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Ace Week 2023 – Recommend Reading Poster from Asexuality SF

Hey everyone! I’ve been quiet this year as I needed a break from the internet for a while, but I wanted to briefly pop back in to share something I’ve been working on with my local group: A printer friendly, nonfiction reading list for Ace Week! All the books in this list come from ace authors, and should be fairly accessible even for readers who are completely new to the topic of asexuality.

Click here to downloader a printer-friendly color PDF file >>

There’s a grayscale version for black and white printers, which removes the ace flag background colors so save ink.

Also, if you run your own local group and would like an editable version of this poster where you can swap in your own group’s contact info or adjust with your own personal rec lists, you can contact me at sennkestra@gmail.com for an editable copy.

Happy Ace Week, everyone!

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(image preview only – for best results, use the full PDF for printing

Diverse Community Spaces Are Not “Comfortable” Spaces – Nor Should They Be

This is my submission for the January 2020 Carnival of Aces, for the theme of “Conscious and Unconscious Difference“.

While we’re talking about difference, I wanted to take a bit of time to talk about what it means to be a part of a diverse community – like the ace or aro communities – that can contain a huge number of different experiences, with people of all different sexualities, genders, racial identities, ages, coming together to discuss the one or two shared aspects of their experiences that they do have in common. However, even within those shared experiences of asexuality or aromanticism, there can still be considerable variation.

For example, among asexuals, some come to the identity because they don’t feel sexual attraction; others don’t like sex itself, others prefer not to pursue sexual relationships (regardless of whatever other internal feelings they have, some just find it hard to figure out any answer to “what gender of people are you attracted to” other than just, “none?”. There’s also huge variation when it comes to whether people feel averse/indifferent/favorable or just confused when it comes to sexual acts, what kinds of relationships people prefer, and more.

The same goes for the aro community, which brings together both asexual and allosexual aros and also those who don’t quite fit into either end of that spectrum. It brings together some people who have never felt romantic attraction in their life, with others who don’t even know what romantic attraction is supposed to mean. Some choose to pursue sexual relationships, some pursue non-romantic, non-sexual platonic relationships, some prefer not to define their relationships in such terms.

Also within both spectrums are people who identify in the “grey areas” around the fuzzy edges of each group – maybe not quite close enough to feel comfortable using the label without amendment, but close enough to still find it’s concepts useful with a few modifiers.

In effect, it can be helpful to think of these groups as “coalitions” – comprised not of a single group of people with a single identifiable shared experience, but as constellations of related experiences that are just similar enough to find it useful to develop new shared concepts, terminology, and support spaces. (For comparison, consider LGBTQ or queer communities – despite covering a hugely diverse range of experiences, from gay cis-men to bisexual transwomen to queer-identified nonbinary people and more, these groups still find it useful at times to all come together at times under one umbrella and one shared identity.)

However, the thing about diverse, coalitional spaces is that they can also be uncomfortable – because meeting a diverse array of people includes meeting people who’s ways of thinking and expressing themselves might be fundamentally different from yours, and who might force you to reconsider some of your previous assumptions, which can be an inherently uncomfortable process. It can definitely be an uncomfortable feeling when you start encountering perspectives from other community members and find yourself struggling to understand or relate to them. However, I want to challenges the idea that this discomfort is always a bad thing to be avoided. Sometimes, a little discomfort is a healthy and necessary part of growing into a new community and an ever-changing world. 

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Allyship: The Little Things Count a Lot

This is my very last minute response to the January 2020 Carnival of Aros, on the subject of “New“, in celebration of my shiny new aro/ace/queer pride swag from the holidays this year.

When it comes to allyship, there’s a lot of talk about the big asks that absolutely vital to being a good ally, like talking time to educate yourself about what it means to be aromantic (or ace, or queer, etc.), trusting people with their own evaluation of their identities and experiences, respecting their labels and chosen relationships, not being cruel or mocking their experiences, not kicking them out, defending them from people who do get hostile, etc.

But once that bare minimum is met, I think one of the things that can make a big ongoing difference is the little, fun, positive things that you can do that show that you haven’t forgotten what my identity means to me, and that you are willing to put in some work to actively support me rather than just agreeing to live and let live in whatever way requires very little work.

To that end, I want to share a few brief anecdotes about some the little above-and-beyond things that friends and family have done for me as allies, that went a long way in making me really feel supported and accepted, in the hope that they might serve as inspiration for anyone who wants to be a better ally to their own friends and family:

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X-Post From Tumblr: On the coining of “allosexual” and it’s relation (or not) to the work of Eve Sedgewick

A/N: So, Tumblr’s seems to have have updated something on the site that now completely messes up the text order of posts on my main page (even if they display ok on the dashboard), so I’m crossposting my recent reply here for anyone who wants to read it in the actual correct order.

A/N 2: Reading this again after writing, and I am realizing it comes off rather negatives….I do want to clarify that really, I actually think the introduction is very good and much more in touch with ace community online discourse than most academics. I just also like to nitpick, and fixing these in future works could hoepfully help bring things from “very good” to “extremely good”.

On November 19th, I sent this ask to Metapianycist:

Hello! This is nextstepcake messaging you from my home blog. I had a question about your coining of “allosexual” – was it at all inspired or influenced by Eve Sedgewicks work on the “alloerotic” at the time? There’s a new book out which has a minor citation that cite’s sedgewick’s work as the ace communities inspiration for creating the term, which doesn’t sound quite right to me, but I wanted to reach out to you first as the actual expert before making any comment in case it is in fact true.

The next day, they responded:

I checked my posts tagged allosexual to see if I could provide sources for you, and I found a post where I referenced scientific usage here. The work I cited at the time (I linked to this page) was the following, which uses the words autosexual and allosexual in its abstract, to describe sexual behavior as self- or other-directed, respectively:

https://www.ncbi.nlm.nih.gov/pubmed/11912001

I don’t think I have ever heard of Eve Sedgewick’s work on “alloerotic.” I was thinking only of “allistic” when I decided to create the word allosexual. Here’s a post from 2015 where I say I modeled allosexual based on allistic (which i did before I discovered the clinical/scientific usage): https://metapianycist.tumblr.com/post/130278620588/queerascat-epochryphal-epochryphal

I am very curious about this new book and its citations? Because it is definitely not the case that I referred to any academic work on sexuality/eroticism when I decided to coin “allosexual.”

To which I replied with a probably overly long response:

Thanks for the elaboration! That jives more with my own memories – I was one of the cranky people who complained at the time that allosexual was going to be confused with “allosexual” (as opposed to “autosexual”) in sexological works, which ended up not being much of an issue at all in the long run, but I remember that that point didn’t get pointed out until fairly retroactively after it started gaining traction, and even then all the citations of outside works (whether in favor or against the term) were all referring to the use of “allosexual” in sexology, and in my memory at least never mentioned Sedgewick at all.

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When being aro/ace means you only ever get to be the no-fun naysayer, it doesn’t end well for anyone.

I was talking with some other aces and aro folks in a local group chat about the inevitably akward situation of finding out that someone likes you / is attracted to you, and the stressful part of figuring out how or if to respond (which in the case of many aro or ace folks, can often mean trying to once again figure out how to let someone down more-or-less gracefully).

I ended up thinking about how, despite being a problem for almost everyone (especially women), it somehow still feels like it can be even more stressful as an aro ace person not really looking for traditional relationships, and I think I managed to somewhat start articulating my thoughts on the subject, so I wanted to go ahead and share them here as well:

For me, the discomfort mostly comes from knowing that it’s going to be a lose-lose situation, because they are going to be sad or upset if/when I ever have to turn them down, and then I’m going to feel bad for making them feel bad.

And like, you can logically understand that you aren’t responsible for their attraction and it’s not your fault that you weren’t attracted but like….the empathy lizardbrain doesn’t care, it just goes “you said x and made them sad, that’s bad”. (And I don’t necessarily want to turn that off! Learning to sympathize/empathize with friend’s romance struggles even when I can’t really understand it well myself is an important social skill that’s taken me time to learn).

And sure, playing oblivious can put off the ultimate confrontation for a long time but there’s still that axe hanging over your head in the background. Even if the person knows you are ace and uninterested and does exactly what they are supposed to do and doesn’t bother you about it or ask you for something you both know you aren’t looking for, once you do find out, the weight of that social concern is still there. So it’s not even like it’s their fault for doing something untoward, it’s just a sucky situation all around.

And, to be fair, is I think this can be a thing for everyone, not just aces, but I think the downside of being an ace person who doesn’t date is that I only ever get to be the one saying no, of  only ever being put in the position of having to deal with unwanted attention and the emotionally fraught task of letting someone’s hopes down.

I don’t ever really get to have the fun part of being asked out by someone you actual want to say to, whether it’s for a date or sex or whatever else. I don’t ever really get to have the warm and fuzzy feeling you get when someone makes your day and then you totally make their day in return by saying yes.

And so the weight of always being the naysayer who makes people sad just piles up and up and up.

Sometimes, I wonder, if I instead had the experience of a few bright spots here and there, and the knowledge that maybe once in a while it will work out well, would that make it more tolerable?

The Economics of Being Alone

This is a submission for the October 2019 Carnival of Aros, on the subject of “Aromanticism and Aloneness“.

On a purely emotional and social level, I don’t really have any objections to “going it alone” in life as single, unpartnered aromantic person. I’ve always had what I think of as a very…self-sufficient personality, I suppose. While I enjoy having a lot of more casual and informal friendships, I’ve never been the type to have super tight “best friend” type relationships where I pour my heart out – my style has always been amicable relationships with large social groups and events rather than the kind of emotionally intimate close friendships that I sometime see others describe.

And when it comes to things like talking about feelings and emotional support, I find that more introspective activities like good cathartic fiction and writing and blogging to strangers on the internet help me process my thoughts and feelings much better than turning to other people in my offline life for direct one-on-one support.

So from that emotional and mental health level, I like to think I do just fine as a single person with no so-called “committed relationships”, whether romantic or platonic or otherwise.

However, where that certainty about my ability to live a sufficient and satisfactory life alone breaks down is when I start thinking of the practical consequences of living alone.

As I’ve gotten to the point in my life where once-immediate concerns about school and job-seeking have receded (at least for the time being), I’ve started thinking more in-depth about what I would want out of a “relationship”, and what steps I would be willing to take to pursue one – not as a hypothetical for future me as I used to think of it, but as a “what steps do I want to take now” kind of thing.

I’ve also reached the point where I now have several years of built up experience on what it’s like to live both alone, and with other people, and without the automatic inbuilt family support structure that I had when I lived at home with my parents as a younger person.

And based on that life experience, I’ve realized that trying to modify traditional relationships (dating, marriage) to fit was going at things the wrong way, because when I actual break down the parts of a relationship that I want – cohabitation, sharing some (but not all) resources, mutual caring during illness, having someone to come home to and talk about the cool things I saw today, short term commitment – and the things that I don’t want or need  – emotional codependence, romantic or sexual exclusivity, lifelong commitments, family recognition – I realized that what I want isn’t a modified boyfriend/girlfriend/romantic partnership. What I actually want is basically just a housemate: I’m not looking for the romantic or emotional support or closeness of having an intimate partner, I’m looking for the more material and social comforts of splitting the bills and having someone to come home to so I don’t become just a hermit.

And frankly, those material commitments of having someone to share expenses with – whether it’s minimal cohabitation expenses like rent and power bills, or slightly more developed entanglements like food costs and entertainment budgets and travel budgets – are pretty serious.

The Costs of Living Alone

As someone currently living with 4 other housemates in a 5 bedroom house (an arrangement which is honestly close to my ideal for short-term relationships, tbh), I can afford to have nice things like living less than 2 blocks from major public transit, an in-unit washer and dryer and dishwasher, a living room large enough to host 15+ person social events, my own room, a garden area for my plants, and more.

If I were a single person living alone, like I was for a short time a few years ago, I could not even afford to live in this city at all, let alone this county – basic studios and one bedrooms start at like 175% of my current rent. Living in a nice place with a yard and washing machine is even more laughable of an idea.

Beyond just rent, other resources like netflix subscriptions, internet bills, food delivery fees, nice furniture, cookware, and more become much more accessible when the costs are split across a household instead of falling on a single person.

Even in terms of intangible resources, having a household also saves time, when you can distribute tasks like cleaning and repairs and streamline cooking for multiple people. Having other people in the household who I can depend on also means that if I’m sick, there’s already someone nearby who can bring me cold medicine, or help me get soup heated up, or to notice and make sure to get me to a doctor if things start getting worse. It means that I have people onsite that can water my plants if I’m home visiting parents, or sign for packages if they come in while I’m out running errands, or check if I left the stove on when I’m having irrational anxiety.

And it’s not just resources in the home that drive home the costs of going it alone – I think what drives it home even more is how much I notice when traveling.

I was recently looking into the possibility of taking an Amtrak Coast Starlight train up to Portland, or maybe Seattle – maybe taking a week off for slow, relaxed, and scenic rail travel in a sleeper car instead of frantic and tightly secured airports.

However, the thing is that if you want to get a sleeper car ticket, you have to buy a ticket for a sleeper car that sleeps two, even if you are a single person traveling alone. Most traditional hotels are the same way – designed and priced for pairs.  And while I totally understand the reason for that (economies of scale!), it really drives home the extent to which life is just not optimized for living as a single agent.

And that’s why I want – not necessarily a “relationship” relationships, but – a household, or traveling partners, or other people who are willing to commit to sharing resources (be it housing, utilities, hulu passwords, hotel rooms or something else).

Rethinking “Committed Relationships”

When people talk about “committed relationships”, I think that the concept is often based on modifying ideas of traditional romantic/sexual relationships, in the same way that I tried (and ultimately failed) to model my own relationship desires for years. Thus, there’s an idea that “commitment” also means lifelong partnerships like marriage, and often some level of exclusivity (whether emotional, romantic, sexual, or otherwise). And the idea that being in a committed relationship required that emotional closeness and lifelong commitment made me wonder if I could ever make that a reality – and if that was even what I wanted.

But what if we model “committed relationships” after another type of relationship – like, for example, roommates! We can think of the central bond as being resource sharing, rather than an emotional or sexual commitment; and the time as the term of a lease, perhaps, rather than the term of a lifetime. When short-term and mid-term commitments, and pure resource based commitments without any feelings stuff, become options on the table, suddenly the idea of a “committed relationship” (of a sort) becomes both more appealing and seems more achievable.

I like the idea that being romantically/emotionally independent, unpartnered, and “alone” in the “are you single or in a Relationship (with a capital R)” sense doesn’t have to be incompatible with other types of committed relationships (with a lower case r), even if they’re not what we traditionally think of as ‘relationships’ (for example, I get along great with my roommates, any my relationship with them satisfies a lot of my ‘relationshippy’ cravings, but they’re all pretty conventional and I don’t think would ever think of themselves as being in a “relationship” with me or our other housemates, if asked in those terms.)

 

Audience Challenge: What’s your preferred one-sentence definition of “Queerplatonic”?

Several years ago, when working on updating a printed piece for a group I was involved with, I got stuck on figuring out how to define “queerplatonic” in a way that is both clear, and fairly accurate, while also being very concise – the limitations of the specific project required very brief definitions no longer than a sentence or two, and ideally not more than 2-3 lines on a printed pages.

Now, you might be thinking “Silly Sennkestra, you’re never going to be able to explain the full complexity and context of queerplatonic in one sentence”, and yes, that’s true to some extent – but I think it’s still worth trying to get as close as possible, even if the end result is imperfect.

As a result of that project, I ended up polling people on tumblr (click “show more notes” to see the actual responses) – and of course, got several dozen different and sometimes contradictory definitions with varying levels of seriousness, as one does when defining any complex term.

Based on that conversation, and several others over the years, my current most common attempt is something like:

Queerplatonic: A significant non-romantic partnered relationship that complicates the concept of being “just” platonic friends.

Although I think this still has room for improvement, I’m trying to get across a few main points:

  1. That queerplatonic relationships tend to generally be characterized as non-romantic (though even that isn’t always necessarily a hard boundary).
  2. That the history of “queerplatonic” as a term is that it was intended to “queer” or “complicate” the idea that the only two relationship options are “romantic” or “[just] friends”, neither of which are really accurate to what “queerplatonic” is trying to describe
  3. That queerplatonic relationships tend to have a certain level of significance to the people involved above that of some of their other relationships (like aquaintances, coworkers, or casual friends), often perceiving each other as “partners”, “significant others”, etc.

However, since it’s been a few years since I asked around more broadly, and since I’ve been seeing a lot of conversations about definitions again recently,  I’m curious to see again what other definitions people like to use, and how each of us choose to confront the problem of summarizing a complex concept into an overly-simple definition. I’m also curious to see what other people consider the most salient parts of the concept that they want to highlight in any definition.

So, I’d love to hear from anyone reading this – what one-sentence definitions of “Queerplatonic” do you prefer? What do you see as the key points that should be included in any definition?

(Or alternatively – what’s a definition you’ve seen before that you find insufficient, and what don’t you like about it? How would you change it to make it better?)

 

Atheism and Aromanticism: Viewing Marriage Law as Contract Law

This is an only-slightly-late entry for the May Carnival of Aros, on the topic of “The Intersection of Aromanticism and Religion”.


Author Notes: This is mostly written from the perspective of US Marriage law (with a few forays into UK examples), and so some parts may not be so relevant for those in other jurisdictions. It’s also very hastily written so consider it some brainstorming and an open invitation to dicsussion, rather than the final word on anything.

When it comes to romance, sexuality, and religion, I fall pretty soundly into the void of the “a”s: Aromantic, Asexual, and Atheist. I find that all three are somewhat similar in that they are defined largely as matters of absence – they are traits that would be completely unremarkable and unmeaningful were it not for the presence of something else in the world around us – the presence of romance, of sexuality, of religions – that make their absence in my life suddenly all the more significant.

Of those three identities, there’s one place where they perhaps most frequently come together: the institution of marriage. When it comes to sexuality and romance in common culture, marriage is considered the ultimate celebration of such relationships. When it comes to religion, it’s often the ultimate form of recognition and sanctification, with many major world religions have some sort of marriage traditions as some of their central practices.

But what happens when you don’t have any religious attachments to give it any weight? What happens when you aren’t interested in the sorts of romantic or sexual entanglements that typically form the core of even most non-religious marriages? Is marriage meaningless?

Not at all. Because there is a major part of  marriage that actually has surprisingly little to do with romance, sex, or religion: the modern civil marriage contract.

In fact, when you strip away the sentimental concerns of romance and sexuality and the religious trappings, which may carry a lot of moral weight but no real legal weight, I think you are left with modern civil marriage in it’s most basic form: a standardized contract, entered into by a person and a chosen partner, which is recognized by the state and granted certain rights and responsibilities.

When you think of civil marriage in this most un-romantic form, it is, in essence, a sort of specialized business contract – much like a business partnership or an corporation, it marks a joint partnership between two people; in which they may have certain rights or responsibilities different than what they have as individuals; that governs the ownership and handling of property within the partnership; and a level or recognition by the state, which grants them additional rights and responsibilities and has special taxation rules specifically for these partnerships.

Of course, there are also many ways in which marriages are unique as compared to other business contracts:

  • One of the most major is that unlike business contracts, which are drawn up and customized for each new venture, marriage contracts are standard and non-customizable (outside of additional contracts like pre-nups which may have limited effectiveness) – this has the benefit of making them easily accessible even to the average person without the need for hours of expensive lawyer consultations, but more limiting in their lack of customizability.
  • Also, unlike business partnerships – which an individual can enter into ad infinitum – any individual is limited to a single marriage contract at any given time. Furthermore, marriage contracts are generally limited to only two people; unlike business contracts, which can encompass anywhere from a single person to dozens of directors or members.
  • Perhaps the greatest difference between marriage laws and contract laws is that marriage law can also sometimes grant one very special right that cannot generally be achieved through business contracts or other customized legal contracts (like power of attorney or advanced healthcare directives): the rights of parenthood.  (There are also a few select other personal rights that are linked only to marriage contracts, but this is one of the most major).
  • In addition to unique rights, marriage can also carry additional responsibilities. For example, many states require (at least on paper) that they must be sexually consummated to be valid (although it’s unclear whether these requirements would fully withstand a modern challenge). They may also have consequences like spousal support even upon dissolution, so they can be lasting in ways that business contracts arent.

However, when you think about it, it isn’t necessarily a given that marriage contracts always need to be this way – if you take away longstanding [modern christian] religious prohibitions against multiple marriages, or the social and cultural assumptions that significant relationships must be romantic and sexual before they can be worthy of state recognition –  there’s perhaps no reason from a legal perspective that marriage needs to have all the limitations above.

Sometimes I wonder, what would it be like in a world where marriage law was treated more like a business contract – where marriages or families could consist of multiple people, or be between platonic friends or partners (or even siblings).

Also, what if marriage contracts were more flexible? After all, marriages often combines several things – parenthood, financial entanglement, decision making powers in healthcare, protection from testifying in court, etc. – that could perhaps be seperated. For example, what if it were possible to have one form of legally recognized co-parenting relationship, but without as many of the tax implications? Or a purely financial contract without as many of the parenting and healthcare related rights?

In more recent years, there have been some glimpses into what such a brave new world might look like, especially with the advent of “marriage-like” legal statuses like domestic partnerships and civil unions. While these were originally intended to give same-sex couples the right to marry all-but-in-name, the creation of a dual relationship recognition scheme has lead to fascinating effects, such as older couples who seek domestic partnerships as a way to formalize their relationships without disrupting remnants of previous marriages like social security benefits, or platonic friends who use them as a way to recognize their relationships without sexual/romantic requirements, or religious folk who use them as a convenient loophole to work around certain religious prohibitions.

As both secular and aromantic and asexual movements continue to grow, I am curious to see what other ways that marriage can be re-imagined.

 

 

On the Horizon: Bremelanotide and AMAG Pharmaceuticals

After delving back into the wonderfully frustrating and misinformation-filled world of HSDD medications, it looks like it’s not just Addyi that has new updates. It’s also probably a good time to start keeping a closer eye on Bremelanotide  / Vyleesi, a new proposed treatment for HSDD from AMAG Pharmaceuticals.

Unlike Addyi, Bremelanotide is designed to be used only as needed, about 90 min prior to sex. It’s currently being developed to be injected subcutaneously, after other methods showed too many side effects, in particular with worries about low blood pressure. Other common side effects were nausea, flushing, and headaches, which are sure to put you in the mood!

I haven’t had a chance to dig into the proposed method of action, but news articles seem to indicate that it’s neurological, and attempts to balance inhibitory vs. excitatory process in the brain.

It looks like it’s been submitted for new drug consideration by the FDA with an original expected approval announcement in March 2019, but is likely being delayed after the FDA requested more data on side effects.

They’ve also already set up their own website about HSDD as well at unblush.com. It even has it’s own quiz!

I’ve only spent like 20 minutes looking at it so far because I really need to pace myself with these, but here’s a few first impressions:

  1. If you indicate no recent drop in desire in the first question of the quiz, it cuts you off and lets you know that if there’s no decrease, it’s probably not HSDD – which is more than the addyi site is willing to do, so there’s that at least?
  2. On the other hand, if you indicate that your desire has decreased “maybe a little”, but in the questions about negative impact you only mark “I’m afraid my partner will cheat on or break up with me”….it tells you that’s “relationship impact”, a sign of HSDD.
  3. Also, this quiz is like a buzfeed quiz, it’s weirdly full of reaction images and gifs
  4. Both this and some of the ancillary materials for Addyi mention the Decreased Sexual Desire Screener (DSDS), so that’s something I probably want to look into more when I can.
  5. Overall, it’s still manipulative / kinda misleading, but doesn’t seem to be quite as pushy as the addyi site overall – but on the other hand they may just be biding their time because they don’t actually have a drug they can legally push yet.

 

Update: FDA updates labeling requirements on Addyi/Flibanserin, and new [horrible] Addyi Marketing Campaign

This post has two parts – updated labeling requirements from the FDA last month and a new marketing campaign from Sprout Phamraceuticals  (thanks to redbeardace for flagging it!)

I’m going to address the FDA changes first because I’ve had more time to read up on it, but I think the latter is going to be a bigger concern for ace activists moving forward.

Part 1: FDA Recommends Labeling Changes for Addyi

I missed this earlier, but apparently the FDA released updated labeling requirements for Addyi/Flibanserin last month:

https://www.fda.gov/news-events/press-announcements/fda-orders-important-safety-labeling-changes-addyi

I’ve only had a chance to skim it for now, but it looks like they are downgrading the original warning (which stated that women should not drink alcohol at all while using the drug) to a statement that women should avoid alcohol within a few hours of taking the pill, but may not need to avoid it entirely:

Based on the results of postmarketing studies, the FDA has determined that changes must be made to Addyi’s labeling to clarify that there is still a concern about consuming alcohol close in time to taking Addyi but that it does not have to be avoided completely. Specifically, the boxed warning, contraindication, warnings and precautions, and adverse reactions sections of labeling are being updated to reflect that women should discontinue drinking alcohol at least two hours before taking Addyi at bedtime or to skip the Addyi dose that evening. Women should not consume alcohol at least until the morning after taking Addyi at bedtime.

The FDA is ordering a safety labeling change requiring Sprout to make these changes because the agency was not able to reach an agreement with the company, which was continuing to request removal of the boxed warning and contraindication about alcohol completely from the product labeling. The FDA determined, based on a careful review of available data, that removing this important safety information was not acceptable for the protection of public health.

These changes were based on the results of two additional post-market studies of Addyi/Flibanserin, whcih sprout had requested, as well as additional lobbying from Sprout Pharmaceuticals (which sells Addyi) which wanted to remove alcohol warnings entirely. The FDA’s April 11 post stated:

In the FDA-required postmarketing trial in women who took Addyi and drank alcohol at the same time, there were missing or delayed measurements for blood pressure from when the women were first laying down to when they stood up that are critical in determining the risk of hypotension and syncope when taking Addyi and alcohol together. The FDA’s specific concerns with the trial included:

  • While there were no reports of syncope or hypotension needing intervention amongst women in the trial, the safety precautions built into this trial did not allow for an adequate assessment of this risk. For example, women with low blood pressure while lying down or with symptoms that could be related to low blood pressure (such as dizziness) were not permitted to stand up to have blood pressure measurements taken or had to have repeated blood pressure measurements while lying down until they were high enough for the women to safely stand up. As a result, the data collected had missing or delayed blood pressure measurements from these women while standing.
  • Many more women had missing or delayed blood pressure measurements when they took Addyi and alcohol together compared to when they received alcohol alone or Addyi alone.
  • The amount of missing blood pressure measurements peaked around the time when Addyi’s blood levels were highest in those taking Addyi with alcohol.

The pattern of the missing or delayed measurements provides further evidence of an interaction between Addyi and alcohol that can increase the risk of hypotension and syncope. Given these results, the FDA has determined that the boxed warning and contraindication continue to be warranted. Women at home will not have the safety measures that were included in this trial or necessarily have access to immediate assistance if they were to experience severe hypotension or syncope, which can lead to serious outcomes including falls, accidents and bodily harm.

Part 2: New marketing campaign from Sprout Pharmaceuticals

Addyi has launched a new “Right to Desire” campaign website [content warning: I strongly recommend not taking any medical advice or trusting any claims from this new site.].

This CNN Health article discusses the campaign in more depth and has some initial criticism.

It features a quiz that you can take, which I’m especially worried about based on what they did the last time they decided to have a quiz as part of the very misleading “Find My Spark” campaign.

I’m still looking into the new campaign and will probably need to make another post to actually evaluate it, but I’m like 3 questions into the quiz and we’re already off to a pretty bad start – despite the first questions at least allowing me to state that I have no sex drive* and no problem with that, Addyi doesn’t want to let me think of it as anything except a problem:

Addyi.PNG

It also still uses “HSDD” as their label for the low desire that they are trying to treat, despite the fact that as of the DSM 5 (released in ~2013), low desire is categorized as [M]HSDD only in men, and low desire in women is referred to as FSIAD or “Female Sexual Interest/Arousal Disorder”. Addyi is only marketed to and approved for women. (props to David Jay for pointing that out to me).

Also, I’m still mad that they decided to use purple for this. Adding insult to injury much?


*Technically I do personally consider myself to have a sex drive / libido, just not towards other people, but I don’t think that’s what Addyi’s asking about and I also wanted to see how it treats the many aces who really don’t have anything along those lines.