yeah like it’s just It’s so layered like it’s just so layered and you realize I think when you go through is it shows up here she’s up here and what the end result is is women not getting the care care they deserve Yeah, or that they need and and nobody innovating for us Hmm and when nobody innovates the care you receive is the stuff that they didn’t study on you and they don’t have Evidence for and so like that’s the cycle that I would love to break the innovation is fascinating and What drives the innovation? Is it the problem? Is it what what drives innovation again? For coming up with these solutions. Is it recognizing the problem first? I think it’s the champion, isn’t it? It’s always the jockey not the horse Like I think that’s the truth and I think that we need champions in women’s health We need women solving problems that they have faced that they’re you know, women have uniquely faced. I think it needs champions I think there’s a lack of champions. You are a really big advocate for other women actually And I think that that brings you a lot of joy. I love it. Yeah, I’m so lucky How lucky am I that you know, I’m surrounded by incredible women doing big things in this world and actually creating Change that is lasting. Yeah did Advocating for Addie change you I had to step out front. I’m really quite introverted and You know when when the thing had to be said out loud It pushed me forward in a way that was probably not in my basic nature But it did change me because here’s what I got I got a front row seat to what it means to advocate and it wasn’t just me. Let’s be clear It was women who took time off of work Got child care flew across the country to sit at a federal agency The US government to describe their struggles with their sex life. They’re the heroes It was you know These women’s rights groups and women’s health groups that when I asked the provocative question of like wait a minute What um, they all started asking questions too And I think once I got to observe that and how that can really create impact and long-lasting change it changed me completely and so when I You know when I got the struggle proved and it’s felt like the dream come true, you know The entrepreneurs so to speak dream come true like crossing the finish line. The work was far from done Yeah, and so to me the joy is how do you help others get there quicker than you were able to or how do you? Celebrate the thing that they’re dismantling So that women have a better future When you do the pinky beta, yes Can you tell me a little bit about you know, I’m just so our mutual friend Ashley Graham. This is making me think about

You know, she’s very much a female entrepreneur is wonderful. So the pink evader is a What is that? It’s really and so for me, it’s about helping women with big ideas. I love the first I love the things that nobody believes are ever gonna get to be done And if I can bet on them in some way be it through mentorship or money or both It’s trying to get them work there more quickly than I did and at what happens out of that Which I love of these companies that I’ve you know Really had the privilege to get to help is that it’s the multiplier effect Because once you get somebody else there then they go get somebody else there then they go get somebody else there And like that’s what you choose wisely. Yes, that’s fair. If you choose that’s fair if you choose

Women that are givers, yes and for sure, you know if you choose for sure you do and I think you can There’s this I can remember a woman came into pitch. She was so nervous She had never pitched before and she was had created a device that was really accessible to all in terms of affordability on detecting concussion and She was so cool like great engineer and and I was in the room and I happened to be Being visited that day by some of like these they’re great male investors But they have a different lens right and they were in the these are the guys that laughed me out of the room By the way, what I asked them to invest they should have to wear they should have to wear a bright Oh, they wear their pink socks their pink tie and it’s so delightful So we happened to be in this pitch meeting and she got so nervous at one point She was actually she’s Cuban and she was showing like all of her prototypes in this Cuban cigar box And it was so great like they were made with popsicle sticks at the beginning You know, you like you see this evolution and like she was so overwhelmed in that moment. She like totally choked up and I can remember she like got herself together kept going and we walked out of the room and we were like talking I was talking To the guys and they’re like we can’t believe that you didn’t say like right then There’s no crying in baseball, right or say something to her like Like this isn’t gonna fly and I said you guys are such idiots. That’s the moment I knew I was investing Because I knew right then like she was gonna work every day wake up Look, I’m emotional talk about it and put it all in and I think that’s how you choose wisely There’s a signal right in some of these people that I’ve been so lucky to tell and people can fool you Of course, I don’t I don’t have a perfect batting average for sure But there’s something in that where you know, it is about so much more and we’ve said this so many times This for me was never about a medication No, I love it. I love it if that helps you you deserve to know it exists Yeah, you deserve to have access to it You deserve for your insurer to pay for you deserve all of those things That’s not what this was all about and actually I should speak to all my team It’s not what it’s about for any of them either Like all the people that came and did this with me or surrounded me. They weren’t doing it for a medication People will criticize them and say like oh, it’s just for that and they’re like it’s about so much more It’s not for the money. Well, we would have given it up a long time ago. We would have we would have said great Did it yay? Yeah, and I think you know, that’s That’s not what this is about and there’s still work to be done. Where what phase are you in now? Oh God? What phase and now let me ask this so? It’s out there. Yeah now what’s what’s the job? Yeah, I Think that the job now well the job for me is always learning So I’m always in that phase but the job was it relates to I think company or product is awareness and It that’s really what sits with me Like isn’t it the most fascinating thing that you’ve never heard of it? And what does that say about us? And does it say that we wrote it off at the beginning because we didn’t value it or we still are stuck in the argument that Women don’t deserve this Are we still debating whether or not it’s a medical condition when it’s been around since the 70s and that’s what I said Those are the things I think about every day of like this is so fascinating Why are we here? But we’re we’re definitely in the awareness phase and we’ve got such great, you know Look, nothing is happier for me than to be out in the world getting to speak or talk and a woman comes up And she pulls me to the side and she’s like, hey, I have to tell you a story. I had one That it was so potent to me because she made a beeline for me when I came off the stage and she said I have to speak to you I have to speak to you and there was another one I’ve been on stage with who was trying to like drag me out Cuz she needed me to go to something and she was not let it she was not letting her have it She’s like nope and and she said, you know, I was already lawyered up Like our marriage was falling apart. This was the beginning of it, but so many more resentments, right? though it’s everything started to unravel because connection and intimacy had really unraveled and she said I heard you on a podcast and I thought what if it’s this? and I went to my doctor and she’s like and I’ve been struggling with this issue. I never knew there was a name for it. I didn’t know it was medical I’ve been told all the things that you talk about and she’s like can I take a picture with you and show my husband? And I was just like who just now I know why I get out So like we’re in that we’re in that phase So like it’s not that no one knows or women are on it But I think we’re a long way from the conversation being really socially acceptable Though in the blue pill came to market. It was the cover of Time magazine. I know

That’s how much we value it

Yeah, I mean again friends this conversation is so much more yeah a medication totally But we can begin to shift the tide. I mean, where do you think the future? Is going is it going to be? With healthcare professionals is it going to be how do you see this changing landscape? begin to move more in the favor of Equal health. Yeah healthcare. I think all things in women’s health have a 10-year truth horizon. That is my thesis I think it takes 10 years for us to like so how far rail against it. We’re there like rail against it Start you know, we have to what is that? What’s the great? It’s literally the Gandhi quote. He says first Hold on first. They ignore you then they laugh at you then they fight you then you win, right? That’s the phase we’re in we’re in the then you win phase And I want like what’s gonna happen is the then you win is when women Speak up for themselves. That’s the then you win really and I think that’s what’s happening culturally right now Is you have actually a pushback? Be careful because the opportunities will come because they’ll see the need and so you have to be clear in that focus But like then you win is when you use the vocabulary to like push a little bit harder Not impolitely but politely to say ask the provocative question. That’s where I think we are Cindy Eckert I could talk to you for another probably three hours But I’m I am so grateful for the work that you are doing and I am a full supporter of you The mission the greater conversation. Thank you and truly you are extraordinary. Thank you so much. Thank you for having me