Hi Dr. Richards,

My name is Mark. It’s me who has asked you before about the hard flaccid penis being caused after taking MDMA and on using alpha blockers. First, thank you for posting the article on MDMA and Sexual Exhaustion and thanks again for this website.

I’ve been doing countless research on human physiology, neurotrasmitters, and all possible causes for what i have to try to piece together this puzzle I’m still dealing with. Now that I’m fully informed on all physiological terms and processes, I understand exactly what you’re talking about in every article, and would like to ask you a few questions in more detail.

I feel like I’m very close to solving my problem and also feel like there’s nobody else in the world that could help me further with this other then you. I’ll make this brief.

Here’s how it started:

The first and second times I’ve done ecstasy everything was fine and there was no effect on sexual function. The third time was spaced only 4 days after the second time. They were ecstasy pills from an unknown dealer and could have been laced with anything else from meth to speed. The next morning I woke up with the hard flaccid penis and that’s when it started. This was 9 months ago. I’ve had periods when the hard flaccid would stay that way for a week or two, and I’ve had periods where it would go away for an entire week. generally the longer I abstained from ejaculation the better it got, but it would always fluctuate. Then 6 months later I had done pure powder mdma. the following week the genitals had shrunken and I had a hard flaccid. Then two weeks later, out of the blue, everything returned to 100% normal and stayed that way for 2 weeks, until the hard flaccid returned. I believe this could have been caused by my serotonin being replenished after 3 weeks, perhaps in combination with exercising consistently, and not eating inflammatory foods for a while. Since then it has been fluctuating. As of a month ago I started doing things right. I exercise consistently, right now I’m trying to avoid ALL inflammatory foods, trying not to stress, trying to get sunlight, taking a multi-vitamin and fish oil and so on..

As for 6 weeks ago I started to abstain from ejaculating for 2-3 weeks. It was going great until i drank a lot of alcohol one day and woke up with a very hard flaccid penis and shrunken testicles. Now I don’t plan on drinking at all. I believe the alcohol could have raised my prolactin + raised prostaglandin E2 and lead to that. Right Now I am still abstaining and am at a point where my penis fluctuates from being perfectly normal to hard flaccid + shrunken tests, several times throughout one day. My sex drive is never like it used to be. It is maybe at 50%.

Before I go on, I also wanted to mention that I’ve taken 2 blood tests and on both my prolactin was extremely high. Cortisol was high on both, but lower on the second. Testosterone was fairly high, and free Testosterone was in average range.

Also, I smoke pot about once a week. When I smoke it, my testicles return to their 100% hang, penis inflammation is not affected, and sex drive is increased. It feels like there’s more blood circulation in the genitals.

SO what i have learned and putting the clues together:

As I understand, my problems are: 1. High prolactin. 2. High norepinephrine (or high dopamine to norepinephrine conversion). 3. Excess Prostaglandin E2 which is released by the excess norepinephrine.
All this is caused by an overworked sympathetic nervous system, and lack of the parasympathetic system.
I want to get a urine neurotransmitter test + adrenal test to get an idea of which nts. are low, but don’t have the money for that right now.

I still have no idea how mdma, or the mdma laced with something, could have caused the hard flaccid overnight. I was very sexually active at the time and deprived of sleep, so i guess my serotonin + dopamine could have dropped dramatically + release of PGE2 + I read that mdma increases prolactin while on it. So many that is it, but how it happened is not important.

From all I read, I understand that prolactin could be lowered by abstaining from ejaculation + taking vitamin E + B6 + living a healthy lifestyle. I do abstain now, and I do live a healthy lifestyle right now. I take a multi-vitamin but that might now be enough vitamin E. I believe the raised prolactin is the cuase of my low sex drive.

To lower prostaglandin E2 and raise E1 and E3, as I understand, diet is very important. As of a week ago I stopped eating ALL inflammatory foods as much as I could. My diet now consists of mainly fish, vegetables, fruits, olive oil, nuts, whole grain, chicken, and green tea. No caffeine, no sugar/sweetener, no alcohol, nothing refined, no omega-6 fats and so on..

As for norepinephrine: I believe my hard flaccid disappears and returns many times throughout the day because of excess norepinephrine. which releases PGE2. I read that this could be caused by too much dopamine being converted to norepinephrine -> epinephrine. If that is the case, then it makes sense that marijuana raises dopamine, thus inhibiting the conversion somewhat, and thus lowering prolactin as a result of higher dopamine I suppose, and as a result returning my sex drive + testicles to 100%. However without the neurotransmitter test i can’t be sure that my dopamine is low but i could only suppose. As for serotonin, I could be low on serotonin, but i don’t suffer from any of the symptoms, and again don’t know until the test.

Are there any ways to reduce dopamine – norepinephrine conversion naturally?? I can’t seem to find much info without using drugs.

You also mentioned that faulty serotonin + GABA could cause dopamine – NE conevrsion. Could you expand on this please.
I have been always exercising. I just fixed my sleeping pattern and am getting sunlight. As of a week ago, I tweaked my diet to make it extremely anti-inflammatory. I try to keep stress (cortisol) at a low. I take a multi-vitamin + fish oil everyday. I try to get plenty of omega 3 from fish. I also take a calcium + magnesium supplement everyday. I limit ejaculation to once in 2-3 weeks now.

Results after 1 week: Some improvements as genitals return to perfectly normal a few times throughout the day, but then return to hard flaccid. This could change within a few seconds. This leads me to believe that my body produces extra NE and releases prostaglandin E2. Is this correct to believe?

I just got some money so I plan on buying your 5-htp + GABA + L’arginine this week.

However, despite my new healthy lifestyle, my body still produces excess norepinephrine OR PGE2 (cause for the quick hard flaccid fluctuations I believe). Also I believe my dopamine might be low. This could be from the mdma that I’ve done, or from the excess Dopamine – NE conversion.
So after tweaking my diet to the extreme, I don’t know what else I can do.

I plan on:
1. Ordering your supplements and hope they help.
2. Perhaps also trying out Mucuna Pruriens to try to boost dopamine. But then I believe my body might down-regulate it’s own supply, and this could not help when I decide to stop taking the supplement. And also I came across Cabergoline. It is a dopamine agonist, which also suppresses prolactin, which almost no side-effects. It is only to be taken twice a week, and apparently has helped many people.

What are your thought on taking Cabergoline on top of your supplements Dr. Richards?

What are your comments on my reasoning and theories?

Am I over-assuming anything or did I get anything wrong?

Anything else you could suggest for me?

Sorry this has turned out so long. Again I really appreciate your expertise, the info you’ve provided, and your help. I feel fortunate that my problem goes away at least on some days which is a good sign. I feel like I’m already this close to putting an end to this, and just need your advice on my action plan.
Again thank you,
– Mark

I appreciate your kind words.

Indeed, different symptom fluctuations are frequently observed during the recovery process since most of the neurohormones are released in surges and depend on numerous factors as well.

However, the problem is a bit more global than just mainly focusing on dopamine-norepinephrine-epinephrine conversions. For instance, if the sexual exhaustion was just related to dopamine-norepinephrine-epinephrine over-conversion, one would only have to suffer symptoms similar to chronic amphetamine usage. However, countless studies and observations have proven that there is much more to it.

The chronically heightened levels of norepinephrine and epinephrine are sustained through the inability of the organism to properly control the inflammatory response in a state of neurotransmitter and hormone depletion. Also, the chronically developed negative neuroplasticity will support the same conversions over and over again for some time, even if the habit has been altered. Much of the available dopamine will be converted to norepinephrine and epinephrine to meet certain organism demands. Heightened prolactin release will keep the dopamine levels low, however, not too low to significantly lower norepinephrine or epinephrine and much (dopamine) will be almost instantly converted to norepinephrine. However, dopamine is easily affected by numerous conversions and neural pathways.

Excessive prostaglandin E2 may be present through the already spoken of, excessive norepinephrine-epinephrine conversions and artery constriction for local inflammations.

To naturally lower the dopamine-norepinephrine-epinephrine conversions (without any specific external support) one just has to be patient and live a healthy lifestyle. A problem arises through the self supporting cycle. Frequently, satisfactory results are severely delayed if the the altered homeostasis is not addressed directly.
There are ways to boost dopamine, with L-Dopa for instance, but as you suspected properly, one will end up with the same or even lowered dopamine levels upon drug discontinuation.

Using Cabergoline may not be a great idea since there is a reason to why one will suffer from increased prolactin levels – if the organism can’t lower it naturally, it is an indication that there aren’t enough neurotransmitters and neurohormones to support similar activities. The cycles of inflammation is usually self-supportive as well. Cabergoline may alter the internal homeostasis and lead to numerous ill side effects, since proper levels of every neurotransmitter and neurohormones are needed for proper utilization of dopamine and every other hormone/neurohormone/neurotransmitter for that matter.

Proper liver functioning and enzyme utilization is crucial to people with a history of drug abuse, so may add Zeolite-DA to the combination. Also L-Arginine shouldn’t be taken without proper amounts of Vitamin C.

Glad if I could help.