Phyllis Randolph Frye, the nation's first openly transgender judge, in her office in Houston last month. In her private practice, she devotes herself to transgender clients.CreditBrandon Thibodeaux for The New York Times
HOUSTON — Nearly four decades before Caitlyn Jenner introduced herself to the world, Phyllis Randolph Frye came out as a transgender woman in a far less glamorous way. No Diane Sawyer, no Vanity Fair.
It was the summer of 1976. As Bruce Jenner, 26, was celebrating his decathlon victory at the Montreal Olympics, Phillip Frye, 28, was admitting defeat in suppressing his gender identity. He, becoming she, had already lost a lot: He had been forced to resign from the military for “sexual deviation.” He had been disowned by his parents, divorced by his first wife and separated from his son. He had been dismissed from several engineering jobs.
Now, with the encouragement of his second wife, Trish, he was starting to transition and wanted to be forthright. Going door to door, he distributed letters to advise the community that the neighbor formerly known as Phil — the husband, father and born-again Christian; the former Eagle Scout, Texas A & M University cadet and Army lieutenant — was going to start living full time as Phyllis.
In response, she got her house egged, her tires slashed, and her driveway spray-painted with obscenities. Teenagers openly mocked her, the engineering profession blackballed her and the federal government rejected her for a job because of her “desire to impersonate the opposite sex.”
The first prescription drug to enhance women’s sexual drive won regulatory approval on Tuesday, clinching a victory for a lobbying campaign that had accused the Food and Drug Administration of gender bias for ignoring the sexual needs of women.
The drug — Addyi from Sprout Pharmaceuticals — is actually the first drug approved to treat a flagging or absent libido for either sex. Viagra and other drugs available for men are approved to help achieve erections, or to treat certain deficiencies of the hormone testosterone, not to increase desire.
Advocates who pressed for approval of Addyi, many of them part of a coalition called Even the Score, said that a drug to improve women’s sex lives was long overdue, given the many options available to men.
“This is the biggest breakthrough for women’s sexual health since the pill,” said Sally Greenberg, executive director of the National Consumers League.
But critics said the campaign behind Addyi had made a mockery of the system that regulates pharmaceuticals and had co-opted the women’s movement to pressure the F.D.A. into approving a drug that was at best minimally effective and could cause side effects like low blood pressure,fainting, nausea, dizziness and sleepiness.
In announcing the approval, Dr. Janet Woodcock, a senior F.D.A. official, said the agency was “committed to supporting the development of safe and effective treatments for female sexual dysfunction.”
The F.D.A. decision on Tuesday was not a surprise since an advisory committee of outside experts had recommended by a vote of 18 to 6 in June that the drug be approved, albeit with precautions required to try to limit the risks and ensure that it was not overused.
Addyi’s label has a boxed warning — the strongest kind — saying the drug should not be used by those who drink alcohol, since that can increase the risk of severely low blood pressure and fainting. It is also not to be used with certain other drugs and by people with liver impairment.
The pill can be prescribed or dispensed only by doctors and pharmacists who watch an online slide presentation and pass a test of their comprehension. Women are advised to stop using the drug if they see no effect after eight weeks.
The big question now is how many people will use Addyi (pronounced ADD-ee), which is also known as flibanserin and has been called the “pinkViagra.”
According to one survey, about 10 percent of women suffer fromhypoactive sexual desire disorder. The F.D.A. said the drug was approved for women whose loss of sexual desire causes marked distress or interpersonal difficulty and is not the result of illness, relationship problems or side effects of other medicines.
Dr. Lauren Streicher, associate professor of clinical obstetrics and gynecology at Northwestern University, said she sensed great interest for a drug like Addyi among her patients. She said the drug’s availability would encourage many women to talk to doctors about their sexual problems for the first time.
“I think this is going to change the conversation that’s taking place in medical offices across the country,” she said, much as the 1998 approval of Viagra made it acceptable for men to talk about erectile dysfunction.
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Addyi is thought to work by changing the balance of certain brain neurotransmitters like dopamine and serotonin.
There are disagreements among researchers as to what constitutes normal sexual desire in women. And there have been difficulties bringing to market a drug that would treat low desire.
Procter & Gamble failed to win approval for a testosterone skin patch for women about a decade ago. The F.D.A. rejected Addyi twice, in 2010 and 2013, citing marginal effectiveness and the side effects.
In one trial, for instance, women who took the drug had an average of 4.4 “satisfying sexual experiences” a month, compared with 3.7 for women getting a placebo and 2.7 before the study began. The drug did not increase desire more than a placebo when measured by a daily diary, but did do so modestly when measured by a monthly questionnaire.
After the second rejection, various women’s and health groups formedEven the Score.
Sprout is paying at least part of the expenses for the coalition, whose members include the National Council of Women’s Organizations, the Black Women’s Health Imperative and the Association of Reproductive Health Professionals.
Even after the favorable advisory committee vote, critics of the drug sent letters to the F.D.A. urging it to reject Addyi. The agency usually follows the advice of its committees, but does not have to.
One letter, written by Dr. Tiefer of N.Y.U. and signed by about 100 others, said it was “absurd” to expect that young women taking Addyi would refrain from drinking alcohol. Another, by the PharmedOut project at Georgetown University Medical Center, which also had more than 100 signatures, said that the “unprecedented and unwarranted manufacturer-funded public relations campaign” may have confused the advisory committee members. A third letter, from sex researchers in the Netherlands and Belgium, said the drug was based on the mistaken notion that lack of spontaneous sexual desire, absent stimuli, was abnormal.
Even the Score is planning to stay in business, hoping that the approval of Addyi will spur other companies to develop drugs for women’s sexual health.
“It’s never been about one treatment,” said Ms. Greenberg of the National Consumers League, which received a contribution from Sprout and which formally joined Even the Score this month.
Molly Mahannah wears a sweatshirt and blanket at work in Omaha, wrapping herself up "like a burrito.”CreditChris Machian for The New York Times
At the office, she bundles up in cardigans or an oversized sweatshirt from her file drawer. Then, she says, “I have a huge blanket at my desk that I’ve got myself wrapped in like a burrito.” Recently, “I was so cold, I was like ‘I’m just going to sit in my car in like 100-degree heat for like five minutes, and bake.’”Summers are hot in Omaha, where heat indexes can top 100 degrees. But Molly Mahannah is prepared.
Ms. Mahannah, 24, who posted on Twitter that at work she felt like an icy White Walker from “Game of Thrones,” said a female co-worker at her digital marketing agency cloaked herself in sweaters, too. But the men? “They’re in, like, shorts.”
Right. It happens every summer: Offices turn on the air-conditioning, and women freeze into Popsicles.
Finally, scientists (two men, for the record) are urging an end to the Great Arctic Office Conspiracy. Their study, published Monday in the journal Nature Climate Change, says that most office buildings set temperatures based on a decades-old formula that uses the metabolic rates of men. The study concludes that buildings should “reduce gender-discriminating bias in thermal comfort” because setting temperatures at slightly warmer levels can help combat global warming.
