Posted 5/13/2017 4:02 PM (GMT 0)
My story: at age 59, I had a prostatectomy with clean pathology. After 3 years, my PSA started to rise. I had IGRT radiation treatments and 15 months of Lupron and estrogen patches. I also took (and still take) finasteride, cabergoline (a dopamine agonist that also suppresses prolactin, the importance of which I will cover later), metformin and Celebrex, all of which I still take.
Erections were non-existent until 6 months after my last Lupron shot and estrogen patch. These erections (with 100 mg of Viagra) were weak and not sufficient for intercourse. My urologist's approach to treating ED is limited to Viagra and injections. He prescribed Trimix which was no more effective than 100 mg of Viagra. So, I started to search online for other treatments.
I found that the Elavil I was taking for insomnia is linked to ED, but that another drug (Trazodone) is frequently prescribed for insomnia. Trazodone is linked to priapism in a very small group of patients. In fact, before Viagra hit the market, many doctors prescribed Trazodone for ED. My PCM switched me to 50 mg of Trazodone daily at bedtime which I found effective for my insomnia and DID improve my erections somewhat. My nocturnal erections also returned; something that disappeared after my prostatectomy. These erections are "chubbies", not adequate for intercourse but important for supporting erectile tissue.
I discovered during my online search that an erection is a carefully orchestrated series of events controlled by the Central Nervous System that depends on a series of sexually inhibitory and sexually excitatory neurotransmitters. Two sexual inhibitory neurotransmitters are serotonin and prolactin. The ones that are sexual facilitators are
dopamine, oxytocin and norepinephrine.
See this excellent presentation: Treatment and evaluation of male anorgasmia by Dr. Stacy Elliot. I found slide 28 especially useful in describing the various drugs and herbs to treat ED and male anorgasmia. Dr. Irwin Goldstein provided the information on that slide. He has authored more than 325 publications in the field of sexual dysfunction, with 20 consecutive years of funding by the National Institutes of Health in this area. He is Editor‐in Chief of The Journal of Sexual Medicine, the official journal of the International Society for Sexual Medicine.
http://www.smsna.org/scottsdale2016/presentations/006.pdf
What I have tried thus far:
Trazodone 50-150 mg - already related my experience. I experienced little benefit to doses greater than 50 mg. Everything else I have tried is in addition to Trazodone and 100 mg of Viagra.
Yohimbine (5 mg) and L-Arginine (1000 mg). Yohimbine is a norepinepherine agonist. L-Arginine is an essential amino acid that plays a significant role in erectile function by contributing to the formation of the vasodilator nitric oxide. This combination gave me a half hour erection but no orgasm. Seriously, we stopped intercourse to avoid my wife having cystitis which she is prone to. Here is a good article on Yohimbine and L-Arginine as well as many other natural substances that may help with ED.
http://www.lifeextension.com/protocols/male-reproductive/erectile-dysfunction/page-06
Here is a study on yohimbine-trazodone effect on ED
Study: Effect of yohimbine-trazodone on psychogenic impotence: a randomized, double-blind, placebo-controlled study. RESULTS: Fifty-five patients (87%) completed the whole treatment schedule. Positive clinical results (complete and partial responses) were obtained in 39 (71%) patients at the end of the drug treatment phase.
https://www.ncbi.nlm.nih.gov/pubmed/7974947
Levodopa (in the form of Muira Puama) - I took 100 mg one hour prior to intercourse. I had a quick orgasm, but I had a noticeable and unpleasant sensation in my brain in the forehead region. I may try 50 mg of this with the Yohimbine and L-Arginine.
I made sure my wife was satisfied regardless of my performance.
Hopefully this information will help with your ED. As my experience with Levodopa indicates, some of these supplements are powerful and can cause undesirable effects. Always check with your doctor before using these and start with lower doses.