Hypogonadal Rescue in Post-orgasmic Illness Syndrome: A Case Report

Post-orgasmic Illness Syndrome (POIS) is a debilitating and poorly understood condition characterized by multi-system symptoms following ejaculation. We report a hormonally responsive POIS phenotype treated with clomiphene citrate and niacinamide. A 36-year-old Middle Eastern man (BMI 24.5) fulfilling all six Waldinger diagnostic criteria for POIS underwent baseline endocrine profiling and symptom assessment, including serum testosterone, estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH). He was treated with clomiphene citrate 50 mg daily and niacinamide 500 mg daily for three months, with monthly safety monitoring. Pretreatment testosterone was 10.7 nmol/L (normal 8.6-29.0), estradiol 114 pmol/L (41-159), and total symptom score 62/90. After three months, testosterone normalized to 41.9 nmol/L and estradiol rose to 229 pmol/L, with a 26% reduction in total symptom score and a decrease in episode duration from 12 to nine days. No adverse events or laboratory abnormalities occurred. Targeted endocrine modulation with clomiphene and niacinamide produced a clinically meaningful reduction in symptom burden and episode duration in this POIS case, supporting routine hormonal assessment and personalized therapy. Prospective, controlled trials employing validated outcome measures are warranted to establish efficacy and safety.