### Tags [[tags/POIS]], [[tags/Vyvanse]], [[tags/adrenal insufficiency]], [[tags/cortisol]], [[tags/dopamine]], [[tags/hydrocortisone]], [[tags/orgasm frequency]], [[tags/prolactin]], [[tags/testosterone]] ### POIS Case Study - ascorbate #### 1. Summary of POIS Experience and History The individual has experienced severe POIS symptoms for over a decade, with symptoms worsening after multiple orgasms in close succession. Symptoms typically onset rapidly post-orgasm and can last up to 1-2 weeks, with prolonged recovery periods following multiple orgasms in a single night. Over time, symptoms have improved, but severe crashes still occur with frequent orgasms. #### 2. Key Symptoms and Patterns - **Primary Symptoms**: Extreme fatigue, depression, apathy, brain fog, cognitive impairment, social dysfunction, and loss of motivation. - **Physical Symptoms**: Erectile dysfunction, reduced flaccid size, and loss of libido and morning wood, which resolve after prolonged abstinence. - **Temporal Patterns**: Symptoms are more severe with frequent orgasms (back-to-back days or multiple in a row) compared to spaced-out orgasms (weeks to months apart). Recovery can take 7-14 days, with longer periods after multiple orgasms in one night. #### 3. Attempted Treatments and Effectiveness - **Prolactin-Lowering Supplements**: P5P and vitamin E were ineffective. - **Dopaminergic Agents**: Vyvanse (40mg), pramipexole, bupropion, mucuna pruriens, B6, ginkgo, and zinc provided significant relief, particularly Vyvanse, which improved cognitive function and mood. - **Stimulants**: Armodafinil was preferred over modafinil, but Vyvanse, while effective, caused sleep disruption and residual fatigue. - **Cortisol Management**: Hydrocortisone (HC) supplementation (20mg baseline, increased to 30mg post-orgasm) was critical for managing symptoms, with recovery requiring 3-4 days of higher doses. #### 4. Current Status The individual is not cured but has found partial relief through dopaminergic agents and cortisol management. Vyvanse is used as a rescue medication for severe symptoms, but the search for a more sustainable treatment continues. #### 5. Relevant Medical Test Results or Biomarkers - **Testosterone Levels**: Robust (free T in the top 5% of the range, total T at 865 ng/dL), ruling out low testosterone as a factor. - **Cortisol and Adrenal Function**: Symptoms mimic low cortisol and high prolactin states, with increased salt cravings suggesting potential aldosterone involvement. #### 6. Identified Triggers or Correlations - **Orgasm Frequency**: Multiple orgasms in close succession significantly worsen symptoms. - **Hormonal Imbalance**: Suspected roles of prolactin, dopamine, and cortisol dysregulation. - **Adrenal Insufficiency**: Symptoms overlap with low-cortisol states, requiring increased HC post-orgasm. #### 7. Quality of Life Impact POIS severely impacts the individual's quality of life, causing prolonged periods of fatigue, depression, and cognitive impairment. While treatments like Vyvanse and HC provide temporary relief, the condition remains debilitating, particularly after frequent orgasms. --- TAGS: POIS, prolactin, dopamine, cortisol, adrenal insufficiency, Vyvanse, hydrocortisone, testosterone, orgasm frequency CURED: false RELEVANCE_SCORE: 9