My ability to have an orgasm has dwindled away.

[tootall41]

I am a VERY healthy 62 year old male. I am 6'-6" tall and weigh 220#. I walk 3 miles most every day in about 45 minutes. I have no prostate problems (PSA level of almost zero), no blood pressure problems, and no arthritis. I do take Prilosec for a bad case of acid reflux problems I've had since I was 21. I have taken various meds for this (Zantac, Pepcid, etc.).

Initially, I had also lost a lot of my sexual desire too. I went to see a urologist. He gave me a prescription for Androgel 1% (5g) as I had a low level of both total testosterone and available testosterone. This immediately brought back my desire and for a time I had no more problems with failed orgasms. Unfortunately, orgasms again became more and more difficult over time to where it is now pretty rare. My testosterone level is now  right where it should be. My libido/desire remains high. My urologist said he couldn't help me any more. He said "we just don't know why this happens".

I then went to see a urologist at Duke University and after making sure I wasn't taking any medication that interferes with orgasms and ran a test that showed that my penis was sensitive at a normal level, he said, "these, things happen and we don't know why".

Neither Dr. ran any tests other than the PSA test, digital prostate exam, penis sensitivity test and testosterone level test. My ejaculate amounts are pretty small if I do have an orgasm. Both urologists said they usually deal with premature ejaculation, not lack of orgasm (I took this to mean that they didn't have much experience in this problem).

I suffer from ADD (diagnosed in 1990) and take 10 mg dextro-amphetimine daily for it. While the Dr. was trying to find the proper meds for me, he tried Zoloft. my ejaculate amount dwindled and I lost my ability to have orgasms. When I came off of the Zoloft (in 1990), the everything returned to a normal level.

My problem manifests itself exactly the same (in symptoms) as when I took Zoloft except I am not taking any meds that will cause the problem and it is progressive, where Zoloft caused the problem almost immediately and the problem disappeared within a couple of weeks after stopping the Zoloft.

Do you know of any diagnostic tests or treatments for my disappearing orgasms or where else I can go to pursue relief from this problem?

Regards,
Alex

[Kevin Pho, MD]

If you have been to two urologists without a revealing cause, you may want to consider another approach.  With the urological evaluation, it is apparent that there is nothing structually wrong with the genital system.  It is also noted that the testosterone level has normalized with the Androgel.

You may want to consider a neurologic referral - to ensure there is no nervous disease causing the symptoms (i.e. neuropathy).  I would also consider testing for thyroid disease and diabetes, which can also cause the symptoms.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[ymaswim]

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