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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Reggie BoStar on August 9, 2013, at 18:19:51
Hi Everyone,
I've been totally impotent for over a decade. I thought that was mainly a combination of age (I'm 62 now) and medications, but now I'm not so sure.The current med stew is: Pristiq 100mg/day, Wellbutrin 200mg/day, Gabapentin 400mg/day, Buspar 60mg/day, Adderall 10mg/day.
In the last decade there have been variations on this combination to try to treat severe depression and anxiety disorder. This mix is the best as far as that goes.
As far as the sexual dysfunction goes, none of the changes have made any difference. It's been total impotence regardless of the mix.
My psychiatrist prescribed the Adderall to try to offset some of the "debilitating" effects of the ADs. It helps me concentrate better but that's about it.
Finally my urologist got the message (after I practically brow-beat him with it) and have me a few samples of Staxyn. Staxyn is a supposedly "new improved" version of Levitra.
I don't know what "new improved" means in that context. What I do know is that it does nothing at all - NADA.
This is why I'm no longer certain that this impotence is solely the result of the ADs and/or age. That a drug like this can do nothing at all is news to me. I've never heard of anyone reporting a total lack of response to Levitra, Staxyn, Viagra, or Cialis.
What does this mean?
Posted by Phillipa on August 10, 2013, at 9:32:59
In reply to If Levitra/Staxyn do nothing, then.... what?, posted by Reggie BoStar on August 9, 2013, at 18:19:51
Have you had your testosterone levels checked? I would feel this would or could be a large factor? Not being a male though? Phillipa
Posted by Hugh on August 10, 2013, at 15:55:44
In reply to If Levitra/Staxyn do nothing, then.... what?, posted by Reggie BoStar on August 9, 2013, at 18:19:51
If Levitra/Staxyn/Viagra/Cialis don't work, then it's probably not a circulatory problem, or at least not solely a circulatory problem. One possibility is Post-SSRI sexual dysfunction (PSSD). Some people (no one knows how many) experience decreased or even nonexistent libido for months or years after quitting an AD. Another possibility is low testosterone. Free testosterone levels are far more important than total testosterone. You should get your estrogen level checked too. When this is too high, it can drive down free testosterone levels, even in men getting testosterone through shots or the gel or the patch.
Posted by Reggie BoStar on August 10, 2013, at 17:47:05
In reply to Re: If Levitra/Staxyn do nothing, then.... what? » Reggie BoStar, posted by Phillipa on August 10, 2013, at 9:32:59
> Have you had your testosterone levels checked? I would feel this would or could be a large factor? Not being a male though? Phillipa
Sorry, I should have included info about that. My testosterone levels are "normal" for a 62 year old. What this means insurance-wise is that my plan won't pay for the supplements. They're very expensive, hundreds of dollars per month.
Normal testosterone levels are another piece of this puzzle. If they're normal, what's the problem?
Posted by Reggie BoStar on August 10, 2013, at 17:55:50
In reply to Re: If Levitra/Staxyn do nothing, then.... what?, posted by Hugh on August 10, 2013, at 15:55:44
> If Levitra/Staxyn/Viagra/Cialis don't work, then it's probably not a circulatory problem, or at least not solely a circulatory problem. One possibility is Post-SSRI sexual dysfunction (PSSD).... Another possibility is low testosterone.
>It can't be PSSD, since I'm still taking an SSRI/SNRI med: Pristiq. I'm also taking Wellbutrin, which is a norepinephrine and dopamine inhibitor. It's not exactly the same mix as the neurotransmitters affected by Pristiq, but I've found in the past that even Wellbutrin alone causes ED in my case.
Thus I am still actively taking AD's that can cause ED.
Still, I've never heard of anyone taking AD's who got no response at all from Levitra et al.
BTW as I reported to Phillipa, my testosterone levels are normal, at least according to both my Urologist and my MD, who conducted separate tests. For this reason my health insurance won't pay for the supplements, because they aren't "medically necessary."
Something else is going on. What? I have to add a little more background which I'll do in a separate post in this thread.
Posted by Reggie BoStar on August 10, 2013, at 18:16:50
In reply to If Levitra/Staxyn do nothing, then.... what?, posted by Reggie BoStar on August 9, 2013, at 18:19:51
Hello Everyone,
I have more info to add in my ED history, but I'm not sure it's relevant to the specific problem.Still... well, here goes.
About 3 years ago I was diagnosed with Peyronie's Disease. It's not really a "disease" per se, but a buildup of "plaque" in the penis that causes deformity. The onset can be gradual or fast, moderate or severe.
In my case, the onset was fast and the degree severe. In one week a sudden buildup of plaque rendered me so disfigured that intercourse would not have been possible.
Yet the problem with ED that I reported in my first post was already happening. The only reason I noticed the deformity was that I still experienced nocturnal erections - the non-sexual ones that occur for most males when they'e asleep.
Occasionally I wake up when such an erection is occurring, always because my bladder is full. By the time I walk the 6 or 7 steps to the john to do something about the bladder, the erection is gone.
Those are the only times I get erections. My urologist says this is proof that the "plumbing is working", at least biologically.
Great, another paradox. If the "plumbing works," why doesn't Levitra et al have any effect when I'm conscious? It makes no sense at all.
There is a surgical method to partially correct the deformity caused the the plaque. It's called the "Nesbit Procedure." I had the surgery two years ago. It did correct the deformity, but only for about 6 months. The Peyronie's disease still progressed after that, and now the deformity is worse than ever.
However I'm not sure this has anything to do with the ED, even though it is a gross deformity that would make intercourse impossible (even if I could get a conscious erection!). I still get nocturnal erections from time to time, always accompanied by a full bladder. Once again this is how I noticed that the deformity returned, in spades.
So the onset of Peyronie's happened to occur in the middle of the ED problem. Does it give some clue as to why Levitra et al don't work?
Summary:
1. Total ED - when I'm conscious - for over a decade. Still get nocturnal erections, usually when I have to empty my bladder.
2. Consistent usage of SSRIs, SNRIs, Wellbutrin, etc.
3. Normal Testosterone levels.
4. Levitra and Staxyn do nothing.
5. Onset of Peyronie's occured about 6 years into the decade of ED. Corrective surgery and continuing progression of Peyronie's have made no obvious difference one way or the other with the ED problem. Does that mean something in the context of this ED?
What a complicated, confounding, contradictory, stupid mess.
Posted by Phillipa on August 10, 2013, at 20:56:37
In reply to Re: If Levitra/Staxyn do nothing - more background » Reggie BoStar, posted by Reggie BoStar on August 10, 2013, at 18:16:50
You are right makes no sense if the surgery corrected the plaque. How are your other arteries? Any idea? Phillipa
Posted by Reggie BoStar on August 10, 2013, at 21:52:29
In reply to Re: If Levitra/Staxyn do nothing - more background » Reggie BoStar, posted by Phillipa on August 10, 2013, at 20:56:37
> You are right makes no sense if the surgery corrected the plaque. How are your other arteries? Any idea? Phillipa
Everything checked out OK in my last physical, only a few months ago. In fact my HDL has gone up by 20+ points in the last few years and is still climbing.
I had always had trouble getting my HDL above 45, the minimum for males in my age group when I was in my 40's.
Then age 50 rolled around and I had to start taking Lovastatin to keep my LDL levels down. It worked well enough for LDL but HDL was still stuck around 45.
Everything changed when I started taking 1000mg Fish Oil supplements every day. Within months my HDL went from 45 to 60 and LDL stayed where it was, slightly less than 200.
In this last physical, my HDL was measured as 67. It's still climbing.
Now of course the status of my arteries was determined in the usual way by my MD in that exam. That is, he used his stethoscope to monitor my heart arteries and neck carotids. There were no signs of obstruction as far as those measurements went.
There is a history of age-onset dementia on my father's side of the family, caused not by Alzheimer's but by artereosclerosis in the cerebral arteries. There's no history of heart problems caused by the same blockages.
Whether or not that dementia was associated with ED I can't say. My father never reported it, but then he wouldn't have said anything about that to me.
Maybe there is a time bomb lurking in me somewhere as indicated by this baffling ED. So far, no one has detected anything unusual.
Posted by Hugh on August 11, 2013, at 11:54:41
In reply to Re: If Levitra/Staxyn do nothing - more background » Reggie BoStar, posted by Reggie BoStar on August 10, 2013, at 18:16:50
Do you experience sexual desire, or has this been affected by your mix?
Here's a site with a few alternative treatments for Peyronie's. One of them is topical DMSO. I don't know if I'd put that on my penis. I used it for tendinitis in my arm, and it would burn for quite a while after applying it and it turned my skin red for hours.
Posted by Phillipa on August 11, 2013, at 18:36:15
In reply to Re: If Levitra/Staxyn do nothing - more background » Phillipa, posted by Reggie BoStar on August 10, 2013, at 21:52:29
Reggie do you have a cholesterol/HDL ratio? As my HDL is very high but the strange thing is that LDH is also high. I googled the ratio and said I was in low risk for heart disease. I still don't understand how one can have three times the HDL that is considered good and then also a high LDH?
I had asked for a C reactive test also and was told by this MD that at my age it wasn't needed as plaque build up was assumed. Same here stethoscope to carotids.
More invasive studies would yield better evidence but todays health care says not cost effective.
So you find the fish oil has really worked for your cholesterol? What brand do you take I just bought some Nordic Naturals pharmacitical brand. Says take two tablets a day so that would be 2000mg. Do you get any psychological side effects from it? Phillipa
Posted by ed_uk2010 on August 16, 2013, at 14:13:51
In reply to Re: If Levitra/Staxyn do nothing - more background » Phillipa, posted by Reggie BoStar on August 10, 2013, at 21:52:29
Levitra/Cialis/Viagra etc frequently don't work. They frequently do work.... but I'm not sure what's given you the idea that lack of efficacy is uncommon. There are hardly any meds out there where lack of efficacy is uncommon!
Since your testosterone is within normal limits, supplementation is inappropriate. It is highly unlikely that such supplementation would be useful.
Levitra/Cialis/Viagra only facilitate the process of an erection. Contrary to popular belief, they do not automatically cause an erection. Sexual desire and stimulation need to be present for them to be effective. Do you feel substantial sexual interest/desire?
Penile injections of alprostadil can be very effective, but need to be used with extreme caution in Peyronie's because the resulting erection might be painful. You'd need to speak to a urologist about this.
This is the end of the thread.
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