Premature ejaculation (PE) or early ejaculation is one of the most common sexual dysfunction that affects 20-30% of men. Unlike ED, which is most prevalent in older men, PE is a common problem for men of all ages.

It impairs our sexual health and significantly reduces our confidence which leads to reduced sexual encounters.

There are four subtypes of PE:

1. Primary (lifelong)
2. Secondary (acquired)
3. Variable
4. Subjective

Primary PE has been present since the patient’s first sexual experiences, whereas secondary PE develops at some point further in life. Lifelong PE (LPE) occurs within 30-60 seconds after vaginal penetration with nearly every session. About 85% of men with LPE ejaculate within 60sec, whereas about 10-20% of men ejaculate within 1-2 minutes.

Variable PE (also called normal variable PE), as the name suggests, is characterized by the inconsistent occurrence of PE.

Subjective PE is defined by the patient complaining of PE even though intravaginal ejaculatory latency time (IELT) is normal.

I’ve put a lot of time and effort into this article because I know what it’s like to struggle with premature ejaculation. I also know how “helpful” google is when it comes to searching for answers and some kind of cure.

If you search for “How to fix premature ejaculation” you come across articles that are loaded with useless information, that is more so suited for men who want to increase libido but don’t address PE or how to fix it at all.

I have full confidence that after reading this article, you will have found more than enough answers and a suitable fix for your struggle. If you want to get the most out of this info, be sure to also listen to the video podcast (linked at the end of the article) that I had with Erik Everhard on this topic. He’s an expert on sex who’s been in the porn industry for over 20 years and knows how to overcome PE with easily applicable methods and techniques.

So without further ado, let’s jump in!

Causes of premature ejaculation

Men suffering from the following have a much higher risk of also having PE:

• Metabolic syndrome (high cholesterol, insulin resistance, etc.)
• Diabetes
• Hyperthyroidism
• Anxiety (sex therapists might help you overcome sexual anxiety)
• Erectile dysfunction
• Inflammation from prostatitis, obesity, diabetes, sleep apnea, etc.
• Relationship issues

I’ll elaborate more on each later in the article.

Hormones and neurotransmitters involved in premature ejaculation

Testosterone

Some studies suggest that low testosterone levels can contribute to delayed ejaculation, whereas others show the opposite.

This study found that those with secondary premature ejaculation were found to have significantly lower testosterone concentrations compared to the other groups (R).

Men with low testosterone (hypogonadal men) who were treated with testosterone, lasted 4.8 times longer. While men given the most common on-demand SSRI, dapoxetine, lasted only 1.8 times longer (R).

Additionally, low LH is an independent risk factor for PE (R).

Low testosterone is also more likely to contribute to anorgasmia (no pleasure during orgasm), weak orgasms or retrograde ejaculation.

Prolactin

Prolactin has been thought to reduce libido, sexual function and reduce orgasm pleasure. According to a few studies, men with premature ejaculation tend to have lower prolactin than men without PE (R).

However, even men with elevated prolactin (between 10 and 25%) can still have PE (R, R).

Prolactin is likely to contribute to sexual dysfunction in general, but perhaps doesn’t contribute all that much to premature ejaculation.

Related article:

• How to lower prolactin

Estradiol

Although estradiol is an independent risk factor for ED (even in men with normal testosterone), estradiol levels don’t seem to differ between men with or without PE (R, R).

There are two mechanisms in how estrogen might contribute to PE.

#1 Since estradiol is an independent risk factor of ED and ED and ejaculatory dysfunctions frequently overlap (50% of men with ED also have PE), I’d focus on keeping estradiol under 30pg/ml regardless of testosterone levels.

#2 Estradiol plays a role in regulating the initial part of the ejaculatory reflex—the emission phase. Estradiol increases epididymal responsiveness to contractile agents such as oxytocin and endothelin-1. The key to lasting longer is to get fewer involuntary contractions. Estrogens might worsen this (R).

Related article

• How to inhibit aromatase

Oxytocin

Oxytocin participates in ejaculation by enhancing sensitivity and involuntary contractions.

Men with PE have higher levels of oxytocin than those without (R). Oxytocin antagonists have been shown to delay ejaculation (R). There are both herbal and pharmaceutical compounds than can lower oxytocin.

Dopamine

Dopamine is a catecholamine that, together with oxytocin, promotes ejaculation. Dopamine agonists are commonly used to treat delayed ejaculation. Certain dopaminergic compounds such as methylphenidate (Ritalin) can contribute to spontaneous ejaculation.

Dopamine antagonists, commonly prescribed for people with schizophrenia, can cause sexual dysfunction and orgasm disorders, including delayed ejaculation (R).

I don’t want to pain dopamine as the bad guy here, since it’s not. Dopamine is very needed for libido and pleasureful orgasms.

Noradrenaline & adrenaline

Noradrenaline and adrenaline are also catecholamines. They are part of the sympathetic nervous system. Overstimulation of the sympathetic nervous system promotes ejaculation. People that are typically overstimulated struggle with sleep, anxiety, premature ejaculation, ADHD, ED, etc.

Suppression of noradrenaline reduces ejaculation latency (R). Clonidine, which lowers noradrenaline production, also contributes to ED and delays ejaculation (R). Yohimbine completely prevented the clonidine-induced suppression of ejaculation (R).

Methyldopa, an anti-hypertensive medication, lowers dopamine and noradrenaline release. A common side effect of methyldopa is delayed ejaculation (R).

Zinc, magnesium, agmatine, theanine, salt, carbs, aspirin, Kratom, etc., can help to reduce the overactivation of the sympathetic nervous system.

Serotonin

Serotonin inhibits ejaculation. There are 7 serotonin receptors, of which there are several subclasses.

Stimulation of the serotonin 5-HT2C receptor delays ejaculation, whereas stimulation of post-synaptic 5-HT1A receptors shortens ejaculation. This created the hypothesis that men with PE may have hyposensitivity of 5-HT2C and/or hypersensitivity of the 5-HT1A receptor.

According to this study, men with PE have lower levels of serotonin and NO (R).

Additionally, Yohimbine, a 5-HT1A agonist, promotes ejaculation (R).

In theory, reducing 5-HT1A sensitivity or antagonizing 5-HT1A should help prevent premature ejaculation. CBG, wild jujube, berberine and cyproheptadine are 5-HT1A antagonists that might help delay ejaculation.

Safe ways to increase serotonin include sunlight, exercise, stress management, meditation, yoga, music, massage, etc.

Glutamate

Glutamate is an excitatory neurotransmitter. It helps a lot with mood, focus, libido and even testosterone production. However, too much can become toxic to the brain and contribute to premature ejaculation (R).

Glutamate acts on 3 receptors, with the NMDA receptor being the most well-known.

The way NMDA activation promotes ejaculation is via enhancing sympathetic drive (higher catecholamines) (R).

Sympathetic nervous system (SNS) sensitivity is remarkably higher in men with PE.

In this study, they have categorized rats into 3 groups: sluggish (delayed ejaculation), normal and rapid (premature ejaculation. The SNS sensitivity was 28.9% ± 8.1% in “sluggish,” 48.4% ± 7.5% in “normal,” and 88.7% ± 7.4% in “rapid” groups.

Compared with “normal” ejaculators, the percentage of neurons expressing NMDA receptors in the paraventricular nucleus (PVN) of “rapid” ejaculators was significantly higher, whereas it was significantly lower in “sluggish” ejaculators (R).

This human study found that men with lifelong PE have remarkably increased glutamatergic activity in the thalamus of the brain (R).

In summary, men with PE have more glutamate and NMDA receptors in the part of the brain that controls ejaculation and this enhances sympathetic nervous system sensitivity.

I’ll take more about what influences NMDA expression towards the end of this article.

Natural ways to lower/inhibit glutamate include theanine, taurine, magnesium, GABA, zinc, NAC, etc.

GABA

GABA is our main inhibitory neurotransmitter. GABA plays an important role in PE by reducing excess dopamine, noradrenaline, serotonin and glutamate firing.

Rats with premature ejaculation had lower expression and distribution of both GABA-A and GABA-B receptors compared to normal rats (R).

GABA-B receptor partial agonists are being studied in humans for premature ejaculation (R). Homotaurine, a compound that can increase GABA-B receptor expression, might also be helpful for premature ejaculation. Isoliquiritigenin, the active ingredient in licorice, is a GABA-B agonist (R).

Lorazepam, a benzodiazepine, has been shown to help with premature ejaculation. According to this case study, 1mg of lorazepam 30 min prior to intercourse prolonged one male’s ejaculation from 30 seconds to 4-5 min (R).

However, I would not play with GABA-ergic drugs due to tolerance, dependence and withdrawal side effects.

DHT, our strongest androgen created from testosterone, has strong GABA-ergic effects. This helps with performance anxiety as well as lasting longer.

To learn more about optimizing your DHT, check out this article (it will open in another tab, so finish this article first before reading that one).

Other natural GABA boosters/agonists include valerian root, lemon balm, chamomile, passionflower, St John’s wort, magnolia, kava, etc.

Nitric oxide (NO)

NO isn’t technically a hormone or neurotransmitter, but it’s a gaseous signaling molecule. It’s classed as gasotransmitters, which are small gaseous molecules that function as neurotransmitters.

NO not only helps with erections but can also help delay ejaculation. This might be one reason why men with ED tend also to have PE.

Good herbs to boost NO include Tongkat Ali, Horny Goat Weed, garlic, artichoke, ginseng, plumbago indica, Balgalala, Shisandra, Dan Shen, pomegranate extract, naringenin, etc.

Opioids

Opioids are used to enhance mood and blunt pain. However, it’s highly addictive and has terrible withdrawal effects. Opioids, by binding to the μ-opioid receptor, might help to reduce sensitivity.

Tramadol is an opioid medication that’s sometimes prescribed for PE.

Naltrexone, an anti-opioid medication can cause premature ejaculation. About 90% of men who use naltrexone experience some sort of sexual side effect, with 87% of men experiencing premature ejaculation (R).

Kratom and Kanna are natural opioid receptor agonists and can help you last longer. Rhodiola also has pro-opioid effects and can help you last longer.

Tianeptine (used as a nootropic and mood uplifter) has pro-opioid effects. People report lasting longer when they take it on a daily basis. 15mg x2-3 daily is a good starting dose, but often higher doses are required to last longer.

Thyroid hormones

Hyperthyroid individuals end to have a higher risk of PE (around 50%) than euthyroid or hypothyroid men. After the treatment of hyperthyroidism, the prevalence of PE decreased from 50% to 15%, which is similar to the levels in the general population (14%) (R).

Histamine

Histamine plays a role in ejaculation. There are 4 histamine receptors and binding to the histamine 3 receptor delays ejaculation (R). H3 agonism lowers histamine levels.

Holarrhena antidysenterica is a natural H3 antagonist (R), which can increase histamine and perhaps worsen PE.

Hormone and neurotransmitter on premature ejaculation summary

• Testosterone, DHT, serotonin, NO, GABA and opioids help to delay ejaculation.
• Noradrenaline, adrenaline, estrogen, oxytocin and glutamate promote ejaculation.

Keep in mind that we want a balance of these hormones and neurotransmitters. Trying to delay ejaculation too much can cause side effects such as anorgasmia (less intense and pleasurable orgasms) and even ED.

Pharmaceutical drugs / prescription medications for premature ejaculation

Most men seek medical treatment to resolve this and here are what doctors prescribe.

SSRIs and other anti-depressants

Anything that increases serotonin should help with premature ejaculation. That’s why SSRIs (selective serotonin reuptake inhibitors) are the most commonly used drugs for PE.

There are many different SSRIs, but I want to mention 2 kinds. For people with depression, a healthcare provider can give patients long-acting SSRIs (it stays longer in your body). Common SSRIs used off-label to treat PE include fluoxetine, paroxetine, sertraline, fluvoxamine, and citalopram.

For people with premature ejaculation, they’re often given short-acting SSRIs, with Dapoxetine being the most common.

Short-acting SSRIs aren’t as effective as long-acting, but they have fewer side effects. In terms of effectiveness, long-lasting SSRIs increase intravaginal ejaculation latency time (IELT) 2 to 9-fold above baseline, compared to 3 to 8-fold when dapoxetine is used.

In terms of side effects, Dapoxetine causes nausea, diarrhea, headache, dizziness, insomnia, somnolence, fatigue, and nasopharyngitis. It rarely causes erectile dysfunction. Long-lasting SSRIs are much more likely to cause ED and other sexual dysfunction issues.

Unlike other SSRIs used to treat depression, which has been associated with high incidences of sexual dysfunction, dapoxetine is associated with low rates of sexual dysfunction; decreased libido (<1%) and erectile dysfunction (<4%). This is termed PSSD (post-SSRI sexual dysfunction). Check out my article on how to fix PSSD.

The recommended initial dose of Dapoxetine is 30mg, taken as needed 1-3 hr before sexual activity. It’s taken once every 24 hr and may be increased to a maximum dose of 60mg daily if 30 mg is inadequate.

30mg Dapoxetine can increase IELT from 0.9-1.1min to 2.8-3.9min and 60mg can increase it to 3.3-4.2min.

SSRIs are also frequently combined with PDE5i such as Viagra, Cialis, mirodenafil, etc, which boosts if effectiveness even more (R).

Despite SSRIs being “effective” for PE, the discontinuation rate is extremely high. Roughly 90% of people quit after 1 year (R). The reasons for discontinuation were:

• Cost (29.9%)
• Disappointment that PE was not curable and that dapoxetine was required every time sexual intercourse was contemplated (25%)
• Side effects (11.6%)
• Perceived poor efficacy (9.8%)
• A search for other treatment options (5.5%)
• Unknown (18.3%)

Other kinds of anti-depressants are also used off-label for PE.

For example, Clomipramine, a tricyclic medication used for OCD, can also help with PE in doses of 25-50mg (R).

I personally would never use SSRIs or recommend them. If you want to boost serotonin to see if it helps, rather use natural herbs, instead of drugs.

Clomiphene citrate (Clomid)

Clomiphene citrate is mainly used to increase testosterone. However, there is a cap on how effective it can be. That cap seems to be on average around 500-600ng/dl. Regardless of the dose, your testosterone is unlikely to go higher than that.

Clomiphene at 50mg daily was able to significantly increase IELT from 2.5 to 10min during a 10-month period, which significantly improved sexual satisfaction (R). Interestingly, other sexual parameters, such as erection quality didn’t improve. More interestingly, quality of life significantly decreased. This could be related to the side effects of clomiphene.

PDE5i

NO has inhibitory effects on ejaculation. NO stimulates the production of cGMP. PDE5 breaks down cGMP, thus reducing the effectiveness of NO.

PDE5 inhibitors, such as Viagra or Cialis, are used mainly for erectile dysfunction, by inhibiting the breakdown of cGMP. However, it’s also effective for premature ejaculation.

Many clinical trials show that PDE5 inhibitors are significantly more effective than placebo or SSRIs for treating PE, while SSRIs are better than placebo. Combining PDE5 inhibitors with SSRIs was the most effective (R).

Involuntary contractions promote ejaculation. PDE5i can inhibit these contractions. The most effective contraction inhibitor is rolipram (-89.6%) > vardenafil (-62%) > sildenafil (-61.3%) > and vinpocetine (-46%) (R).

Side effects of PDE5is include, such as headache, dizziness, flushing, and nasal congestion (R).

As a side note, PDE5is can also help reduce the refractory period. Post-ejaculatory refractory time dropped significantly after vardenafil (16.7+/-2.0 to 4.3+/-0.9 min), compared with placebo (15.3+/-2.2 to 15.8+/-2.3 min) (R). I prefer natural PDE5is, such as Horny goat weed.

TRT

Low testosterone can contribute to PE and putting men on TRT can boost IELT by 4.8 fold (R).

Topical anesthetics

Penile hypersensitivity is a major contributor to premature ejaculation. That’s why people often recommend masturbating before sex, because it can help to desensitize the penis. However there are downsides to this, such as causing limp dick and low libido.

There are different kinds of numbing topical creams, with prilocaine/lidocaine (FORTACIN™) being the most common (R).

However, it also has side effects, such as localized irritation, including pain, burning, delayed ejaculation and loss of penile sensation.

Other options include PYT, Emla, pau yuen tong, secret severance cream (R) (made up of extracts from 9 natural products), etc.

Oxytocin antagonist

Oxytocin promotes ejaculation. Specific oxytocin receptors have been discovered in various parts of the genitals, namely the tunica albuginea, epididymis, and vas deferens.

Cligosiban is an oxytocin receptor antagonist developed to treat premature ejaculation. The average increase in IELT from baseline to the last 4 weeks of treatment was 61sec (R). Although it’s not that potent, it still helps.

Alpha 1‐adrenoceptor antagonists

α1-adrenoceptor antagonists are used for the treatment of lower urinary tract symptoms (LUTS). However, one of the main side effects is ejaculatory dysfunction.

They mediate ejaculatory dysfunction via two mechanisms:

• Inhibition at the bladder neck, prostate, and urethra, resulting in retrograde ejaculation
• Inhibition of seminal emission resulting in ejaculatory dysfunction

After 2 months, Silodosin (an α1-adrenoceptor antagonist), increased IELT from 3.4 to 10.1min. In addition, all patients reported that their ejaculation problem was ‘much better’ or ‘slightly better’. In terms of side effects, anejaculation (25%), reduced semen volume (37.5%), and pain during orgasm (87.5%) were common (R).

Although it works, the risk of side effects is also high.

Opioids

Tramadol, by binding to the opioid receptor and inhibiting serotonin reuptake, is highly effective for PE.

100mg increased IELT from 59.2 to 238.2 sec (R). 50mg is better than 25mg, but 100mg isn’t much better than 50mg.

Tramadol is significantly more effective than paroxetine on-demand, sildenafil, lidocaine gel, or behavioral therapy for PE. However, tramadol is associated with significantly more adverse events including erectile dysfunction, constipation, nausea, headache, somnolence, dry mouth, dizziness, pruritus, and vomiting (R).

Modafinil

A sexual study in male rats has shown that the administration of D-modafinil resulted in a significant delay in ejaculation latency times (R). The mechanism of action is unknown, but it could be mediated via an increase in serotonin release in the brain or spinal cord or action on the dopamine system or both.

In this study, 55 men with lifelong PE were given 100mg of modafinil. This led to an IELT increase from 25 to 50 sec.

A pre-clinical study is underway to investigate the short-acting modafinil d-isomer for the treatment of PE.

Pregabalin

Pregabalin helps with PE by reducing excessive excitation.

Pregabalin is used for the treatment of epilepsy, neuropathic pain, fibromyalgia, restless leg syndrome, opioid withdrawal and generalized anxiety disorder.

It works by inhibiting certain calcium channels. Inhibition of calcium channels reduces the excessive release of multiple excitatory neurotransmitters, including serotonin, dopamine, and other neurotransmitters.

150mg pregabalin increase IELT by 2.4-fold (R). Although it’s not bad, the fold improvement with on-demand tramadol, dapoxetine, and clomipramine ranged from 4 to 13-fold on some occasions.

Pregabalin has not only been shown to cause delayed ejaculation (R), but also ED in some people (R).

Magnesium and taurine are natural calcium channel blockers and I would try them first.

Vitamin supplements for premature ejaculation

Folic acid/folate

Folate, vitamin B9, can help with PE and low folate is an independent risk factor for ED.

Men with PE have lower folate levels than men without PE. According to this study, serum folate concentrations were lower in ED (7.61 ± 3.97 ng/ml), PE (9.37 ± 3.40 ng/ml), and ED/PE (8.84 ± 4.28 ng/ml) patients than in healthy men (12.23 ± 5.76 ng/ml) (R).

It works via interacting with a few systems, namely the serotonergic (5-HT1A and 5-HT2A/2C receptors) and noradrenergic (alpha1- and alpha2-adrenoceptors) systems (R).

Folate is also essential for NO, dopamine and serotonin synthesis and is a powerful antioxidant (R).

Supplement:

• B-complex

Vitamin D

Men with a vitamin D deficiency have a higher risk of getting acquired PE (R). According to this study, the best cut-off value of vitamin D to detect patients suffering from lifelong PE was 50.65 ng/ml (R).

Vitamin D stimulates the production of NO, which puts brakes on the sympathetic nervous system. Vitamin D also controls dopamine and serotonin synthesis and binds to androgen receptors (R).

I recommend getting lots of sunlight since sunlight specifically (not vitamin D) increases testosterone, natural opioids, dopamine, serotonin, nitric oxide and much more!

Related article

• Shedding light on the one thing an Alpha Energy Male needs more of

Vitamin B12

Low vitamin B12 is associated with PE (R).

Vitamin B12, similar to folate, is involved in dopamine, serotonin and NO synthesis.

Supplement:

• B-complex

Minerals for premature ejaculation

Magnesium

Men with PE have low magnesium levels in their seminal fluids, but not necessarily low serum magnesium (R). 

Low magnesium causes vasoconstriction and decreased nitric oxide levels. This may lead to premature emission and ejaculation processes (R).

Supplements:

• Magnesium

Zinc

Zinc supplementation in rats significantly delayed ejaculation (R).

Zinc increases testosterone and NO and lowers glutamate and increases GABA (R).

Just don’t go overboard with zinc, as it can start to inhibit dopamine synthesis and dopamine receptors (R, R). This can then lead to an increase in prolactin and suppressed libido.

My preferred source of zinc is oysters and red meat.

Best foods for premature ejaculation

The best foods will be high in folate, B12, zinc and magnesium.

• Beef/chicken liver – high in folate, B12 and zinc.
• Red meat – high in B12 and zinc.
• Leafy greens – high in folate and magnesium
• Yellow passion fruit – high in folate (R)
• Oysters – high in zinc and B12
• Milk – a great source of zinc, magnesium and B12

Herbs for premature ejaculation

Let’s look at the best natural supplements to improve sexual performance and PE. Many of these compounds will also improve sex drive and sexual desire.

Caffeine

This clinical trial studied the effects of 100mg of caffeine taken 2 hours before sex. IELT increased from 144s to 312s (R).

If you plan on taking caffeine before sex, be sure to take theanine with it to prevent it from disrupting your sleep. Most people would recommend a 1:1 ratio, but I benefit more from a 2:1 or 3:1 ratio of theanine to caffeine.

Supplement:

• 100mg caffeine

Tongkat Ali

Tongkat Ali contains 9-hydroxycanthin-6-one (9-HC-6-one), a β-carboline alkaloid. In vitro, 9-HC-6-one stopped the involuntary contractions that cause PE, by blocking calcium channels (R).

Quite a few people on Reddit have reported that Tongkat Ali helped with their PE (R, R).

Supplement:

• 2% eurycomanone
• 10% eurycomanone

Yimusake

Yimusake tablets are Chinese medicine for impotence, premature ejaculation, spermatorrhea, nocturnal enuresis and neurasthenia.

Yimusake Tablet increased IELT from 62.5 sec to 168.9 sec after 4 weeks and 222.2 sec after 8 weeks (R).

CAMPEDEX-5

CAMPEDEX-5 is a combination of natural ingredients, namely Thiosulfinate (found in garlic), diosgenin (extracted from wild yam) and nuciferine (found in the plants Nymphaea caerulea and Nelumbonucifera).

Thiosulfinate increases glutathione and hydrogen sulfite (H2S). H2S acts as a pro-erectogenic gaseous mediator, similar to NO. Similar to NO, it can also help with PE. Cysteine and taurine, two sulfur amino acids, can also increase H2S and help delay ejaculation.

Diosgenin increases DHEA and DHT, which can help delay ejaculation.

Nuciferine could potentially block dopamine receptors.

Supplementing CAMPEDEX-5 has been shown to increase IELT from 45.5 sec to 123.7 sec after 3 months. That’s a 3 fold increase (R).

Kanna

Kanna can help with premature ejaculation. It inhibits serotonin uptake, promotes the release of dopamine and GABA and is an agonist to the GABA-A, µ-opioid and δ2-opioid receptors.

People report good effects from LiftMode’s Kanna extract. Take it sublingually for fast onset.

Supplement:

• Liftmode kanna (strong Mesembrine extract)
• Sceletium kanna

Qiaoshao Formula

Qiaoshao Formula used twice a day was very effective for PE and increased IELT from 1.5min to 3 min (R).

Patients’ sex life satisfaction was improved from 1.3 to 6.3, and the spouse’s sex life satisfaction increased from 1.3 to 6.1.

The way it works is to increase serotonin, dopamine and NO levels while decreasing oxytocin (R).

Mondia whitei

Mondia Whitei is a perennial herb found in Africa. It’s been found to prevent ejaculation (R). It has also been shown to increase testosterone and act as a sexual stimulus and improve erectile function (R).

Supplement:

• Mondia Whitei

Dracaena arborea

Dracaena arborea is a medicinal plant with an aphrodisiac reputation.

In rats, Dracaena arborea extracts dose-dependently blocked the pro-ejaculatory activity of dopamine and oxytocin (R).

EndEP

EndEP has been shown to increase IELT from 73.6±46.9 to 102.3±60.0 after 90 days (R).

It’s a combination of 200 mg Rhodiola rosea, 10 mg zinc, 200 µg folic acid and 50 µg biotin.

Rhodiola is a strong adaptogen and restores normal serotonin levels in the hippocampus of depressed rats (R). It also increases dopamine by inhibiting MAO-A nad MAO-B (R).

In small and medium doses, Rhodiola stimulates the noradrenalin, serotonin, dopamine and acetylcholine receptors in the central nervous system (CNS) (R).

It may stimulate the synthesis, transport, and receptor activity of opioid receptors and peptides such as the β-endorphins. β-endorphins attenuate the intensity of the stress response and the sudden release of opioid peptides that occurs as part of the pituitary–adrenal axis response to stress (R). 

St John’s Wort

St John’s Wort, and specifically the active component hyperforin, reduces excessive contraction, which causes PE (R). It also inhibits serotonin reuptake.

Apart from delaying ejaculation, it can also cause anorgasmia or absent orgasm for some people.

Anacyclus pyrethrum & Spilanthes acmella

A small 4 week clinical study looked at the effects of Anacyclus pyrethrum & Spilanthes acmella on ED and PE. Both herbs were given at 1g x2 daily with honey (R).

Anacyclus pyrethrum was found to be the stronger aphrodisiac, resulting in stronger and longer lasting erections, less post-sex fatigue, than Spilanthes acmella. Spilanthes acmella on the other hand was better for premature ejaculation. Both can be combined for ideal effects.

Spilanthes acmella has also been shown to mildly increase testosterone in humans (R).

Products:

• Anacyclus pyrethrum
• Spilanthes acmella

Chinese medicine for premature ejaculation

From the traditional Chinese medicine point of view, kidney yang failure is one of the main reasons for premature ejaculation. Herbs with hot properties (that restore yang) include Radix Aconiti, Herba Asari (wild ginger), Syzygium aromaticum (clove) and Pericarpium Zanthoxyli (R). 

Cistanche is another aphrodisiac herb used to treat kidney yang and might be helpful for PE.

Traditional Ayurvedic herbs for premature ejaculation

Traditional Ayurvedic classified aphrodisiacs into the following five categories. One of those categories is aphrodisiac herbs that delay the time of ejaculation or improve ejaculatory performance (R). 

These include:

• Sida cordifolia,
• Asparagus racemosus
• Cinnamomum tamala (indian bay leaf)
• Anacyclus pyrethrum
• Mucuna pruriens
• Cannabis sativum

The best tactics for premature ejaculation

11 Tricks to last longer / alternative treatment of premature ejaculation

#1 Thicker condoms

One of the main problems with PE is the hypersensitivity of the penis. Wearing a thick condom can reduce the sensation of touch and delay ejaculation.

The thickened condom can also help to effectively maintain and prolong the duration of an erection (R).

#2 Modify tempo

Listen to the podcast linked below for more detail on this one. You have to experiment to see what tempo suits you best. Sometimes going fast can help desensitize you and sometimes going slow helps you get off the edge.

The longer you stay inside, the more it can help you to become desensitized which will also help you last longer.

#3 Stop-start technique

When you feel that you’re coming close, stop. Wait until the intensity of the feeling has gone away, then continue…slowly. This is a last resort. Listen to the podcast to learn more about what else to do instead of this technique.

#4 Squeeze technique

This technique involves pulling out before you ejaculate, then pinching your dick just under the head. Listen to the podcast to learn what Erik thinks about it.

#5 Shift your focus/distraction

Shifting your focus away from your dick can help to reduce sensation a bit which will help you last longer. There are many ways to distract yourself and Erik gives a lot of good ideas for this.

#6 Pelvic floor muscle rehabilitation

Pelvic floor muscle rehabilitation is meant to help you gain control of your ejaculatory reflex.

Based on this study, the pelvic floor muscle rehabilitation protocol consists of:

• Physio-kinesiotherapy to achieve a muscle contraction that allowed the patient to be aware of motor activity
• Electro-stimulation of the perineal floor to stimulate directly the pudendal nerve, resulting in stimulation of the puborectalis muscle, which causes the urethral sphincter to contract
• Biofeedback, in which the patient learns to control the muscle contractions of the perineal floor and the genitourinary sphincter.

The patients had three 60-min therapy sessions each week, during which the three techniques were applied for 20 min each.

At the end of the 12 week treatment, 82.5% of the men gained control of their ejaculatory reflex and increased their IELT from 39.8 to 146.2 sec. Even 6 months after stopping the treatment, the men retained the benefits of the treatment.

#7 Kegels

Kegels are pelvic floor exercises that involve contracting the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum for 2-3 seconds and then relaxing. Do this for 5 minutes x2-3 weekly.

Strengthening these muscles can help with stronger erections and also with better control when you feel like you want to ejaculate.

#8 Sleep

Poor sleep quality is an independent risk factor for acquired premature ejaculation (R).

#9 Activity

Being active (e.g. walking) for 30min 5 times a week is a good alternative to dapoxetine (R). Erik elaborates on how all the top performers in the industry are always in good shape.

#10 Get into good (healthy) shape

Why it’s important to be in good shape

Men with PE also tend to have other health problems / medical conditions compared to people without. For example, men with diabetes and metabolic syndrome are at a much higher risk of premature ejaculation than healthy individuals (R).

For example:

• The prevalence of PE among patients with MetS (35.2-51%) is significantly higher than those without (7.6%).
• 33.3% of men with fasting blood sugar over 110mg/dl have PE compared to only 5.5% who have a fasting blood sugar below 110mg/dl (R).
• Men with glycated hemoglobin (HbA1c) >7% were 10 times more likely to have PE than patients with HbA1c <7%.

The reason for this is inflammation.

People with obesity, metabolic syndrome and diabetes usually have higher inflammation than those without.

The way inflammation contributes to PE is by upregulating the NMDA receptor (glutamate system), thus dramatically enhancing sensitivity (R, R).

Since inflammation is the cause of PE, any other inflammatory condition will also likely contribute to PE. Other common contributor to PE is chronic prostatitis, urinary tract infections and even sexually transmitted diseases, such as Chlamydia trachomatis, Ureaplasma urealyticum or Neisseria gonorrhoeae.

Easy ways to reduce inflammation are to:

• Clean up your diet (eliminate ultra-processed foods and replace it with easy to-digest nutrient-dense animal foods)
• Improve sleep quality
• Weight loss (Lose excess weight)
• Improve gut health
• Reduce excess alcohol consumption

#11 Breathwork

If you’re hyper excited before sex, you’ll likely blow quickly. Doing deep slow in and exhales can help a lot to activate the parasympathetic nervous system. Aim for a 4-6 sec inhale and exhale.

Erik elaborates on an interesting technique that helped him, namely rapid short exhales to take him away from the edge.

Summary

Fixing PE is multifactorial, but the two most important things are your health and technique (as discussed by Erik).

In terms of health, focus on maximizing your testosterone, DHT, NO, GABA, dopamine and serotonin. If you’re sympathetically dominant (hyperactive, anxious, restless legs, etc.), focus on activating your parasympathetic nervous system more. Boosting GABA will help with this.

My preferred supplements for lasting longer include:

• 2-3g Taurine + 0.5-1.5g GABA
• 25mg sublingual Kanna beforehand
• 100-300mg elemental magnesium (1-3g magnesium glycinate / threonate)
• 200-400mg theanine

There are many supplements you can try, but start with improving your health and hormones, while working on your technique.