Human chorionic gonadotropin: A successful treatment modalit
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Post-orgasmic illness syndrome (POIS) is a rare disorder in which affected men experience a cluster of bothersome symptoms following ejaculation, which may include severe fatigue, nasal congestion, burning eyes, concentration difficulties, irritability, depressed mood, and a flu-like state of generalized malaise.1 Symptoms may last from one to seven days.

To avoid these symptoms, men with POIS tend to minimize sexual activity, or attempt to avoid ejaculation when they do engage in sexual activity. The prevalence of POIS is unknown and difficult to determine, as it is likely that many affected individuals do not seek medical attention, and most physicians are unaware of the syndrome.Treatment recommendations have included antihistamines, benzodiazepines, selective serotonin reuptake inhibitors, and CNS stimulants.

A 25-year-old single heterosexual man was seen for a chief complaint of anxiety, low energy, and weakness following ejaculation, accompanied by mental fog and difficulty with word-finding. The onset of symptoms could be immediate or delayed by 2–3 days and would last 1–2 weeks. Symptoms began at 16 years with sexual maturity and continued to the present time, regardless of whether ejaculation occurred via masturbation or intercourse with a female partner. For these reasons, he avoided masturbation and also attempted to avoid ejaculation when engaging in sex with a partner. At the time of presentation he was single and orgasm frequency was once every 2–3 months.

An endocrinologist told him testosterone levels were low. Adderall provided some benefit for the brain fog. Alprazolam was prescribed as needed for POIS, but provided minor benefit. Trials of treatment for POIS with bupropion, and Vyvanse (lisdexamfetamine dimesylate) were unsuccessful. Laboratory blood tests from two years earlier included serum total T of 293 ng/dl and calculated free T of 33 pg/ml. On examination, vasa were palpable, and no varicoceles or hernias were noted.

Treatment was initiated with hCG 1500IU injected subcutaneously three times per week. At six-week follow-up his symptoms had resolved completely, and he had discontinued the use of alprazolam. He ejaculated more frequently and experienced no weakness, anxiety, brain fog, or malaise afterward. He noted improved mood, overall energy, and libido.

Blood tests showed robust levels of total testosterone at 952 ng/dl and free T at 2.8 ng/dl. LH and FSH were below threshold limits. He reported this was the first time since he was 16y that he could experience orgasm without negative physical or emotional consequences afterward.
At six months of follow-up he continued hCG treatment, was happy, and masturbated several times per month. He still described mild POIS symptoms immediately following an orgasm, but these resolved within 12 h and were not bothersome. Importantly, he no longer experienced dread with anticipated sexual activity.