Alternatives to Vyleesi If You Can't Fill Your Prescription

Vyleesi (bremelanotide) is one of only two FDA-approved medications for hypoactive sexual desire disorder (HSDD) in premenopausal women. But it's a specialty-pharmacy-only medication with a high cash price and frequent insurance hurdles. If you're unable to fill your Vyleesi prescription right now, you're not without options.

This guide covers the most practical alternatives — from the other FDA-approved HSDD drug to off-label treatments — to help you and your provider make an informed decision.

Option 1: Addyi (Flibanserin) — The Other FDA-Approved HSDD Medication

Addyi (flibanserin) is the only other FDA-approved prescription medication specifically for HSDD. Originally approved in 2015 for premenopausal women, its indication was expanded in 2025 to include all women under 65. Unlike Vyleesi — which is an as-needed injection — Addyi is a 100 mg tablet taken once daily at bedtime.

Addyi works by modulating neurotransmitters (serotonin, dopamine, and norepinephrine) rather than activating melanocortin receptors. It can take 4–8 weeks of consistent daily use before meaningful effects are felt. Key differences from Vyleesi:

• Daily pill vs. as-needed injection
• Has some alcohol restrictions (wait at least 2 hours after 1–2 drinks before taking)
• Also available primarily through specialty pharmacy channels
• Cash price approximately $800–$1,173/month at retail; $149/month through PhilRx mail-order

Addyi is a good alternative if you prefer not to self-inject, can commit to a daily regimen, and can navigate the alcohol restriction. Side effects include dizziness, nausea, fatigue, and insomnia.

Option 2: Compounded Bremelanotide (PT-141)

The active ingredient in Vyleesi is bremelanotide, which was originally developed under the research name PT-141. Compounding pharmacies can prepare bremelanotide in various forms — including subcutaneous injections, sublingual lozenges (troches), or nasal sprays — that are not FDA-approved but may be available at lower cost through telehealth providers.

Compounded PT-141 is not FDA-approved, meaning it hasn't gone through the same rigorous review as Vyleesi. Quality and dosing can vary by compounding pharmacy. However, for patients who can't access or afford Vyleesi, compounded bremelanotide may be a practical interim option under a provider's supervision.

Option 3: Off-Label Low-Dose Testosterone

Testosterone is not FDA-approved for women in the US, but it is one of the most commonly prescribed off-label treatments for low sexual desire — particularly in postmenopausal women. Low-dose testosterone is typically applied as a compounded cream or gel to the skin. Clinical evidence, particularly in postmenopausal women, shows it can meaningfully improve sexual desire and satisfying sexual events.

If your HSDD may be related to hormonal changes — especially after surgical menopause or as you approach natural menopause — testosterone may be worth discussing with your gynecologist or endocrinologist. Blood tests are typically ordered to assess baseline testosterone levels before starting therapy.

Option 4: Bupropion (Off-Label)

Bupropion (Wellbutrin) is an antidepressant that affects dopamine and norepinephrine pathways. Some providers prescribe it off-label for HSDD, particularly in women whose low desire may overlap with depressive symptoms. The evidence base is more limited than for Vyleesi or Addyi, but bupropion is widely available, inexpensive, and may benefit women who also have mood concerns.

Option 5: Sex Therapy and Counseling

For some women, HSDD has psychological or relational components that medication alone won't address. Certified sex therapists and couples counselors can help identify contributing factors — stress, body image, relationship dynamics, past trauma — and develop strategies for rebuilding desire. Many providers recommend combining medication with therapy for the best outcomes.

Comparing Your Options at a Glance

• Addyi (flibanserin): FDA-approved, daily pill, works over weeks, some alcohol restriction, ~$149–$1,173/month
• Compounded PT-141: Same active ingredient as Vyleesi, not FDA-approved, various forms (injection/troche/nasal), typically lower cost, variable quality
• Off-label testosterone: Compounded cream/gel, good evidence in postmenopausal women, requires monitoring, not FDA-approved for women
• Bupropion (off-label): Antidepressant, widely available and inexpensive, limited HSDD evidence, best for those with overlapping mood symptoms
• Sex therapy: Non-pharmacological, addresses psychological/relational factors, best combined with medication

Talk to Your Provider Before Switching

Before making any changes to your HSDD treatment, discuss your options with your prescribing provider. They can help determine which alternative is most appropriate for your specific situation, medical history, and preferences. And if you just want to keep trying to access Vyleesi, read our guide on why Vyleesi is so hard to find and how to get it.

Need help finding any of these medications near you? medfinder contacts pharmacies near you to find which ones can fill your prescription — so you don't have to make all those calls yourself.