questions

Hey doc, (from bob)

I saw my neurologist over spring break and we discussed doing autonomic testing and hormone testing (one specific hormone would be dihydrotestosterone-involved in normal male orgasm). I asked another doc online and he suggested getting my serum levels of free and total serum testosterone, prolactin, and LH luteinizing hormone. Keep in mind I do get lots of erections but I never orgasm (never have had an orgasm plus I only ejac every six months in wet dream-never had sex also). Anyway my doc is writing all the experts he knows in neuro-urology to see what they think. I wanted him to at least test my hormones but he said it would be difficult to interpret the results-for instance if we found a dihydrotestosterone level he could tell whether it was abnormal or not-by looking it up but he said he would not know what to do once he found out it was abnormal. He said the same for autonomic testing and nerve testing of the pudental nerve (both of which I have been pushing him for-especially after your recommendation for autonomic testing). Is there a book or something he (or I too) could do to find out the next logical step after finding an abnormal hormone, pudental nerve, or autonomic test? What would u do if a patient of yours had a deficient amount of dihydrotestosterone? Also one point I brought up with the doc which may be important is that when I touch myself I notice that it has an effect (I get harder) but that sensation doesn

[CCF Neuro[P]-M.D.-RPS]

Dear Bob:

I would be very surprised if your problem is testosterone or the metabolite of testosterone.  Your problem does not seem to be related to testosterone as your maleness hasn't changed nor have you described that your desire for sexual initmacy has changed.  Again, ejaculation is a sympathetic function.  Erection is a parasympathetic function.  I would proceed with autonomic testing.  Boston, Cleveland, Mayo are the places that I think do autonomic testing.  If you come here to the Clinic, Dr. Robert Shields is the person you want to see.  I hope that you find the reason and then the proper treatment for you problem.

Sincerely,

CCF Neuro MD