What Do Women Want

portable fire pit on iron legs, flames breathing heat into air on a cusp between spring and summer. Their upstairs windows were opened wide, letting that air transform the rooms. Their children swooped on a rope swing behind Wendy’s house; their husbands were at an Orioles game; the women sipped their wine.
    A beeper went off, faint, then louder, more insistent, bleating into the suburban calm. Wendy’s next-door neighbor sprang up. The study Wendy and two of the others were in that year worked a bit differently than the EB trials; electronic diaries, logs of sexual acts and feelings, were to be updated every day, and Wendy’s friend sprinted inside to silence the company’s automated reminder before it began screaming across the neighborhood. They were taking Flibanserin. They tracked their responses for the company and talked with each other—and with their other friends at the fire pit, who were monitoring their progress—about whether the experimental pill was working. They wondered together what the odds were that two or all three of them had been given the placebo. They agreed, on evenings like this, or in the mornings, over coffee after putting their kids on the school bus, that whatever they’d been handed wasn’t having any effect, though one of them thought there might be a chance she was starting to feel something.
    I ntrinsa and Libigel, Flibanserin, Bremelanotide, these were among the defeated drugs that had come before Lybrido and Lybridos. Intrinsa and Libigel, a patch and an ointment, delivered infusions of testosterone—and within testosterone’s failure with the FDA were lessons about how little science had managed to sort out when it came to the biochemistry of women’s lust.
    Somehow, by mechanisms still just broadly understood, testosterone primes the making and messengering of dopamine, the brain’s courier of urgent wanting. This priming happens within and right near the almond-sized hypothalamus, which sits down by the brain stem and helps govern our base drives and bodily states—hunger, thirst, lust, body temperature. Intrinsa and Libigel tried to influence the dopamine circuits that are devoted to sex by sending more testosterone through the blood to the brain.
    Spiking dopamine directly, instead of using testosterone, can cause trouble. The techniques aren’t refined; the results can be a brain in overall overdrive, damage to the circuitry of motor control, severe nausea, a risk of addiction if you spike too often. And, Pfaus told me, testosterone might assist desire in ways that reach beyond dopamine by tweaking other crucial neurotransmitters. Given all this, a drug supplying extra testosterone seemed a promising approach. But there were baffling complications. They were known, to some extent, even before the testosterone aphrodisiacs went into development and into trials. Whether because testosterone isn’t the main primer after all, as some scientists argue, or because there is too much other biochemistry at play, the puzzle was this: add testosterone to a woman’s bloodstream, and you wouldn’t necessarily cause a rise in desire; deplete the hormone, and you wouldn’t dependably reduce libido.
    Oral contraceptives, Goldstein said, launching into a lecture on hormonal confusion, could all but eradicate a woman’s blood-borne testosterone. “Birth control pill–takers have free testosterone levels one-tenth, one-twentieth of where they would normally be.” This situation hadn’t always been so drastic. Pharmaceutical companies had lately been fabricating contraceptives that pushed testosterone lower and lower to strengthen a sales-enhancing side effect—the elimination of acne. For plenty of women, the hormonal decimation didn’t seem to make any difference to desire. For some, the pill generated drive, probably, Goldstein went on, because women without worry of pregnancy, with lighter or less frequent bleeding, were more likely to seek out sex. But for others, oral contraceptives led to a crash in libido. Why were some women harmed by the bottoming out of testosterone, others unaffected?
    Menopause added to the riddles surrounding the hormone. Middle-aged women and lots of their physicians tended to blame menopause for dissipating desire. Doctors gave out testosterone as a remedy—they gave it in a way known as “off-label,” unapproved by the FDA, semilegal. And some women reported successful results. Yet despite popular belief about the time of life when