Ejaculation but no orgasm. Lab tests???

[DaviSh]

TL/DR: no longer having orgasms even though I ejaculate normally. Looking for advice, RE: lab work or other variables.

I'll appreciate any helpful feedback. I've been on TRT for about 8 years, and have been on multiple protocols, injections and compounded creams, with variable results. For the last two+ years I have used the same protocol and generally feel well, but still struggle with intermittent ED and shortage of energy/motivation. At 50 years old with a stressful job, that may just be an occupational hazard. Sildenafil (50mg) is usually successful in addressing ED as needed. My primary doc manages my prescriptions after an awful experience with a functional medical doc who believed in driving my numbers higher and higher. That all seemed OK until my E2 crashed three years ago, never having taken an AI, and that doc was zero help in the aftermath. So I punted on the functional med doc, and have essentially been managing myself, using my family doc for test cyp prescriptions. Protocol is 150 mg/week test cyp (divided into three dosages) along with 250 iu hcg, twice weekly. Overall that has been the best and most stable, while not perfect, protocol. I have never taken any other Rx drugs other than TRT/HCG/Sildenafil. Overall health is reasonably good. 6'2", 200 lbs, but I know I need to improve activity with weights and cardio.

Now the most pressing issue is that orgasms have come to a complete halt. Weak orgasms have been a sometimes-issue for a year or more, but starting 6-8 months ago, they got very rare, and now it's been four months since what I would consider a "real" orgasm. At most, I feel a pulsing at the time of ejaculation, but nothing else. Formerly, an orgasm was a full body experience. I'm married nearly three decades to a wonderful woman, and we enjoy frequent sex, but this has been very discouraging (understatement!) and now effecting my libido negatively.

I'm not due for my annual physical and blood work until May, but I want to pull some labs now rather than waiting. My primary doc is a good guy and he works with me, but he's not particularly knowledgable in this area.

I'm looking for recommendations, blood work or otherwise. I'm planning on pulling Total/Free T, sensitive E2, SHBG, and prolactin for sure. Any other tests I should get? I know this type of thing is multi-variable, so any other things to check out or try?

 

[sammmy]

You have ejaculation (semen flows out, with of without pulsations) but no orgasm (pleasure waves all over the body during pulsations).

Do you experience pleasure during sex at all, before the ejaculation happens?

 

[Systemlord]

At most, I feel a pulsing at the time of ejaculation, but nothing else.

This sounds awfully familiar, this happened to me and the next thing I knew was I have a vitamin D deficiency and if my supplement dosage isn’t high enough, when I ejaculate, I get a pulsing, cramping feeling somewhere in my pelvis, groin area.

Getting my vitamin D elevated increased the penis sensitivity and restored the lost orgasm quality. The vitamin D increased my energy and muscle strength tremendously and greatly reduced recovery time.

The vitamin D supplementation also restored my ejaculatory strength, now it’s quarts out, rather than dribbles out.

Your issue could be estrogen related, high estrogen in some men can delay orgasm and reduce orgasm quality.

 

[DaviSh]

You have ejaculation (semen flows out, with of without pulsations) but no orgasm (pleasure waves all over the body during pulsations).

Do you experience pleasure during sex at all, before the ejaculation happens?

Yes, correct, "ejaculation (semen flows out, with of without pulsations) but no orgasm (pleasure waves all over the body during pulsations)."

Yes, pleasure during sex before ejaculation, but admittedly, that is reduced as well. Diminished penis sensitivity, and yet ejaculation still happens, and sometimes even quickly.

 

[DaviSh]

This sounds awfully familiar, this happened to me and the next thing I knew was I have a vitamin D deficiency and if my supplement dosage isn’t high enough, when I ejaculate, I get a pulsing, cramping feeling somewhere in my pelvis, groin area.

Getting my vitamin D elevated increased the penis sensitivity and restored the lost orgasm quality. The vitamin D increased my energy and muscle strength tremendously and greatly reduced recovery time.

The vitamin D supplementation also restored my ejaculatory strength, now it’s quarts out, rather than dribbles out.

Your issue could be estrogen related, high estrogen in some men can delay orgasm and reduce orgasm quality.

Thanks for this. Functional medicine doc monitored Vitamin D levels, along with a whole host of supplements. When I walked away from that clinic, I walked away from supplements and testing those levels. That is definitely worth a try! I have also experienced a strange cramping feeling in my pelvis/groin area a few times.

Can you share what brand and dosage you use? How l long with Vit D supplementation before you experienced improvement? Thanks again!

 

[sammmy]

Penis sensitivity, sexual pleasure, and orgasm are all controlled by the nervous system. It could be a neurological issue: either a direct nerve damage (past infection or trauma) or neurotransmitter issues.

Neurotransmitters are controlled partially by hormones but not only. You may wanna try dropping the HCG if you don't absolutely need it. I am not on TRT but have used HCG in much higher doses (1000 IU every other day) and observed that "ejaculation comes gradually and softly and is not explosive or strong" while on HCG.

 

[Systemlord]

Can you share what brand and dosage you use?

I have type 2 diabetes and require 8400 UI. I buy it off Amazon, real cheap brand too. Now brand 400 IU per capsule for which I must take 21 capsules over a 6 hour period due to absorption issues.

For a single daily dosage I recommend Nature Made brand, but you shouldn’t take vitamin D without vitamin K because D3 supplementation, can deplete vitamin K sending calcium from your bones and into your soft tissue, heart, liver etc.

You may even need magnesium with the vitamin D as it’s needed to make vitamin D bioavailable.

 

[DaviSh]

Penis sensitivity, sexual pleasure, and orgasm are all controlled by the nervous system. It could be a neurological issue: either a direct nerve damage (past infection or trauma) or neurotransmitter issues.

Neurotransmitters are controlled partially by hormones but not only. You may wanna try dropping the HCG if you don't absolutely need it. I am not on TRT but have used HCG in much higher doses (1000 IU every other day) and observed that "ejaculation comes gradually and softly and is not explosive or strong".

Thanks, I should have stated in original post that I cycled off the HCG three weeks ago. I plan to take about six weeks off and restart unless I notice improvement while not taking it.

 

[DaviSh]

Getting my vitamin D elevated increased the penis sensitivity and restored the lost orgasm quality.

How long on supplementation before you experienced increased sensitivity and restored orgasm quality?

 

[Systemlord]

How long on supplementation before you experienced increased sensitivity and restored orgasm quality?

Results are pretty darn fast and symptoms or lack there of are based on vitamin D levels. My vitamin D levels increased quickly even with absorption issues related to the diabetes. I went from 15->37 in 1 month and levels increased exponentially faster once above 40.

 

[bixt]

Get DHT tested along with all the others you mentioned.

How is the semen itself? Watery/clear or thick and white?

 

[DaviSh]

Thanks, I’ll check DHT. Semen is thick and white.