Lyrica-Induced Anorgasmia

[Esq]

I hope I'm posting this in the correct sub-forum, and I apologize for the wall of text. I'll preface this by saying that I've been a TRT patient with Defy for several years now. I've had great success and TRT has helped immensely. Historically, I've never really had any sexual performance issues, but libido and erection quality still got better once I got things dialed in with TRT.

I've had some spine/nerve issues going on for several years. I had an anterior lumbar interbody fusion at L5-S1 last year, which helped some, but I continued to have some lingering musculoskeletal and nerve pain. To help treat that, my doctor has put me on gabapentinoids, first gabapentin/Neurontin and now pregabalin/Lyrica. While those have helped with the nerve pain, an unfortunate side effect is decreased penile sensitivity which is causing anorgasmia issues. Basically, while arousal is normal and erection quality remains pretty good, it is extremely difficult for me to climax most of the time.

Defy prescribed oxytocin and PT-141 to help with this, but unfortunately without much success. I didn't notice any benefit from the oxytocin, and I had very bad reactions to the PT-141 each time I tried it. I was expecting the nausea, but it caused flu-like symptoms and whole-body pain that lasted for two to three days after. I have no idea if it would have helped the sensitivity issues because there was no way I could have sex in that condition.

Just wondering if there's something else I could try to help with this. I read that cabergoline can help, but I'm not sure if that's only if prolactin levels are high, and although I don't know my prolactin levels, I have no reason to believe they're high and I don't think Lyrica causes increased prolactin.

Just getting a bit desperate. It's definitely affecting our sex life, and right now the only option I can think of is to taper off the Lyrica and exchange better sex for worse nerve pain.

 

[Cataceous]

You should test prolactin, though without a baseline the result may be inconclusive. "Pregabalin decreased testosterone level while FSH, LH and prolactin showed a significant increase."[R] It's possible that dopaminergic supplements or drugs would help regardless. On the mild side are L-tyrosine and NALT. More intense are things like wild green oat extract, macuna pruriens (L-Dopa), selegiline and cabergoline. You have to decide if you can accept the added complexity of counteracting the side effects of one drug by taking another.

 

[Esq]

You should test prolactin, though without a baseline the result may be inconclusive. "Pregabalin decreased testosterone level while FSH, LH and prolactin showed a significant increase."[R] It's possible that dopaminergic supplements or drugs would help regardless. On the mild side are L-tyrosine and NALT. More intense are things like wild green oat extract, macuna pruriens (L-Dopa), selegiline and cabergoline. You have to decide if you can accept the added complexity of counteracting the side effects of one drug by taking another.

Thank you. This is very helpful. I did not know Lyrica/pregabalin could significantly increase prolactin like that. Before starting TRT, Defy had me try clomid therapy and my prolactin was tested once during that phase back in 2017 (6.1 ng/mL), but hasn't been tested since. I'm not sure that's a good baseline, but I'll still have it tested and see where it is. I won't talk with Dr. Saya again until March or April of next year, but I could get it tested through DiscountedLabs sooner.

 

[Cataceous]

As a Defy patient you can order tests directly from their store at any time. [LabCorp, Quest] Good prices there.

I also had a baseline prolactin of 6 ng/dL. When it later crept over 10 I was getting close to anorgasmia. A different protocol and/or regular use of selegiline has solved the problem, with prolactin now a little under the old baseline.

 

[Esq]

As a Defy patient you can order tests directly from their store at any time. [LabCorp, Quest] Good prices there.

I also had a baseline prolactin of 6 ng/dL. When it later crept over 10 I was getting close to anaorgasmia. A different protocol and/or regular use of selegiline has solved the problem, with prolactin now a little under the old baseline.

Thanks. That had slipped my mind, but I remembered and reached out to Defy for the lab order. Going to get prolactin tested early next week.

 

[sammmy]

If lowering prolactin doesn't work, you might want to try increasing acetylcholine by Huperzine-A, 200-400 micrograms (not miligrams!) 1-2 hours before sex. It makes muscle contractions more possible. It is a nasty drug if overdosed though.

Pregabalin, gabapentin, and benzodiazepines are all known to reduce ability to orgasm. They all act directly or indirectly on the GABA system, and from that probably on other neurotransmitters (say decrease dopamine, increase prolactin).

If you can't reverse the anorgasmia on pregabalin, you might want to try alternative pain management with for example ***. Unfortunately contemporary modern medicine is quite weak and most drugs that it offers come with side effects.

 

[Esq]

To update this thread, I had my prolactin tested on Tuesday, and the results came back today. It is definitely high at 26.3ng/mL (range of 4.0-15.2). I plan on reaching out to Defy to discuss, but does that seem high enough to cause or at least contribute to the anorgasmia issues?

 

[Cataceous]

Maybe not high by prolactinoma standards, but in my experience that's certainly high enough to contribute to anorgasmia. If you can't change other medications then I'm pretty sure Defy would be willing to prescribe cabergoline. Dr. Saya has mentioned prescribing with prolactin as low as 10 ng/dL when other problems are ruled out. A lesser-known alternative is selegiline. It may have some other benefits, which are described here. Since you're around 40 the anti-aging potential may be of interest.

 

[Esq]

Maybe not high by prolactinoma standards, but in my experience that's certainly high enough to contribute to anorgasmia. If you can't change other medications then I'm pretty sure Defy would be willing to prescribe cabergoline. Dr. Saya has mentioned prescribing with prolactin as low as 10 ng/dL when other problems are ruled out. A lesser-known alternative is selegiline. It may have some other benefits, which are described here. Since you're around 40 the anti-aging potential may be of interest.

I'll look into the selegiline and discuss cabergoline with Dr. Saya. Unfortunately, I can't really do anything about the medication. My spine-related nerve pain is unbearable without the Lyrica. I'm trying other treatments to help with that pain as well like ketamine infusions and steroid injections, but the Lyrica at least keeps the nerve pain moderately controlled.

 

[Esq]

Just wanted to update this thread. Dr. Saya prescribed cabergoline at 0.125mg BIW (0.25mg/week), so a pretty low dose. I've been on it now for a little over three weeks, and it has definitely helped some. Sensitivity isn't quite where I'd like it, but it's noticeably improved and I now can reach climax within a reasonable amount of time. Libido also seems up a bit as well, but that could just be reduced anxiety over the performance issues.

He wants me to retest prolactin at the six week mark, so at the end of this month. It seems like I may need to up the caber to 0.5m/week since sensitivity could be a bit better, but I suppose my prolactin levels will drive that decision.

Overall, I'm very pleased, as is my wife. I haven't noticed any side effects whatsoever.

 

[jobshopper]

Just wanted to update this thread. Dr. Saya prescribed cabergoline at 0.125mg BIW (0.25mg/week), so a pretty low dose. I've been on it now for a little over three weeks, and it has definitely helped some. Sensitivity isn't quite where I'd like it, but it's noticeably improved and I now can reach climax within a reasonable amount of time. Libido also seems up a bit as well, but that could just be reduced anxiety over the performance issues.

He wants me to retest prolactin at the six week mark, so at the end of this month. It seems like I may need to up the caber to 0.5m/week since sensitivity could be a bit better, but I suppose my prolactin levels will drive that decision.

Overall, I'm very pleased, as is my wife. I haven't noticed any side effects whatsoever.

Thank you for the update! Please keep us updated as things progress!

 

[jobshopper]

Please let us know if your anorgasmia issue has been resolved.

 

[Nelson Vergel]

You may want to talk about adding Buspar

Buspar for libido...

Dr. Saya and all, Does anyone here take Buspar and have it increase libido? I have read that in some people with some level of anxiety that it increased libido. I read that it is mild and not addictive like benzos,

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