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In the general population, orgasm difficulties affect 8% of men and 24% of women. Androgen supplementation is used to help arousal and desire difficulties. When checking male hormone status, androgen should be checked, while in women both androgen and estrogen should be checked. Testosterone treatment may encourage tumor growth in cancers dependent on androgen, estrogen, or progesterone. The 4th edition of CURRENT Diagnosis & Treatment: Family Medicine states that “medications that lower the threshold for orgasm can be very problematic for men with premature ejaculation but, can be very effective for treating problems with orgasm.” This applies to bupropion, cyproheptadine, and possibly PDE5 inhibitors. SSRIs negatively affect arousal and orgasm within the sexual response cycle. Diuretics, β-blockers, and antiandrogenic agents all negatively affect arousal and desire. PDE5 inhibitors require erotic or physical stimulation in order to generate erection. PDE5 inhibitor use with nitrates can create serious hypotension and a side effect of temporary greenish-blue hues in color vision can appear because of cross-reactivity with PDE5 isoenzyme in the retina.
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