[John21 (OP)]

POIS Update:
I recently had an NE with some minor POIS symptoms. I had been consuming cooked whole clove garlic daily at the time.  A few days after the NE I switched to eating crushed garlic, slightly cooked, 2 or 3 cloves per day with my supper. I let the garlic sit after being crushed for 5 min or so before the slight cooking.  Read this for info on how crushing garlic alters its chemistry. Last Friday morning I had another NE (for me they often occur in clusters).  This time I had no POIS symptoms, and I am favouring the theory that garlic is helping something in my system. 
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[Ambient123]

Also, just to clarify, is excessive cortisol a possible cause of POIS?

[Counterpoints]

Also, just to clarify, is excessive cortisol a possible cause of POIS?

Possible.  High cortisol causes cognitive symptoms somewhat similar to POIS.  It could also be an "effect" of POIS, or something that comes with POIS, but does not cause it.  e.g. the hypothalamus and pituitary are responsible for regulating sexual response.  But they are also partly responsible for regulating cortisol levels.  So a pituitary problem could both cause POIS and high cortisol levels.

In either case though, lowering the cortisol levels is extremely important.

[Ambient123]

Hey Demografx,

Just to ask, how did you set up an appointment with an Endocrinologist? Just wondering as i wish to arrange one for myself

Thanks

Ambient

[Ambient123]

Thanks for clearing that up, Counterpoints.

However, i always believed that orgasms were supposed to reduce cortisol levels

Is this not the case?

[Counterpoints]

Thanks for clearing that up, Counterpoints.

However, i always believed that orgasms were supposed to reduce cortisol levels

Is this not the case?

It depends.  Normally, following orgasm, there is a release of tension.  So it makes sense this would have a mild cortisol reducing effect, on normal people. (e.g. see: http://joe.endocrinology-journals.org/cgi/reprint/177/1/57.pdf).

However, I don't expect orgasm to reduce cortisol for us. 
1) Because we get stressed out after orgasm, because of the symptoms. 
2) A pituitary problem could both cause high cortisol and orgasm problems
3) High cortisol can cause similar cognitive symptoms.  In fact, orgasm may be stimulating the release of cortisol, causing our symptoms.  For instance, orgasm could potentially stimulate pheochromocytoma.

[Ambient123]

I see, so for all i know, a pituitary tumor or problem could be causing my POIS?

It's interesting, because my main POIS symptoms are cognitive. Plus, after orgasm, i do feel more...how shall i put it...Stressed. Hyper, and unable to focus on things. After orgasm i feel like i am in some kind of rush.

Do you currently have an Endocrinologist? Because i wouldn't mind seeing one and getting that checked.

[Counterpoints]

I see, so for all i know, a pituitary tumor or problem could be causing my POIS?

It's interesting, because my main POIS symptoms are cognitive. Plus, after orgasm, i do feel more...how shall i put it...Stressed. Hyper, and unable to focus on things. After orgasm i feel like i am in some kind of rush.

Do you currently have an Endocrinologist? Because i wouldn't mind seeing one and getting that checked.

I have seen an endocrinologist.  We are investigating the cortisol issue.  But I doubt an endocrinologist you see will have many ideas about POIS.  I had the cortisol tests before I saw the endocrinologist, and I would recommend you do the same.... otherwise it will take you longer.  At best (likely), the endocrinologist will just order these tests, and you will have to wait longer to deal with any potentially abnormal results. After you get the results (normal or abnormal), push for an endocrinologist visit (my advice).

24 hr urine while symptomatic is probably the best test to get.  I would approach a GP, with the Waldinger paper, and other information, in order to get this test. 

Other tests worth getting (while symptomatic), are Total Testosterone, Free Testosterone, LH, FSH, Prolactin, IGF-1, TSH, Free T3, T4, and DHEA.

In my opinion the 24 hr urine cortisol, prolactin, free testosterone, and TSH are the most important of these tests.

I recommend taking the questionnaire at http://pois.olympe-network.com

There are sometimes physical signs of chronically high cortisol.  e.g. thinning skin, fat accumulation on stomach, near collar bone, and face.  skin conditions.  insomnia, etc.

[Ambient123]

Thank you Counterpoints for your kind advice.

Unfortunately, my GP is not convinced of any orgasm-related illness. All that he has done is merely referred me to a Councellor. God knows why. I refused to see her, though, and have lost faith in his ability to deal with the issue. I doubt he will consent to give me such tests, as he will probably deem them wasteful.

That is why i am seeking an endocrinologist, to get an expert opinion on the matter and more in-depth tests.

I have attmepted to treat it myself and self-diagnose, however my lack of expertise makes such an endeavour almost impossible.

How did you go about getting an appointment with an endocrinologist?

[Counterpoints]

I would see a different GP.  I saw an endocrinologist through a referral from another medical doctor.

[demografx]

Hey Demografx,

Just to ask, how did you set up an appointment with an Endocrinologist? Just wondering as i wish to arrange one for myself

Thanks

Ambient

Ambient, I called a local major university medical center's Endocrinology Dept. and asked if they worked with sexually related problems. The doc's resume was on their website and I felt that this is a world class facility. They treat many celebrities, Sidney Poitier was there on one of my visits. For insurance, my complaint was 'hormonal balancing". The endo I saw liked the fact that Dr. Waldinger's study co-author is an endocrinologist. This doctor (my endo) is a full professor at the University, 30 years experience. He was also impressed with our forum's successful existence.

He took my POIS seriously, referring to it as "your syndrome". Yesterday was the 3rd lab work he scheduled for me, plus he authorized an MRI of the brain (pituitary). Unfortunately not all doc's are this enlightened. It often requires a little pushing on our part since we're not mainstream patients. Good luck!

[demografx]

Ambient, the NY Times article is also good to show docs that our syndrome is not "in our heads".

[martin88]

I have posted an extract of " A hypotetical explanation of panic disorder" (german journal of psychiatry,2001). During panick attacks, body converts steroids (DHEA) to cortisol. Priority for body is to keep cortisol to normal level.

Thanks B_Jim, I put a link here : http://www.gjpsy.uni-goettingen.de/gjp-article-howard.pdf

[Ambient123]

One thing i should probably mention about my original POIS (without treatments) symptoms are that they are somewhat delayed

For example, Day 0 (day of orgasm): Fine

             Day 1: Still fine, though feel somewhat unbalanced

             Day 2: This is when most symptoms tend to kick in, especially concentration and cognitive symptoms.

             Day 3: Still bad, though beginning to fade slightly

             And so on...

Any thoughts or ideas?

[demografx]

1. How long do you have to follow the prescriptions? If you cease the treatment will the symptoms reappear?

No norms have really been established. We're all still experimenting.

In my case, when I stopped testosterone the POIS symptoms returned.

2. What is the specific dosage for the levitra+testosterone combo? How long do you have to take it for? What are some of the side effects? Will this not increase your want for sex or increase the frequency of wetdreams?

Again, we're in an experimental mode. And I don't know how safe it is to take this combo just for POIS if you don't need it for the classic symptoms of ED and low testosterone.

I would suggest seeing your doctor and discuss what you found in this forum, then let him decide. He may do the hormonal testing himself, or refer you to an endocrinologist to get a hormonal diagnosis, as mentioned often here at the forum.

In my case, as prescribed by my endocrinologist after blood tests revealed low testosterone, high prolactin, plus an MRI scan of my pituitary was performed before Rx: I apply 2 5mg Androderm testosterone patches = 10mg daily, every day, with or without POIS. And as prescribed by my GP doctor: Levitra 20mg before engaging.

My side effects have been, with T-patches: slight burning and itching at contact sites. I also had an allergic reaction of intense itching one day and discontinued the patches for several days. But as others have experienced, the itching and burning subsided. Levitra side effects have been some tiredness. But others have experienced all types of side effects for both drugs, from minimal to very serious. Your doctor and pharmacist and pharmaceutical manufacturer's product information literature are the ones to consult about this.

You asked if this can increase desire? Yes it can, but in my case that has been compensated for with POIS relief as long as I stayed on the medication as prescribed.

Hope this is useful.

[Ambient123]

B_Jim,

That is a very interesting point about the inflammation/alleric theory. I had noted that.
 
Are there any specific details regarding this inflammation theory? For example, what hormones/chemicals are affected?

[demografx]

Ambient, you might want to obtain Dr Waldinger's paper. Just send a Private Message to "pyropeach" requesting it, and give him your regular email address so he can send the PDF.

[demografx]

Ambient, the NY Times article I mentioned several posts back:
http://www.nytimes.com/2009/01/20/health/views/20mind.html?_r=3&scp=1&sq=friedman%20sexual%20January%2020&st=cse

[demografx]

I Googled "ask an endocrinologist" and came up with two interesting results:

http://www.medscape.com/diabetes-endocrinology/asktheexperts

http://www.doctorslounge.com/endocrinology/forums/archive.htm

[demografx]

I can't understand why some other pois sufferers don't have this deficiency shown in blood tests. It would be so much more simple like that! Maybe low androgen receptors,

Martin and Demo,

It seems to me too that testosterone absorbtion can be the culprit, even if it does not show up in low levels of free testosterone in the blood. As Martin mentioned, there may be a deficit in androgen receptors. If that were the case, we should probably still observe symptoms that are similar to hypogonadism, right?  Question is, what test would be available to identify this problem of low androgen receptors?

Rob, could "ask the endocrinologist" links above (immediately preceding post) be a type of source to ask your excellent question about androgen receptors?