Drug restores normal orgasm in men

Anorgasmia improved or resolved completely in almost 70% of men treated with the dopamine receptor agonist cabergoline, results of a small retrospective study showed. Overall, 50 of 72 men had improvement in orgasms, and 26 of the 50 had return of normal orgasm during treatment with cabergoline. In a multivariate analysis, duration of therapy and concomitant testosterone replacement therapy (TRT) predicted response to cabergoline, Tung-Chin Hsieh, MD, reported here at the American Urological Association meeting. "Cabergoline is an effective treatment option for male anorgasmia," said Hsieh, of Baylor College of Medicine in Houston. "Further studies are needed to better understand the pathophysiology of anorgasmia and to validate our observations of cabergoline's action in anorgasmic patients." Anorgasmia usually has a psychological origin but can occur after radical prostatectomy for localized prostate cancer or secondary to drug treatment. For instance, selective serotonin reuptake inhibitors and classic antipsychotics that are not prolactin sparing have been shown to cause disturbances in orgasmic function. And as many as 75% of men have reported orgasmic dysfunction following radical prostatectomy, said Hsieh. The rationale for studying cabergoline in secondary anorgasmia came from observations of a prolactin surge in some men in the post-ejaculatory phase, leading to reduced erectile and ejaculatory potential. Additionally, increased levels of dopamine have been reported in association with orgasmic response, Hsieh continued. Cabergoline has a direct inhibitory effect on prolactin-secreting cells in the pituitary and has a history of use as first-line treatment for hyperprolactinemia. Given the background of anorgasmia and biologic effects of cabergoline, Hsieh and colleagues hypothesized that the drug might improve anorgasmia by means of its inhibitory effect on prolactin. They retrospectively evaluated medical records of patients treated with cabergoline from 2009 to 2011 at a single andrology clinic. After excluding men who received cabergoline for conditions unrelated to anorgasmia, the investigators identified 72 men for the analysis. All of the men received cabergoline 0.5 mg twice a week. Laboratory assessments included serum prolactin, follicle stimulating hormone (FSH), luteinizing hormone (LH), and serum testosterone. Additionally, investigators determined whether the men were receiving concomitant TRT. Response to treatment was determined by the patients' self-reported improvement in orgasmic function or return of normal orgasm. Response was defined as either improvement or restoration of normal orgasmic function. Results showed that 69% of the men had improved orgasmic function, and 52% of the men with improved function had return of normal orgasm. Mean treatment duration for men who responded to therapy was 296 days compared with 218 days for nonresponders (P=0.02). Concurrent testosterone replacement therapy was associated with an increased likelihood of response (P=0.03), but the testosterone formulation (topical versus injectable) did not influence response. Mean age of men in the study was 63, which did not differ between responders and nonresponders. Patients who responded to cabergoline had lower baseline prolactin levels and higher FSH, LH, and testosterone levels, but none of the differences achieved statistical significance. The findings impressed Hossein Sadeghi-Nejad, MD, who moderated the poster presentation that included Hsieh's study. "Anyone who is in sexual medicine knows that this group of patients is a very difficult group to manage," said Sadeghi-Nejad, of the University of Medicine and Dentistry of New Jersey in Hackensack. "Really, we have had very little to offer them. I think this is excellent work and, hopefully, an avenue for our patients." In response to a question, Hsieh said no serious adverse effects occurred in any of the patients. Headache and dizziness are the most commonly reported adverse events in patients treated with cabergoline. The drug has to be used with caution in patients with heart-valve disease, as some evidence of exacerbation with cabergoline has been reported. "Any patient with valvular disease should be screened with echocardiography before starting treatment with cabergoline," said Hsieh. Primary source/American Urological Association