Question: I am a 64-year old male with excellent health, 5'8" 149 lbs, bp 120/70. I walk 4-6 miles per day and work out at a fitness center. I take vitamins, SAM-e as mood elevator, and occasional Viagra (1x 90mg). I have never taken recreational drugs, smoked, or drunk alcohol. My question concerns (1) difficulty in reaching orgasm, and (2) reduced ejaculate volume.

I can easily maintain a full erection, and with Viagra maintain it for several hours, which has proved to be a benefit for my wife. She has had the best sex of her life and I have learned multiple ways to please her. She wants me to orgasm, but it takes extreme effort on my part, mentally and mechanically, for me to climax, either manually by myself or with my wife. With intense effort, I can orgasm about twice per week. My wife and I are monogamous and do not have other sexual partners.

About 3 years ago, my ejaculate volume decreased significantly, and has reduced even more, maybe 1/8 teaspoon or less, mostly clear.

From a "layman's perspective," it seems to me that my nerves have become desensitized. Adding some pain did help me to orgasm (squeezing testicles, pinching nipples or tensing muscles), but even these things are becoming desensitized. I only have a slight sensation from testicle or nipple squeezing. I remember the intense pain of being kicked in the testicles as a teenager, but what I experience now is almost nothing compared to that.

I do not think these issues are psychological, rather I believe it to be either chemical or neurological (dorsal/pudental nerves). I have been treated for kidney stones and have seen a urologist. I asked him and my PCP about these issues and they have no answers. The urologist was least interested; he said "it happens" with some men.

(1) How can I regain sexual sensitivity to pleasure and pain, and increase my ability to orgasm? (2) How can I increase ejaculate volume?

Here is some additional information I thought useful.

My wife is a Nurse Practitioner specializing in wellness. She found my hormone levels to be low, and has given be bioidentical hormone slow-release pellets inserted under the skin. After treatment, she says my testosterone level has reached the elevated to normal range.

According to my research, "testosterone fluctuates widely over the course of a day, with peak levels occurring in early morning, dropping by 30 to 40 percent by mid-afternoon." However, my peak interest in sexual activity IS mid-afternoon, and ability to orgasm (although difficult) is improved then, opposite of the preceding statement.