Dr. Deb Muth
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Welcome back to Let's Talk Wellness Now. I'm your host, Dr. Zab, and we are continuing our discussion this week on
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peptides. And so, if you haven't heard our first conversation about peptides,
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please go back and look at that episode. We talk all about the manufacturing, the safety, the quality of peptides, and we
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dove into GLP1s. And today we're going to dive into peptides for sexual
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wellness, immune function, growth hormone, and all the amazing fun things
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we can do with peptides. So, as usual, grab your cup of coffee or tea, settle
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in, and let's talk wellness now. And we're going to take a short pause from our sponsor. I know we've got to do
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right, everybody. We are back. And are you ready? We are talking all things peptide and I am opening the show today
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with sexual wellness. Yes, I'm going there, you guys. I am going there. You
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know, this has really become a big issue for people um of all ages. It's not just
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us older people. It's younger people, too. And there's a whole variety of reasons why we have sexual dysfunction.
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And when we're talking about sexual dysfunction, we're not just talking about it doesn't work, right? Or I can't
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reach orgasm. A lot of it is around desire and um the thought of it and
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wanting to connect, wanting to be kinder to one another, wanting to be touching
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one another. A lot of it resolves or revolves around that. And so there are some peptides that can help us and I'm
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really excited to be able to talk about those today. So the first one is called PT-141.
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This targets the brain not the periphery. Right? So for many women I
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will always tell you sex starts between here. It is a brain thing for us. It is
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not necessarily a physical thing. For guys that's a little different. It's very physical. For women it's all in our
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brain. So tip for you men that are listening. You have to prime your woman's brain first if you want her to
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have sex with you that night. You have to be nice to her. You have to bring her flowers. Do the dishes for her. Do
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something kind. Bring her a cup of coffee or tea or a glass of wine. Take her to dinner. You have to woo her. And
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I don't care how long you've been married. That has to happen. And tip number two, don't say anything stupid
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that day. I'm just being honest. When you guys say things that make us upset,
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that lingers with us for the rest of the day. And it's it's a turnoff for us. And
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for a lot of women, we can't get past that when it comes time to snuggle at night. And sex doesn't always have to be
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at night either. So, you can tell I really love talking about this conversation, but we're going to get into the peptide part of it because this
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is going to help people. So, um, PT-141 is marketed as I'm going to slaughter
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this name, Vali, and it represents a fundamentally different approach to
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sexual dysfunction than the PDE5s inhibitors like Slenden, Viagra,
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Tedataphil, which is Seialis. And while the PDE5 inhibitors work specifically by
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enhancing blood flow to the genital tissues, PT-141 works centrally in the brain by
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modulating neural s neural circuits involved in the sexual desire and
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arousal. Now PT-41 is a cyclic hpatipeptide. It's seven amino acid
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peptide arranged in a cyclic structure that acts as a melanoortin receptor
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agonist and with particularly the infinity for MC3R and MC4R subtypes.
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It's actually a metabolite of the melanotan 2, a peptide originally
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developed for tanning that was also found to enhance sexual desire in early
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studies. Now the melanoortin system in the brain is involved in multiple functions including energy homeostasis
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but it also is involved in sexual motivation and arousal behaviors. The FDA approved PT-141 in 2019 specifically
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for the treatment of acquired generalized hypoactive sexual desire
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HSDD in permenopausal women. So for the first time we have a medication that was
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approved by the FDA to use for women for sexual dysfunction. We have had all of
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these seialis tedataphil viagros for men but we had nothing for women. And so
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this is amazing that this is available for women and approved by the FDA. It's a big deal. This represents the first
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and only FDA approved medication specifically targeting these circuits of sexual desire rather than the peripheral
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arousal mechanisms. And this indication is quite specific, meaning it was developed at some point, not lifelong.
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So I if you've had sexual dysfunction your entire life, this medication was
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not approved for you. But if it's something that you developed over time, like when you went through pmenopause or
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menopause or some women have this experience happen after childirth, that's what we're talking about here.
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Now, it's also not just um supposed to be used if you dislike your partner,
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right? If your relationship is bad and you dislike your partner, this probably isn't going to fix a ton. It might help
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a little bit, but that's not what it's meant for. So, you really have to know what you're using it for and why. And
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the other thing that I would say is this is something that we don't go to if your hormones are not balanced properly. You
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have to balance your hormones properly before using something like this because it still may not work. Now, the only
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caveat to that is if you're a woman that has a risk of breast cancer and can't use hormones, then that's a different
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story and we would have that conversation about whether or not this medication would be appropriate for you. Now, the FDA label specifies PTA1 uh
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PT-141 as it not being indicated for HSDD in causes where low sexual desire
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is due to coexisting medical or psychiatric conditions, problems with relationships, like we had talked about,
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side effects to medications or other substance use. This specifically reflects the importance of differential
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diagnosis. Low sexual desire can have many root causes and PT-41 is only
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appropriate when those causes have been ruled out. Now, I have I used PT41 in
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people who have sexual dysfunction issues as a result of using
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anti-depressants. Yes, I have. I've used Flynn in that effect as well. And it
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does work sometimes, but it doesn't work completely. But you need to know that that is not what the approval is for the
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FDA. So that is done in something that we call off label use. So very important
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to know. Now in these clinical trials leading to FDA approval, this was published by Kinsburg and colleagues in
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obstetrics and gyne gynecology in 2019. PT-141 demonstrated statistically
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significant improvements in sexual desire and decreases in distress related
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to low desire compared to placebo. The effects manifest over 45 minutes to
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several hours after the injection and the mechanisms involved modulation of dopamine and melanoorton pathways in the
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hypothalamus and the brain regions that involved sexual motivation. Now cardiovascular effects of PT 141 require
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careful attention. This drug causes transient increases in blood pressure about 3 to four points and transient
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decreases in heart rate. And because of this, it is contraindicated in patients
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with uncontrolled hypertension or known cardiovascular disease. And it has been studied in patients who've had recent
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cardiovascular events or sorry hasn't been studied hasn't been studied in patients who've had recent
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cardiovascular events. So patients need to have their blood pressures checked before starting therapy. Nausea is
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extremely common. It is one of the biggest things I often will tell people to take an anti-nausea medicine if
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they're going to do this because the last thing you want to do is inject this medication and think it's going to give
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you this great time with your partner and you're so nauseated that you can't even perform, don't want to kiss, don't
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want to do anything. It it can be pretty profound for some people. um it does affect about 40% of the patients in
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clinical trials which is why many clinicians require or recommend an
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anti-nausea medication like I had just said other common adverse effects include flushing injection site
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reactions headache in about 13% of the population whic
