Endocrine Abstracts

A 51-year-old man presented with a plethora of symptoms that affected him soon after ejaculation and often lasted for a few days afterwards. These symptoms were characterised by debilitating fatigue, palpitations, muscle aches, possible phonophobia, reduced concentration, irritability, headaches and blurred vision. He had reduced libido, erections, reduction in spontaneous early morning erection and his muscular strength was affected leaving him unable to perform in the gym as he had in the past. The history was suggestive of post ejaculation illness syndrome (POIS). He had been taking testosterone, but he had elevated haematocrit, so testosterone therapy was discontinued which he tolerated, and he subsequently had unequivocally normal total and free testosterone readings at follow-up. He also had low-normal salivary DHEA level: 0.34nmol/l [0.25 – 2.22nmol/L]. Dietary supplements, stress management strategies and Melatonin had little noticeable effect. Treatment with DHEA (50 mg daily), although unlicensed, produced a substantial improvement of POIS related symptoms. As a result, the patient was able to drop many other supplements. Reducing the dose of DHEA to 25 mg saw a return of symptoms. POIS is rare but could be underreported and can cause intrusive symptoms in affected men. There is poor understanding of the causes which include, but are not limited to, autoimmune phenomenon, allergic disorder, and micronutrient deficiencies. As a result, there are no recognised treatments for this disorder. However, various treatments have been tried including antihistamines, selective serotonin reuptake inhibitors, non-steroidal anti-inflammatory drugs, glucocorticoid steroids and benzodiazepines. In this abstract we present a case that responded quickly and dramatically to DHEA treatment. It is known exactly why it helped but DHEA is known to have immunomodulatory effects which might be helpful in autoimmune pathologies.