I am a 47-year-old male who has been on testosterone therapy for about 5 years. I have to take the highest daily gel dose possible in order to get my T levels into the mid 500s. I’ve noticed lately that it’s taking an uncomfortably long time to reach orgasm. This isn’t something that happened suddenly, but gradually. With complete focused attention it should take under 5 minutes, but it now takes me at least 30 minutes, and ejaculation produces a smaller amount than usual, only about 1/2 teaspoon. And the orgasmic feeling is less satisfying and shorter duration. My testes have shrunk somewhat over time with the HRT. I have no libido problems or erectile difficulties. The best way I can describe how I feel is “the well is running dry”. I’m afraid of eventually becoming sexually non-functional, I would be devastated if that happened. Would even higher doses of Testosterone (injections or implants vs. gel) fix the problem, or would that make it worse? I don’t have any known health or psych problems that could be causing this. Can this deficiency be fixed with pill supplements of some sort? What do you recommend?

Responses

  • Michael Castleman says:

    Long-term testosterone therapy is controversial for reasons I’ll get to shorly. But after a thorough search of the recent medical literature, I find no reports that the hormone could impair ability to have orgasms or reduce the amount of ejaculate. This evidence means one of two things: (1) It’s possible that T therapy does not cause these problems. Or (2) it’s possible that it does, but that researchers haven’t taken notice because of the other controversies about T therapy’s long-term effects.

    I’m inclined to believe option #1. Men on long-term T therapy have been studied closely for more than a decade. If it impaired ejaculation/orgasm, I think researchers would have noticed. SSRI antidepressants have this effect, and it’s all over the medical literature. So based on current information, I doubt that your T supplementation has caused your sexual issues.

    What might be causing them? Do you take antidepressants? If so, that’s probably the cause. If not, then both problems you mention—longer to reach orgasm and less ejaculate—are common effects of aging. Many men over 60 or so notice that they need more vigorous penis stimulation for a longer period to come, and that when they do, they produce less semen than they used to. But you’re only 47, kinda young for this. Still, it’s possible that you’re an outlier experiencing these effects earlier than usual.

    What to do? As far as less semen is concerned, my only suggestion is to drink more non-alcoholic fluids. The better hydrated you are, presumably the more fluid finds its way into your semen. But unless you’re actively trying to father children, there’s no real downside of less semen, and maybe some upsides: less messy sex, less of a wet spot, and if your lover doesn’t care for semen in the mouth, less semen may raise fewer objections.

    To ejaculate and have orgasms with less delay, my first suggestion is to read my article, Can’t Get There? Resolving Ejaculation/Orgasm Problems. It describes the self-help program sex therapists have developed for your situation. If the article does not provide sufficient relief, then I’d suggest consulting a sex therapist, who can provide individualized counseling/coaching. A sex therapist might also be able to refer yo to a sexual medicine specialist who have insights beyond mine into any possible connection between your situation and your T therapy.

    As I mentioned, testosterone replacement therapy, especially long-term, is controversial because some studies suggest possibly increased risk of heart disease and prostate cancer. But just a few months ago, a Stanford team reported reassuring results. They followed 509 men for an average of 10 years—284 on long-term T, 225 not taking it—and found no significant differences in their death rates over that period. (Eisenberg, ML et al. “Testosterone Therapy and Mortality Risk,” International Journal of Impotence Research (2015) 27:46)

    To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

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