My 20 year history of efforts

[fishinghat]

First of all let me say I have monitored this site for quite awhile and have been very impressed with the openness and appropriateness that all of you use as well as your knowledge level.

The following is my history. I hope my experiences may help others in their efforts to improve their situation.

Let me start by saying that my wife (of nearly 40 years) and I had a wonderful and full sex life for many years. Unluckily I developed severe anxiety about 30 years ago and was placed on an antidepressant and other anxiety meds. As I am sure most of you know, antidepressants really limit erections. At first I was still able to get an erection but our sex life was just tolerable. After a couple years my doctor changed me to a different antidepressant with less side effects. At first it controlled my anxiety well, side effects including sexual were about the same. After about one year on this new antidepressant, I developed severe depression. After visiting a couple doctors it was determined that the new antidepressant had dropped my total testosterone from 486 to 386 and was still dropping. Of course my withdrawal from this drug (Cymbalta) was horrible but my doctor expected my testosterone situation to improve within 3 months of coming off the antidepressant. After 6 months my total testosterone had actually worsened and had further dropped to 295. Talk about depression. WOW!! At that point I was diagnosed with PSSD (Post SSRI Sexual Dysfunction). The doctors said there was no treatment for that condition but they started me on testosterone gel to bring the testosterone back to normal. Within 3 months my total testosterone had leveled off between 480 and 600 and the depression was gone and my total T has remained at those levels ever since. Unluckily I was still suffering from PSSD. No sexual function at all. My libido was unchanged though, which is unusual. No erections ever and my penis withdrew into my abdominal cavity not to be seen (I was not overweight either). This made urination difficult and very messy.
During my initial first years with PSSD I tried a number of supplements, viagra, cialis, and much much more. I had always done kegels and found them beneficial but they no longer had any effect. In the meantime I had weaned off nearly all my anxiety meds and was on a low dose of a weak antidepressant. Even with this my PSSD symptoms had not changed any. I tried a number of ED supplements and still with no benefits.

These supplements included;
Vitamin E
Omega-3
Folic Acid
Arginine
Propionyl-L-carnitine
DHEA
Ginkgo
Red Ginseng
Yohimbine
Horny goat weed
Vitamin D
Vitamin B3
Tribulus terrestris
Zinc
Vitamin C
Vitamin B12
tongkat ali
Maca (Lepidium meyenii)
Crocus sativus (Saffron)
Withania somnifera (ashwagandha)
Pinus pinaster (maritime pine)
L-carnitine
Trigonella foenum-graecum (Fenugreek)
Punica granatum (pomegranate)
Black Pepper
Zingiber officinale (Ginger)
Vitamin B1
Magnesium
Selenium
Capsicum annuum (cayenne. capsaicin)

Some had known drug interactions with my medication, others had severe side effects but most simply did not work at all. I always tried to find supplenents that were third party tested and by reliable companies using GMP.

It has long been known that nitric oxide is critical for sexual function and libido. Nitic oxide increases blood flow to most organs of the body. This release of nitric oxide not only leads to erections in men but also contributes to libido and orgasm in women. Our body produces nitric oxide by the processing of the amino acid L-Arginine. Research into the taking of L-Arginine supplements has shown little benefits though. Research in the recent past has shown that L-Arginine is largely destroyed when taken as a supplement and results are minimal at best. Research has also shown that most of the L-Arginine found in the human body comes from converting L-Citrulline (another amino acid) into L-Arginine. Unluckily as we age our body does not absorb amino acids or convert them to usable compounds very efficiently. L-Citrulline on the other hand is more efficiently absorbed by the body.

After reviewing many medical journal articles as well as numerous forums my wife and I developed a plan for the use of L-Citulline for sexual dysfunction in myself as well as her. After she had 4 back surgeries and being post menopausal for 20 years with no libido, vaginal dryness and incontinence as well as loss of orgasm she decided to try it as well. The following is a summary of our approach.

(Please note that I am NOT a doctor and this has just been the approach I have used to address my issues.)

1) Due to some complaints from people who posted that it can cause bloating I took a tip from some to start with 800 mg once a day and then every 3rd day increase by 800 mg until a dose of 4800 mg was taken daily.

2) Those doses should be 800 mg, 6 times a day for men. Each dose should be separated by at least 2 hours before taking the next dose. If 4800 is taken at the same time than most of the dose over 1500 mg is passed out in the urine.(per research)

After 2 weeks I was rewarded with frequent erections and some, shall we say, extreme libido. The erections were about 40 to 60% of my youthful erections. This was very positive for a man who had not had ANY erection in over 20 years. When flaccid my penis hung normally and no longer went inside. That was a big relief.
After 6 weeks My frequent erections gave way to erections only during foreplay with, again, limited usefulness. (still 40 to 60%) with an occasional 80% erection. My penile anesthesia was gone as well. My libido returned to normal levels which still applies today. Due to the very significant rise in sexual function and libido my wife decided to start taking it as well. We figured the dose for her should be around 4000 mg/day. After around 2 weeks her libido went through the ceiling. We were very active during that time. Pursuing each other sexually 2 to 3 times a day. She had a much easier time having orgasms as well as improvement in vaginal dryness and incontinence. Just as in my case, her benefits from the L-Citrulline dropped to normal levels after 4 or 5 weeks. In the 4 years before this the doctors had determined that she was testosterone deficient BUT they normally do NOT treat a woman for testosterone deficiency if they have been through menopause. She was prescribed biogenic cream but after two years her testosterone levels had decreased further. One of her blood samples actually had no detectable testosterone. After a 2 year fight with the doctors and the hospital system the doctor worked for we finally got permission for testosterone therapy. She has been prescribed testosterone therapy and that has helped her significantly with her energy levels but no effect on her libido.

Recently I have made attempts to see if I can get any additional benefit from the L-Citrulline by other means. As most of you probably know L-Citrulline is water soluble and NOT oil soluble. I experimented with mixing L-Citrulline with water soluble lubricant in different amounts and applying it topically to the shaft and glans. Effects can be within three tp five minutes and include a 10 to 20% improvement in the erection, increase in libido and definitely an increase in ability to orgasm. When my wife used this combination topically she did not greatly increase libido but did increase her ability to orgasm. Unluckily these benefits are significant but not consistent. Sometimes there is little to no benefit. I can confirm that this mixture must be used freshly mixed. A mixture that has sat around for a couple days is of little value. (I thought I could mix some up and have it handy when needed.).

Our current formula is 1500 mg L-Citrulline in 3 ml water soluble lubricant, 5 drops of vitamin E, and her formula also contains 1000 IU vitamin D.

After all the time, money and suffering I went through with the other supplements I wanted to share our experiences with others here so they may benefit. This especially applies to the women members. My wife's experience, while not due to an antidepressant, may still provide some guidelines for women to try and correct or improve their situations. Certainly the medical profession has done little research on the PSSD treatments for women. We are in our 70's so if it has helped us it may help others as well.

I have a lot of other information on other details of specific L-arginine/L-citrulline physiology as well as on available commercial topical supplements containing these items. If you need further information please do not hesitate to let me know.

There are still a few other steps we are/will be evaluating to see if there is anything else we can do to help our issues. I will be posting what steps we will be trying in the future and also post follow-up with the results as we go along.
------------------------------------------------------------------------------------------------

[The_Eye]

This forum is dead. Btw that's an impressive list of things. I've probably tried half of them . Thanks for sharing your experience !
I will think about it and let you know.