If the cause of your erectile problem is more between your ears than between your legs, it may be that your dopamine response needs to be addressed. There are several drugs, some specifically licensed for ED, others not, which could help.
Cabergoline (Dostinex, Cabaser and Caberlin). Cabergoline is a dopamine agonist, with a half -life of three or four days. It was invented in Italy in 1982, was approved by the FDA in 1996, and is used for the treatment of hyperprolactinaemia. Prolactin reduces dopamine and so the theory is that as cabergoline reduces prolactin, dopamine levels increase. It is not licensed anywhere for erectile dysfunction.
A high level of prolactin in men is associated with a low testosterone level and so, by reducing prolactin, cabergoline tends to boost testosterone, thus potentially providing a double boost to erectile function.
There are many reports that the refractory period between orgasms is much reduced with Dostinex, and that multiple orgasms are frequently experienced. The theory being that prolactin naturally increases after orgasm to reduce your libido for a while; but with cabergoline the effect is much reduced.
Dostinex is even reported to reduce gynaecomastia, which is possibly the reverse of high levels of prolactin causing women to lactate. Prolactin s purpose in men is not known, except perhaps for causing a desire to stop after orgasm.
(Norprolac is a dopamine agonist, which seems similar, but I can find no reports of pro-sexual effects. Requip and Quinagolide are two more, and there are some reports of enhanced erectile function with these.)
NOTE: You may also want to look at the page which discusses Natural Dopamine Increasers.
Clinical Trial 1: The International Journal of Impotence Research published, in 2007, the results of a 2005 Austro-German trial (M. Nickel et al). It reported that the effectiveness of cabergoline in 50 men with psychogenic erectile dysfunction was investigated in a 4-month, randomized, placebo-controlled, double-blind study. Cabergoline treatment was well-tolerated and resulted in normalization of hormone levels in most cases. Erectile function improved significantly. Sexual desire, orgasmic function, and the patient’s and his partner’s sexual satisfaction were also enhanced. Cabergoline may be an effective and safe alternative agent for men with psychogenic ED .
Participants were subjectively suffering from chronic stress, and anxious or depressive mood, and were recruited from the general population via advertisements. Exclusion criteria were psychotic disorders, organic ED (including smoking, hypertension and diabetes) current use of PDE5i, and an IIEF-EF score of 25 or more.
The treated men increased their average IIEF-EF score from 16.5 at baseline to 24.8 after four months. The placebo group rose from 16.4 to 19.5. Perhaps more impressively overall satisfaction increased in the treated group from 4.4 to 8.0 (in a range that spans from 2 to 10). It rose from 4.4 to 5.3 in the placebo group.
Testosterone level rose in the treated group from 14.5 nmol/l (lowish-normal) to 26 nmol/l (high-normal) range.
The men in both groups had an unusually high average prolactin level at baseline of around 32ng/ml. Normal range is 2 18ng/ml. Stress can cause elevated prolactin levels. The figures show that 18 of the 25 treated patients had moderate baseline hyperprolactinaemia, however analysis did not show significant difference in the time taken for those with high or low baseline prolactin (or low baseline testosterone) in respect of a favourable outcome. So a high prolactin level was (as confirmed by M R Safarinejad) not necessarily the problem and, it seems, dopamine response is usefully enhanced whether or not prolactin levels are high. In the treated group the prolactin level lowered to an average of 4.9ng/ml, – thus in the bottom fifth of the normal range.
As stated, treatment was well tolerated. In the treated group, five experienced nausea (as did three in the placebo group). Four experienced dizziness (against two in the PG). Three experienced constipation (against two in the PG). It was the same for headaches.
The men on the trial received 0.5mg of cabergoline twice a week (This is 14 to 42 times smaller than the dose used to treat Parkinson s Disease.)
Clinical Trial 2: An Iranian trial (by M R Safarinejad) published in 2006 in the International Journal of Impotence Research reported on cabergoline combined with sildenafil in men who failed to respond adequately to sildenafil alone.
370 men completed the six month double-blind trial. 187 were initially given 0.5mg Dostinex a week, increasing to 1mg, a week. 197 were given a placebo. All were given sildenafil, and expert guidance for usage. Average age was 41.5 years (ranging from 21 to 59). In contrast to the M. Nickel trial , men with low testosterone or elevated prolactin levels were excluded and, also in contrast, men who smoked, had hypertension, or diabetes were included. The M Nickel trial was intended for men with psychogenic dysfunction, whereas only 7.3% of men on the Safarinejad trial were so classified. Despite this the increase in IIEF-EF scores in the two trials were broadly similar
The self-assessed IIEF-EF mean average score increased from 10.5 to 19.6 in the treated group (an increase of 9.1) but only increased from 10.3 to 11.3 in the placebo group. The increase in the treated group is better than the 8.3 increase seen in the M Nickel trial; and both trials showed higher increases than shockwave therapy achieved. The average score achieved in the how much have you enjoyed sexual intercourse? question increased from 1.7 at baseline to 3.7 after six months. This seems impressive; however the report states that positive clinical results were seen in (only) 31.2% of patients in the cabergoline group , – based on patients reporting improved erections. And cabergoline treatment was described as only moderately effective . (With inferior IIEF results, M Nickel reported more positively.)
Simple arithmetic suggests that if only around a third of Dr Safarinejad s patients responded, but the average increase for the whole group was around nine points, then those who responded must have increased their score by 27 points! (And that is impossible in a questionnaire that here spans a range from 6 to 30 points.) Perhaps positive clinical results meant an increase of more than, say, five points?
The report states that cabergoline (Dostinex) significantly increased scores relating to penetration and maintenance of erections; and that the notable finding of our study is the superiority of cabergoline over a placebo in increasing all of the measured parameters . The various statements and the various IIEF scores, as so often happens, seem highly contradictory.
Patients with vasculogenic problems were, as might be expected, poor responders to cabergoline (and 62% of patients had two or more vascular risk factors). Those with other somatic conditions had a 28% to 36.4% response rate. The 7.3% of patients with only psychogenic ED had a 75% response rate. Those who responded must have enjoyed a dramatic response to have had such an impact average scores in a trial where 68.8% of patients didn t respond.
75 to 80% of the improvements seen at six months tended to be apparent at two months. A plateau was generally reached at three months.
12.2% of the treated patients reported adverse side effects. 10% reported nausea, 9% reported headaches, 9% dizziness and 6% somnolence. 5.9% of patients discontinued due to adverse effects.
My Experiment: I ordered cabergoline in March 2013, and it arrived twelve days later on 3rd April.
I took 0.25mg the day it arrived, and again three days later, then I started the first of my 0.5mg twice-weekly doses and at first experienced no obvious negative side-effects. By the twelfth days I felt that the cabergoline was having some positive effect: there being more continuous firm npt that night than I can recall, and a particularly easy self-test.
After fifteen days, I felt less sure of the positive effects, and felt a little more concerned about dizziness, tiredness, constipation, shortness of breath, and depressed mood.
I abandoned my 81 day period of p**n abstinence on 16th day of cabergoline. Fluctuations of mood and performance continued. After two months I went to bed with my new girlfriend, and my performance was poor, – worse than I had expected. I had felt exceptionally tired in the week before. Perhaps the explanation is as follows.
After the fifth week of cabergoline I reduced my testosterone supplement on the orders of my endocrinologist, after a blood test showed 29nmol/l, which is at the higher end of the normal range, and I felt unusually tired (even by my standards). Though tiredness is a side effect of cabergoline. But npt seemed to be increasing, and self-testing suggests an improvement in erectile function. Pleasure of orgasms clearly improved too.
I increased my Testosterone back to 50mg daily on 17th June, but a long weekend away with my girlfriend in late June showed (generally after half a litre of wine and a three-course dinner) no improvements. And that was after three months of cabergoline
I wonder if Caberlin isn t quite Dostinex? After four and a half months I had strong doubts that cabergoline is doing anything much for me. On 26th August I stopped taking cabergoline (Dostinex).
Blood Pressure down to around between 105/70 and 100/65 by day 12 (from the usual 120/80) but only less than 90/60 is considered low. B.P. has continued at about that level since.
Uprima & Zyprima: (Also Apokyn, Ixense, Spontane.) Uprima and Zyprima are apomorphine hydrochloride, which works on the hypothalamus as a dopamine agonist and, unlike cabergoline, was marketed specifically as a treatment for erectile dysfunction. The dopamine increases the subliminal signals required for an erection. Contrary to the Wikipedia entry there was no noticeable effect on desire. Though, of course, knowing you re going to perform well generally does act as an aphrodisiac.
Uprima was available in the UK from 2002 to 2006. It was withdrawn, because most doctors thought it ineffective, it made many patients feel sick, and most patients didn t request a second prescription; but it worked well for me every time. A little-known drug called Zyprima seems to be a generic version of Uprima and is available online at around 4 per dose.
The effects of Uprima could last for about three hours, – shorter in duration than Viagra. And so, unlike Viagra, it was better taken after a romantic dinner rather than before.
One advantage of Uprima was that it was little affected by food and alcohol. Another was its speed of onset of action, of about twenty minutes. It s a sublingual drug, absorbing into the bloodstream through the tongue, bypassing the stomach. Doses could be repeated at eight hour intervals. Disadvantages were that you had to let it dissolve for ten to fifteen minutes under your tongue, and it was not always so easy to be discreet if you re trying not to let on that you might have a problem.
The sleepiness sometimes caused by Uprima could be so extreme that I fell asleep in front of the fire before sex. But, upon being woken, I was fine. I didn t experience the reported nausea.
A dopamine agonist acts directly on dopamine receptors, mimicking dopamine.. Yet Uprima did not work for most men, perhaps because in 2002 there was, for obvious reasons, much less internet p__n addiction ? (Though, on balance, I doubt that was a major reason.)
Uprima and Zyprima can be combined with Viagra. I started taking Uprima in January 2003 and was immediately impressed (even though my Harley Street doctor said it hadn t worked on his other patients). It restored the Viagra effect back to the 1999 level. I ve never had a failure with this combination, even after most of a bottle of wine and dinner.
I ordered Zyprima in November 2012. It looks like Uprima, though the pills are round rather than diamond shape, and they taste like Uprima. My first test suggested no effect on erections and no side effects (nausea or somnolence). Unlike Uprima, Zyprima left a residue under the tongue, and gave an unpleasant sensation in the mouth for several days, and mouth ulcers developed. So I assumed Zyprima was not quite the same as Uprima, and was ineffective. However I took a second Zyprima in August 2013, after a heavy dinner and much red & white wine and whisky; and I then went to bed and quickly fell asleep. I awoke at 3am with a firm erection (unusual at 3am) and then drifting in and out of sleep till 7am with much more npt than usual. I dissolved the tablet more vigorously the first and no sore mouth or residue resulted. The following afternoon I tried again, combined with one 10mg orodispersible Levitra: again no residue or sore mouth and two very good responses to p**n-assisted self-tests . The best response I can recall for years, combined with more powerful npt that night than I can recall. No nausea or somnolence associated with either dose.
Other Methods of Dopamine Enhancement:
A blogger on Yahoo Voices opines that prolactin s actions are said to be responsible for about 80% of erection failure in men as well decreased libido . He added you can take about 300-400 mg of p-5-p; a specialized form of vitamin b6 that has been proven reduce prolactin/raise dopamine. L-Tyrosine supplements also raise dopamine levels which should in turn decrease prolactin. The best amino-acid to reduce prolactin is L-Dopa, which directly and efficiently increases dopamine .
The Social Anxiety Support website states the only things that have been reported to increase dopamine receptors are exercise, abstinence from ejaculation, stopping addictions like p____graphy and fasting .
Love and Spring: Biological anthropologist Helen Fisher explained that she had tested 75 people who were in love , with a brain scanner, and found much higher than usual activity in the ventral tegmental area of the brain, which is the area that produces dopamine. This even applied to people who d claimed to be in love after more than twenty years. After a while the anxiousness associated with love tends to vanish to give a more relaxed enjoyment of dopamine.
I recall with my amazing initial response to Viagra in 1999 was when I was more completely in love than I have ever been. My dopamine level must have been high. Perhaps love can be a cure for ED. Perhaps rejection tends to lower dopamine resulting in widower syndrome .
Melatonin levels increase in winter, so that you might feel low. Melatonin suppresses the release of gonadotropins and for many mammals means it s not the breeding season. Spring comes melatonin is reduced and gonadotropins are released, and it s breeding season.
Inhaled Apomorphine: An inhaled version of apomorphine was investigated by the British company Ventura, but Ventura are currently not taking it forward, – though they are looking for a partner to help with development.
A Warning? Serge Kreutz is a writer I ve found interesting for around twelve years. He has written numerous articles on dopaminergics (and other ways to your enhance your sex life). His initial enthusiasm for dopamine agonists is gone, and he now believes that dopamine agonists will physiologically and physically mess up the dopaminergic system of your brain, and after some time will ruin your sexual health . I m not clear why he believes that, for he doesn t explain why, perhaps the problem is similar to excessive p___ography. (Uprima didn t work for him. And he tried other forms of dopamine agonists, including cabergoline.)