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BACKGROUND: Some men treated for testosterone (T) deficiency have persistent difficulty reaching orgasm despite normalization of T levels. There are limited reports on the success of salvage pharmacotherapy for these men.
METHODS: A retrospective medical record review identified 29 T deficient men who were treated with oxytocin or cabergoline for persistent difficulty reaching orgasm despite treatment for T deficiency. All men were euthyroid and had normal T levels. Sublingual oxytocin was taken 10-15 minutes prior to sexual activity at a starting dose of 24 or 48 IU. Oxytocin was increased up to 96IU if not effective at a lower dose. Cabergoline was given at a dose of 0.5mg twice weekly and prolactin levels were measured to confirm suppression. Improvement in orgasmic function and side effects from therapy were determined from the medical record.
RESULTS: Twenty-four men were initially treated with oxytocin. Of these, 11(45.8%) men had improvement in orgasmic function including 4 of 8(50%) men with complete inability to reach orgasm through any means. Four men were initially treated with cabergoline on the basis of high-normal or mildly elevated prolactin (mean 19.2 ng/mL). One of these men (25%) reported improvement in orgasmic function. Three of 5 (60%) men who initially failed oxytocin therapy were subsequently successfully treated with cabergoline (mean prolactin 8.1 ng/mL). Two men initially treated with cabergoline were later treated with oxytocin, both without success. Two of 4 men taking SSRIs had improvement with oxytocin. No side effects were reported for either oxytocin or cabergoline.
CONCLUSIONS: Cabergoline and oxytocin are safe therapies that may benefit some men who have persistent difficulty reaching orgasm despite treatment of T deficiency.