interestingI am a 46 year old male, not on TRT but it has become hard for me to get to orgasm since my HIV diagnosis in 2013 - my hormones are in normal ranges, except high SHBG. I probably have some brain or neurological damage which remains not diagnosed.
The most consistent thing that increases the probability for me to reach orgasm is taking 400 micrograms Huperzine-A two hours before sex (I chew the tablets with water, no food). It inhibits acetylcholine esterase, which boosts acetylcholine, which reduces the threshold for muscle contractions and orgasm is basically muscle contractions. Huperzine activates 1-2 hours after ingestion and stays active for about 4 hours.