Ejaculatory Anhedonia (loss of sensation / no contractions)

[SDP]

I've had peyronie's for about 10 years. The curvature is not significant and there's no problems with sex or erections (except in the morning...see below), however, ever since then the main problems have been loss of sensation during ejaculation (no contractions) and significantly less sperm volume. Starting 4 years prior to that I was taking warafin (a blood thinner) and atenolol (a beta blocker) due to heart disease but during a check-up, my cardiologist said I could stop taking them, but since then there's been no increase in sensation It's possible the beta blocker contributed to it, but I doubt it because I never had an issue with loss of sensation before the peyronie's. I had my testosterone checked a few years ago and the result was that it was in the low end of normal. I asked my doctor for a prescription to increase it but she refused because she said it was normal.

From a google search, I have a condition called ejaculatory anhedonia, and one of the causes has something to do with the nerves between my brain and my penis, which I don't understand why because I'm not depressed about the peyronie's (or anything else), so I think the cause is the peyronie's, however, I don't want surgery for fear of making it worse and from posts I've read, I'm not convinced the other treatments work.

The treatments for ejaculatory ahendonia include prescription drugs and one (there may be more) supplement called Yohimbine, therefore, I'll at least try a supplement. From a case study I read, Yohimbine was very successful for treating it but only when used with other drugs, but I couldn't find in the article which ones.

Has anyone on this forum experienced loss of sensation/no contractions during ejaculation, and if so, what, if any, drugs/supplements did you try for treatment and what were the results?

Also, before the peyronie's, I frequently had morning erections, but no more. I have a box with numerous supplements I've tried, but nothing works...any suggestions for natural supplements?
 

[DaneS89]

Yohimbine has potential to work. It is an a2-adrenergic receptor antagonist. From what I've read that can assist with both erectile and ejaculatory function. Used to be popular as a treatment for ED - largely superceded now by other drugs. Known to produce a stimulating effect also (can be anxiety inducing).
 

[Mikel7]

SDP could you please fill out your signature line -->Signature Line . You will then get a better member response and it will help us out regarding your history of peyronies.

Two things I will tell you from experience. 1: Your low normal testosterone is the main culprit here. Dr's go by numbers and that really is not subjective of the patient. I have been on full testosterone replacement for 20 years now. I have studied and researched extensively. I have tried a lot of different treatments and been through about 12 Dr's who for the most part didn't even have a clue regarding real hormone replacement for men.
Have you ever taken the ADAM questionnaire? -->ADAM Questions. Be honest in your answers and you may be surprised that you are suffering from hypogonadism. Primary or secondary really doesn't matter. You just need the correct suppplementation to bring up those levels. Yes the drugs you were on may have caused the drop in T levels.

You need to get a real hormone Dr for men that will give you a correct diagnosis. With correct supplementation you will regain function back. Testosterone is what all men need to function correctly. How is your libido? Morning erections? Motivation foe life? Have you lost strength or height?
Your levels for a man should NEVER be low normal. So was yours hovering around 200 or 300? Get a new mindset and educate yourself.

2nd:  I will tell you that yohimbe does actually work and tends to improved circulation to the genitals. It does have a dark side to it though as it will increase your blood pressure and cause anxiety in some individuals.

[SDP]

Thanks for you input. I added the signature line.

Answers to your questions:
No morning erections.
My libido is low, but there's no issues with having intercourse.
It is difficult for me to get motivated, and I do have lower energy, and I have difficulty getting motivated, but I've started taking Ashwagandha (any other recommendations for other energy boosters appreciated).
I have not lost strength or height.

Other:
I've had pre-diabetes off and on for a few years, but my blood sugar is normal now.

During all my physicals, the doctor said I have excellent blood pressure, as good as an olympic swimmer, therefore, taking the Yohimbine will not be a problem for me.


I was mistaken about my testosterone levels, here is history:

2021: 737
2018: 601
2016: 426
2015: 417
2014: 583
2013: 397

I'm not sure what supplement I took to cause such a significant rise. The symptoms I've mentioned haven't improved even with the increase in testosterone.

From the specialist visit in 2013: I asked about my reduced contractions, low sperm volume, and reduced libido. He said the reduction in contractions could be caused by the Peyronie's Disease but not sure, but said reduced libido could be psychological. I asked if any supplements would help the other and he said Maca Root and DHEA. I probably bought those because I'm a huge fan of supplements, but if I did, they didn't help.

I'll get my testosterone checked again, but not sure if I should see a urologist and get an ultrasound since the first one didn't do it to establish a baseline, and if I don't want the surgery, is there any point in having it done?

 

[SDP]

I didn't see edit option, so here's update to my last post:

Answers to ADAMS questions with YES:
Low libido, but no difficulty with intercourse.

Lack of energy.

Erections less strong, and non-existent in the morning.

Not falling asleep every day after dinner, but usually I lay down after work and take a nap before eating.

Not sure by "deterioration in work performance" means at my job or working on projects at home. If means at my job (desk job), the answer is No, but when doing projects at home, most I can do at one time is about 2 hours. I think it's more being lazy. It is difficult for me to get motivated, and I do have lower energy, and I have difficulty getting motivated, but I've started taking Ashwagandha (any other recommendations for other energy boosters appreciated).

I answered the questions online, and the result was "You may have Testosterone Deficiency. We would recommend a comprehensive blood test to identify if you have low testosterone."

[Mikel7]

So your numbers are very low for you. The testosterone test that you need is the free testosterone. This is the liquid gold that we men need to function correctly. You are showing symptoms of being hypogonadal.  The DHEA can cause a rise in your estrogen levels and that can make you feel even worse. I know they say it converts to testosterone but they don't tell you that it also converts to estrogen. Your answers to the questionaire show that it is testosterone related.  

[SDP]

Free testosterone tests were done only in 2018 (result 15), and 2016 (result 11.1). Normal value: 3.87 - 14.7 ng/dL

The Adams result was "You may have Testosterone Deficiency". Since the last testosterone test was 2 years ago with result of 737, (higher than the normal value range of Normal value: 188 - 684 ng/dL), therefore, I assume my testosterone has plummeted since then.

 

[SDP]

I had a testosterone test...results:

Total: 553 (Normal value: 240 - 950 ng/dL)
Free: 14.4 (Normal value: 3.67 - 13.9 ng/dL)

Doctor Comments: "Your testosterone level was not low as initially concerned for based on your symptoms you sent to me in your message. I would recommend you call our office to schedule an appointment to discuss your symptoms."

Comments?

[Mikel7]

So your free T looks good. Now you need to go one step further. Have you had your prolactin levels checked? This is also a cause for male problems. Also have you had your thyroid checked? All of these work together concurrently so any of these out of whack will cause symptoms. Hormones can be difficult to actually understand just how they relate to each other. One slightly off for the individual and bam you have a problem. When I first started having symptoms in 2004 it took around 6 separate Dr's and a lot of $$ and a lot of blood work to find out exactly what was happening in my body. Then trying different meds and routes of administration and seeing subjectively how I felt. The problem with 99% of Dr's these days is that they only look at the numbers and never subjectively at the patients symptoms.  

[SDP]

I have not had prolactin or thyroid levels checked, but here are results from metabolic panel last year, all are near mid-range of normal except chorlide at high end of range, and gluclose near low end:

Sodium: Normal range: 135 - 145 mmol/L, Your value is 141 mmol/LNormal range 135 - 145 mmol/L

Potassium: Normal range: 3.4 - 4.8 mmol/L, Your value is 4.3 mmol/LNormal range 3.4 - 4.8 mmol/L

Chloride: Normal range: 98 - 107 mmol/L, Your value is 107 mmol/LNormal range 98 - 107 mmol/L

CO2: Normal range: 20.0 - 31.0 mmol/L, Your value is 27.3 mmol/LNormal range 20.0 - 31.0 mmol/L

Anion Gap: Normal range: 5 - 14 mmol/L, Your value is 7 mmol/LNormal range 5 - 14 mmol/L

BUN: Normal range: 9 - 23 mg/dL, Your value is 13 mg/dLNormal range 9 - 23 mg/dL

Creatinine: Normal value: 0.60 - 1.10 mg/dL, Your value is 0.85 mg/dLNormal value 0.60 - 1.10 mg/dL

BUN/Creatinine Ratio: Your value is 15

eGFR CKD-EPI (2021) Male Normal range: above >=60 mL/min/1.73m2 Value>90,
Your value is >90 mL/min/1.73m2Normal range above >=60 mL/min/1.73m2

Glucose: Normal range: 70 - 179 mg/dL, Your value is 87 mg/dLNormal range 70 - 179 mg/dL

Calcium: Normal range: 8.7 - 10.4 mg/d, Your value is 9.2 mg/dLNormal range 8.7 - 10.4 mg/dL

I'll request prolactin and thyroid check during my next physical in March.

 

[Mikel7]

Those numbers look good and I wouldn't be concerned with your chloride levels. They could be stress related, dehydration, etc... Testing your thyroid and prolactin would be my next guess. Also have you ever had any problems with pelvic pain/tightness or urination problems? Pelvic disorders can wreak havoc.

[SDP]

No problems with my pelvis or urination.

[SDP]

Those numbers look good and I wouldn't be concerned with your chloride levels. They could be stress related, dehydration, etc... Testing your thyroid and prolactin would be my next guess. Also have you ever had any problems with pelvic pain/tightness or urination problems? Pelvic disorders can wreak havoc.

I had my physical yesterday, and told the doctor about the problems with loss of sensation, no contractions. Also, said I was experiencing some depression due recent death of my cat. She prescribed Bupropion (generic of Wellbutrin) and said it should help with the sexual function and depression. I've been reading about it and one study said:

"Using antidepressant drug could worsen the sexual dysfunction and by changing the drug with bupropion the orgasm will be improved. The study has shown that using the bupropion can be used in purpose of treatment of orgasm disorder.21 These results are consistent with our study and it is shown that bupropion has a significant association with erection and orgasm, however bupropion was without effect on libido and sexual arousal."

Even though this may help with sexual function, I'm not sure if I will take it because of side effects including migraines, seizures. The depression will go away eventually, so that's not a major concern.

Here is link to the study: https://www.elsevier.es/en-revista-european-journal-psychiatry-431-articulo-the-effect-bupropion-on-sexual-S0213616317300423

Hawk, on this forum, said he takes trazadone for NTE's, appears that it's similar to the bupropion and has similar side effects...both are dopamine transporter inhibitors. I asked for prescription for the trazadone, but doctor said she may do it if the bupropion doesn't work.

Also, I asked for thyroid and prolactin blood tests, and said she would order the thyroid test but not the prolactin test because prolactin related to nipple discharge.

Thyroid test results:

TSH: 1.809 (range .55 - 4.78)
T4 Free: .96 (range .89 - 1.76)
T3 Free: 3.17 (range 2.3 - 4.2)

Metabolic Panel, high glucose and CO2, which are out of range and higher than last year's test results.


 

[Mikel7]

I would say that you should at least give the bupropion a try and see if it works. Thyroid evaluation can be a very tricky and controversial topic with a lot of Dr's. Your TSH is in the mid range which is good. You could be sub clinical regarding your thyroid. There are different roads to viewing the thyroid and how to treat it in terms of meds. My Dr pointed me to this website for a better understanding of whats going on -->Stop The Madness .

If your glucose keeps coming back high you could have an A1C blood test which can give a clearer picture of any sugar related issues. Also have you had your Vitamin D levels
checked? A simple vitamin like that being low will definitely make you feel pretty sluggish. My vitamin D levels were tanked and when I started supplementing with 5,000 a day my energy came back.

I know that getting labs done can be a royal pain but it can give you a better picture as to what is going on inside of you. Keep in mind that worrying and anxiety is a major destroyer of your sexual functioning and overall health.

[SDP]

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Blood samples taken for vitamin D and B12, but results not received.

My average glucose was 111 (unchanged from last year and 2 yr prior to that was 120). Glucose was 5.5.

My cholesterol at 186 just under the high range at 186. HDL below normal @ 33, LDL at upper limit at 99, and most concerning is my triglycerides at 271 (upper limit 150). Last year my doctor said I should take lipitor, but I refuse to take it because studies that show those type of drugs really don't help and because of the side effects. I'll ask for prescription strength fish oil for the triglycerides. Also, about 12 yr ago I had a stress test due to rapid heart beat and dr. said from the results I needed a stent. I decided to get a CT scan done and results showed I didn't need a stent. Yesterday I asked for referral for another CT scan but she refused saying I didn't have serious symptoms and didn't think a good idea to expose me to the radiation. I replied that I did have some symptoms because I periodically take a beta blocker whenever the rapid heart beat happens. And during the exam with her stethoscope she said "you have afib don't you?" I said yes. I think the risk of the radiation worth it to see if calcium in the arteries is worse than last time.

[RexRG]

most concerning is my triglycerides at 271 (upper limit 150).

My triglycerides were routinely over 300 for years until my Dr prescribed omega-3 at 2 grams a day. Been normal since.  

[SDP]

Quote removed by Administrator - It is a VIOLATION of Forum rule
#7 Limited Use of the Quote Button - Normally, we should use the REPLY button to reply to a post.  We can use the quote button on a member's post only when we want to quote a small portion of another post.  We can also use it when responding to anything that was previously posted BUT NOT when we are responding to the post immediately before our own post in the same topic.  When we do use the quote button, we should trim the quote down so entire posts are not repeated. That way,


If your glucose keeps coming back high you could have an A1C blood test which can give a clearer picture of any sugar related issues. Also have you had your Vitamin D levels
checked? A simple vitamin like that being low will definitely make you feel pretty sluggish. My vitamin D levels were tanked and when I started supplementing with 5,000 a day my energy came back.

I know that getting labs done can be a royal pain but it can give you a better picture as to what is going on inside of you. Keep in mind that worrying and anxiety is a major destroyer of your sexual functioning and overall health.
[/quote]

Since my doctor wouldn't order a prolactin test, I found out I can get it online and have the blood drawn at a partner lab, however, if I did that, the next issue would be if my doctor would prescribe something for it if the levels are out of range. Do you think would be good idea to have the test done?

[Mikel7]

I would have the Vit D test performed first as high prolactin in men is not common. Vit D shortage is very common and symptoms are major fatigue and brain fog etc...

[SDP]

I received my vitamin D results...16.8 which is below the bottom of the normal range of 20. My dr. said she will prescribe some prescription strength pills containing 1000units/25mcg.

[Hawk]

I take about 6,000 IU a day over-the-counter.

Also, 20 minutes of full body sun at solar noon will raise your serum levels faster than supplements.

[Mikel7]

From my experience it does take some time with supplements to raise your levels. The sun works wonders though

[SDP]

I was prescribed a generic of wellbutrin for depression last month. I asked for trazodone instead because I've read from others in this forum that it also improves NTE's, but my doctor refused.

There are websites where the trazodone can be obtained without a prescription, even some for pets. How much risk, if any, doing this as long as I order the same dosage as the anti-depressant my doctor prescribed?



 

[williamm]

It sounds like you've been dealing with some challenging issues related to Peyronie's disease and its effects on your sexual health. While I'm not a doctor, I can offer some insights based on what you've shared.

Firstly, it's understandable that you're cautious about surgical options, especially given the potential risks involved. Exploring alternative treatments like supplements is a reasonable approach.

Yohimbine is indeed one of the supplements that has been explored for ejaculatory anhedonia. It's derived from the bark of the yohimbe tree and has been used traditionally as an aphrodisiac and to treat erectile dysfunction. Some studies suggest it may help improve sexual function, although its effectiveness can vary from person to person.

However, it's important to note that while supplements like yohimbine may offer some benefits, they may not work for everyone, and their efficacy is not universally supported by scientific evidence. Additionally, they can have side effects and interactions with other medications, so it's essential to consult with a healthcare professional before starting any new supplement regimen, especially considering your medical history and the medications you were previously taking.

As for natural supplements to consider, there's a range of options that some individuals find helpful for sexual health, including L-arginine, ginseng, and maca root. Again, it's crucial to approach these with caution and discuss them with your doctor to ensure they're safe for you and won't interact negatively with any other medications or conditions you have.

In terms of your morning erections, the fact that you've experienced a change in this pattern could be related to various factors, including Peyronie's disease, hormonal changes, or other underlying health issues. It might be worth discussing this with your doctor to explore potential causes and solutions.