Cabergoline Improves Orgasms in Two Thirds of Men

[Nelson Vergel]

Cabergoline in the Treatment of Male Orgasmic Disorder-A Retrospective Pilot Analysis.

Hollander AB, et al. Sex Med. 2016.


Authors
Hollander AB1, Pastuszak AW2, Hsieh TC3, Johnson WG1, Scovell JM4, Mai CK1, Lipshultz LI4.
Author information
1Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
2Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA.
3Department of Urology, University of California-San Diego, San Diego, CA, USA.
4Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA.
Citation
Sex Med. 2016 Mar;4(1):e28-33. doi: 10.1016/j.esxm.2015.09.001.


Abstract


INTRODUCTION: Male orgasmic disorder is common, with few treatment options. Cabergoline is a dopamine agonist that acts centrally to normalize serum prolactin that could improve orgasmic dysfunction.

AIMS: To determine whether cabergoline increases the potential for orgasm in men with orgasmic disorder.

METHODS: A retrospective chart review of men treated in a single andrology clinic for delayed orgasm or anorgasmia in a pilot study using cabergoline 0.5 mg twice weekly was performed. Duration of treatment and response were noted. Medical records were examined for other factors including history of prostatectomy and concomitant androgen supplementation.

MAIN OUTCOME MEASURES: Subjective improvement in orgasmic function resulting from cabergoline treatment.

RESULTS: Of 131 men treated with cabergoline for orgasmic disorder, 87 (66.4%) reported subjective improvement in orgasm and 44 (33.6%) reported no change in orgasm. Duration of therapy (P = .03) and concomitant testosterone therapy (P = .02) were associated with a significant positive response to cabergoline treatment. No differences were found between injectable and non-injectable testosterone formulations (P = .90), and neither age (P = .90) nor prior prostatectomy (P = .41) influenced the outcome of cabergoline treatment. Serum testosterone levels before (P = .26) and after (P = .81) treatment were not significantly different in responders vs non-responders.

CONCLUSION: Cabergoline is a potentially effective and easy-to-administer treatment for male orgasmic disorder, the efficacy of which appears to be independent of patient age or orgasmic disorder etiology. Prospective randomized trials are needed to determine the true role of cabergoline in the treatment of this disorder.

 

[Nelson Vergel]

Be careful with taking more than 0.25-0.5 mg per week of cabergoline since your prolactin can drop too low.

Low Prolactin Is Associated with Sexual Dysfunction & Psychological/Metabolic Issues

 

[Vince Carter]

I would like an opinion on using Cabergoline. I have tested low Prolactin twice, 4.7 and 5.1, while on TRT and am now using the drug "Reglan" @ 5mg daily that increased my last test to an 11 (Dr Saya).

I am still suffering with the standard libido issues with anorgasmia or inability to orgasm (above). Reading these reports and looking to the aspect of a Dopamine, agonist, to which I've been using N-Acetyl-L-Tyrosine with fair success, could Caber help me? Many times while enjoying my partner and my sex act of choice, I just can't orgasm, to the point of saying "stop, it's just not going to happen", which is terribly frustrating, for her and me. When I can orgasm it's a marathon, delayed orgasm with tremendous effort. Then there's once in a while it's not such an ordeal to get there.

ED is still a factor here and there, I use plenty of Arginine and Citrulline with Tadalafil daily. 4-5G of both two-three times per day, and Tadalafil @ 10-15mg a day. Less Tadalafil is really not effective for me, or reliable. It's hit or miss about 50/50. Even going solo, I experience the same levels of ED and delayed orgasm.

But my Prolactin is already LOW...so I'm wary of Caber but the Dopamine Agonist has me curious.

 

[Gene Devine]

I have used a very low dose of caber at .25 mg twice weekly.

It has significantly increased my libido and also increased the intensity of my orgasms as well.

Prolactin is still mid range.

Dr. Eugene Shippen prescribes if for his guys who have the same problems as you Vince.

I swear by the stuff!

 

[Vince Carter]

Its easily accessed so .25mg 2xw or .5mg 2xW in successive weeks would be easy to try.

 

[Vince Carter]

Now Im reading that less than 5 (or 3-5) with Dr Shippen and then Dr Crisler endorsing that, and then somewhere else referencing a Prolactin of 2.X being the place to be...which would mean I'm high, not low, as I thought.

 

[Re-Ride]

Vince C, My best for a resolution of your symptoms. You were already 4.7 to 5.1 and now 11 with the new protocol. If the ED and libido have persisted I'd be wary of messing with caber too.

Before, during and post hCG mono here are my numbers
standard range Male: 2.1-17.7 ng/mL

2/10/15 9/8/15 11/13/15 12/31/15 6/1/2016
Prolactin 7.9 18.1 9.0 11.7 10.3 (off hCG)

Feb 2015 was baseline, off all protocols 10 weeks , pre-hCG mono

June 1 reflects the current supply shortage of both Novarel and APP hCG.

 

[Vince Carter]

I was trying to rationalize it, conflicting info on high/low, even from the authorities and MD's...I figure I've gone one direction with this, maybe try the other (lower) and see how that pans out. I can always go higher on prolactin with the Reglan I have, for a few days, perhaps 10mg up from 5mg. Moreso the dopamine angle because I've had some positives with Tyrosine.

 

[Nelson Vergel]

Diabetics use Reglan for GI issues but the FDA sent a warning a few years ago, so be careful.

FDA Requires Boxed Warning and Risk Mitigation Strategy for Metoclopramide-Containing Drugs

Agency warns against chronic use of these products to treat gastrointestinal disorders

The U.S. Food and Drug Administration announced today that manufacturers of metoclopramide, a drug used to treat gastrointestinal disorders, must add a boxed warning to their drug labels about the risk of its long-term or high-dose use. Chronic use of metoclopramide has been linked to tardive dyskinesia, which may include involuntary and repetitive movements of the body, even after the drugs are no longer taken.


So, have you tried low dose cabergoline with N-Acetyl-L-Tyrosine ?

Cabergoline did nothing for me. I also stopped it when I read info on how chronic use could affect the immune system and even heart function.

Also (like estradiol) low prolactin can cause sexual dysfunction.

Low Prolactin Is Associated with Sexual Dysfunction & Psychological/Metabolic Issues

Vince, remind me if you already tried HCG.

 

[Vince Carter]

No I havent tried Caber at all, just using the NALT twice per day, which has been positive. The reglan is dosed for me at 5mg daily. That's my thing is not to go low Prolactin but two of the big three Drs, in one of the video chats, stated PRL 5 as being "high" and that he treats that with Caber after seeing Dr Shippen use Caber with PRL at 5 or higher.

What I can do is stop the Reglan, and add in some high dose (200mg divided daily) B6 that is reported with good results to lower Prolactin, avoid the caber for now.

I use HCG....in all it's dosing and frequency imaginable, I'm one that doesn't have a tangible feeling from the HCG. I use 250iu E3.5D for about 6 months now (steady). I've done it all...100iu daily, 250 EOD, 400 EOD, as much as 750 E3.5D, 100 E3.5D...never had a tangible sex related feeling from any of those.

 

[trt4me]

What dose of Tyrosine have people seen an effect and after about how long?

Also what is the duration for the caber to see if it's effective ?

And I have the delayed thing due to low sensitivity, which I think is from some level of death grip, low libido.

 

[Vince Carter]

What dose of Tyrosine have people seen an effect and after about how long?

Also what is the duration for the caber to see if it's effective ?

And I have the delayed thing due to low sensitivity, which I think is from some level of death grip, low libido.

The N-Acetyl crosses the blood brain barrier better than L-Tyrosine, with NALT I see 1-2g twice a day. I find I can't use it after about 2pm or it will disturb me getting to sleep. It's not an energized or wired feeling, its just more not tired, if that makes sense.

Caber I see is typically an every 3 days, with a 60hr half-life but don't qoute me on that.

Last time with my girl I did have some better sensitivity with her manually stim and later oral didn't take me so long to orgasm and wasn't the chore it usually is. I don't know what was different as I'm very consistent in everything I take, but that encounter I actually remarked that I like it when my **** works that way which was closer to normal. But this last time...little sensitivity and just couldn't do it.

 

[trt4me]

So is a 2 week trial of caber good enough to evaluate?

I know my prolactin has always been good but id be willing to try it.

For me, I am getting closer to just thinking dopamine is a predominant factor.

The first time I ever started trt (I was at a 350-400) 3 days after inject I was better than 18. Sensitivity through the roof and had sex 5 times in one day with very little time in between. It lasted 2 days (thank god it was a weekend) but everything seems to point to dopamine.

 

[Vince Carter]

That honeymoon period for new TRT guys is linked more and more to a dopamine push that runs out as endo Test production tapers and then stops.

 

[trt4me]

Yes I agree. Which also says 2 things:
Hcg should be used to keep testes active and that dopamine should have more attention paid overall.

I do wonder if the honeymoon works on people with ED. If so wouldn't that point to test /E2 level and dopamine as the issue rather than stuff like cialis / trimix?

 

[davidrn]

I am adding Prolactin to my next labs, would like to try Caber if the levels are high enough. I wonder what the opnions are of Caber and LDN? I have been taking LDN for some time, and it seems to have similar effects on Dopamine. There were cases of those taking LDN who described significant increases in libido, didn't see that myself. I still have delayed orgasm and am looking for help.

 

[Nelson Vergel]

How many men with low testosterone due to high prolactin caused by an adenoma reach normal testosterone when they are treated with cabergoline? (a third of them)


Abstract
Context
Data regarding prevalence, predictors, and mechanisms of persistent hypogonadotropic hypogonadism (HH) in males with a macroprolactinoma who achieve normoprolactinemia on dopamine-agonist therapy is limited. None of the previous studies provide cut-offs to predict the achievement of eugonadism.

Objective
To evaluate the prevalence of persistent HH and its determinants in males with a macroprolactinoma who achieve normoprolactinemia on cabergoline monotherapy

Design
Retrospective study with prospective cross-sectional evaluation.

Setting
Tertiary health care center.

Patients
Males with a macroprolactinoma and baseline HH who achieve normoprolactinemia on cabergoline monotherapy

Intervention
None.

Main outcome measures
Prevalence of persistent HH and its predictors.

Results
Thirty subjects (age: 38.3±10.1 years) with baseline tumor size of 4.08±1.48 cm and median (IQR) prolactin of 2871 (1665-8425) ng/ml were included. Eight of 30 participants achieved eugonadism after a median follow-up of three years. Patients with persistent HH had suppression of LH-testosterone axis with sparing of other anterior pituitary hormonal axes including FSH-Inhibin B. Baseline prolactin (1674 vs. 4120 ng/ml; p=0.008) and maximal tumor diameter (2.55±0.36 vs. 4.64±1.32 cm; p=0.003) were lower in patients who achieved eugonadism. Baseline maximal tumor diameter ≤ 3.2 cm (sensitivity: 75%, specificity: 63.6%) and serum prolactin ≤ 2098 ng/ml (sensitivity: 87.5%, specificity: 77.3%) best predicted reversal of HH.

Conclusion
Recovery of LH-testosterone axis occurred in 26.7% of males with a macroprolactinoma who achieved normoprolactinemia on cabergoline monotherapy. Higher baseline tumor size and serum prolactin predict persistent HH. Our data favors chronic functional modification of hypothalamic-pituitary-gonadal axis over gonadotroph damage as the cause of persistent HH.

https://academic.oup.com/jcem/advan...J4hI2MTiuKOkjKGGxA2EIiE#.X2UR77z2390.********