For fifteen years I told diabetic men their vanishing ejaculate was part of ageing
For fifteen years I told diabetic men their vanishing ejaculate was part of ageing. Then it happened to me at 51 — and I found out it is a three-to-five-year warning that ends at the heart.
Consultant urologist David Miller, FRCS (Urol), on the symptom men never raise in a ten-minute appointment, and why not one tablet on his own prescribing pad — metformin, ramipril, amlodipine, tamsulosin — had ever touched the thing that was actually narrowing.
The same process, in two different sized tubes. The narrow vessels go first.
I need to tell you what I did for fifteen years.
But first I want you to understand something: I did it all by the book. I followed the guidance. I hit the targets. Every man who walked out of my clinic had his symptom managed and his numbers where they were supposed to be.
And I never once told any of them what was coming.
I am a consultant urologist. Nineteen years in practice. I have spent the last decade watching the same thing unfold in diabetic men on long-term blood pressure tablets, and I said nothing, because the appointment is ten minutes long and the symptom that matters most is the one no man volunteers.
If you are a diabetic man on amlodipine, ramipril, losartan, atenolol or bisoprolol, and what comes out has gone — weaker, less, or nothing at all — I am writing this because you have somewhere between three and five years before the same failure reaches your heart.
Here is what nobody told me either.
You already know the thought. You had it, and you pushed it away, and it came back at two in the morning: if it's happening there, where else is it happening?
I thought that was just worry talking. It isn't. It is the most accurate reading you have of your own arteries, and it is more honest than anything on your printout.
I know that now because it happened to me. At 51. And I understood something I had never explained to a single patient.
In the next few minutes I am going to show you why every tablet you take moves a number without touching the thing that is narrowing, what that thing actually is, and what changed for me in eight weeks — while I stayed on every tablet I was already taking.
Keep reading. Three to five years is not a long time.
It started the way it starts for most men on three tablets a morning.
It arrives as a series of small things, and every one of them has an innocent explanation.
You do not notice it arrive. That is the whole problem with it.
It comes as a series of small things that each have an innocent explanation, and every one of those explanations is age:
- It takes longer to get going than it used to. You stand at the toilet a second or two before anything happens.
- It dribbles rather than goes.
- You are up in the night, and you have stopped counting.
- And then one night, after sex, nothing comes out. Or barely anything. And you look it up on your phone, and you close the browser, and you never mention it again.
Not to your GP. Not to your urologist. Not to your wife.
Because it is not the sort of thing you raise in a ten-minute appointment about your bloods.
I know exactly how that goes, because I was the man on the other side of that desk for fifteen years, and I can tell you what happens next.
Nothing. Nothing happens next. You get asked about your cuff reading and your HbA1c, both of which are fine, and you go home.
The erection isn't the disease. The vanished ejaculate isn't the disease.
They are all symptoms of one thing that has been happening inside the wall of every artery you own since long before anybody handed you a prescription. And almost every treatment added on top of a diabetic's morning tablets masks the next downstream symptom while that process carries on underneath.
Four things I tried. Not one of them worked.
Four prescriptions for four problems. Not one of them aimed at the wall.
When my own symptoms started, I did what men do. I did it quietly, and I did it in the order everyone does it.
- Mediterranean diet. Exercise. Weight off. Marginal. Genuinely marginal — I lost the weight and the symptoms stayed exactly where they were.
- Saw palmetto. Pumpkin seed oil. Beta-sitosterol. The standard list. The one I had been half-tolerantly nodding at in clinic for years when patients asked. Nothing moved.
- L-arginine, on the theory that if this was a blood flow problem I could push more blood through it. Nothing.
- Berberine on its own, from a high street chemist, for two months. Nothing I could feel. I want you to remember that one, because I got it wrong twice and it cost me most of a year, and I will come back to exactly why it did nothing.
And all the while, every number anybody took off me said I was fine.
My PSA was stable. My cuff reading was managed. My HbA1c was 49.
And it took me a moment to get going, my mornings were gone, and what came out had been getting less for two years.
I was a consultant urologist with a set of results that said there was nothing wrong with me.
Calcium score 287. Blood pressure 134 over 86. Managed the entire time.
Both taken the same morning. Only one of them was ever looked at.
I have treated thousands of men on long-term blood pressure medication in my career. Most of them Type 2.
I have seen what happens at year three. Year five. Year eight. Year eleven.
Let me give you two of them, because between them they are the whole argument.
The 58-year-old Managed
Type 2 since 2011. Metformin, ramipril, atorvastatin. Cuff readings managed at 132 over 84 at every single review. HbA1c 53, then 51, then 53.
His GP was satisfied, and she was right to be — the tablets were doing exactly what they were prescribed to do.
The dry cough had been there for seven years. He had been told to live with it. His PSA crept past 4 in year seven and a urologist added tamsulosin. Within four months he rang the surgery quietly to ask why nothing came out any more.
He was on four prescriptions for four separate problems and not one person had stopped to ask what all four had in common.
Two years after that he had his first cardiac event. His blood pressure on admission was 134 over 86. Managed. His HbA1c that month was 52. Managed.
His arteries had been narrowing the entire time and no number anybody ever took had been looking at them.
The 54-year-old Managed
Diagnosed at 45. On amlodipine for a decade. Cuff reading perfect.
The ankle swelling had been there for seven years and he had been told to put his feet up at night. He noticed the ejaculate going backwards around year seven and said nothing.
His urologist called it a normal part of ageing and wrote him tadalafil for the erections that were already starting to go. So he was now taking a drug to open the very vessels that another drug was being blamed for nothing at all.
Three years later he was sitting in a cardiology clinic with chest discomfort. Blood pressure still managed. Calcium score 287.
The urinary symptoms had been the warning at year five. The vanished ejaculate had been the warning at year seven. The erections had been the warning at year eight.
By the time anyone looked at his arteries directly, his body had been signalling for years, and every single signal had been answered with a different prescription.
What I never said to either of them.
The next thing I would have written for any other man in my position.
I see these men in follow-up. They do not complain. They are grateful their cuff reading looks good and that somebody is managing the prostate.
But I know what they lost.
They had years. Years in which the thing that was actually narrowing could still be reached. Years before the escalation became inevitable rather than merely likely.
Their symptoms had been telling them the entire time.
The prescriptions just turned the volume down, one organ at a time.
And when my own symptoms got bad enough, I sat at my desk and looked at the next step I would have written for any other man in my position, and I could see the whole thing laid out in front of me like a timetable.
- Tamsulosin. Which would have taken what was left of my ejaculate deliberately — a known, common effect that almost no man is warned about before he is handed the box.
- Tadalafil on top of it. A drug to open vessels, stacked on a drug that loosens them, neither of them aimed at the wall.
- And in five or eight years, the conversation about surgery — with the incontinence, the permanent dry finish, and the one-in-five failure rate inside five years that comes with it.
Four prescriptions for four problems. Exactly like the 58-year-old.
I very nearly wrote the first one for myself.
Managing a number is not the same thing as treating an illness. I had said that sentence out loud in teaching sessions for years without ever once applying it to my own prescribing pad.
The 14th of November. Twenty past ten at night.
I read the same three paragraphs four times.
I was reading after a long clinic. Not looking for anything in particular.
I came across the term lipotoxicity in a paper about vascular tissue.
Not a supplement paper. Endocrinology.
I read the same three paragraphs four times.
Then I sat back in the chair in my own kitchen and understood that everything I had been prescribing for fifteen years worked on a signal, a hormone, a receptor, or a number.
Not one thing on any prescription I had ever written went inside the cell and dealt with the reason the cell had stopped working.
And the reason nobody had ever mentioned it to me — not in training, not at a conference, not once in nineteen years — was not that it was fringe, or hidden, or disputed.
It is that it has never been patentable.
Nothing that cannot be patented gets the money behind it that a drug gets. And nothing without that money behind it ends up on a prescribing pad, or in a guideline, or in the ten minutes I had with you.
That is the whole of it. Not a conspiracy. Economics.
What is actually happening inside the wall.
Left, a wall that has not needed repairing. Right, years of repairs.
Start with the artery itself.
Glucose is abrasive at that scale. It is not a soft molecule. Every time the level runs high it scours the inside of the artery wall, and the body does what a body does with a scratch — it patches it. It lays a thin repair over the damage, and cholesterol is what it patches with.
Once. Then again, a bit further along. Then again.
Patch on top of patch on top of patch, for years, in a tube only a few millimetres across. Every patch makes it slightly narrower than it was.
That is what a blockage is. It isn't fat that got stuck to the wall. It's years of repairs.
The arteries that feed your penis are the narrowest in your body. One to two millimetres. The ones that feed your heart are three to four.
Same process, same patches, in tubes of different sizes.
That is the entire reason the bedroom goes first. Not bad luck. Not age. Arithmetic.
And it is why the question you had at two in the morning is the right one. If it's happening there, where else is it happening? It is happening in the same wall, in a wider tube, three to five years behind.
But if your numbers have been good for years, the obvious question is where the sugar is still coming from. It is the right question and almost nobody asks it.
Every cell in your body has a door on the outside that lets glucose in. It is called a GLUT4 transporter, and it is how sugar actually leaves your bloodstream and gets used. Not the pancreas. Not insulin on its own. That door.
Behind the door there is a switch, called AMPK, and its one job is to tell the cell to stop storing fat and start burning it.
Years of blood sugar spikes wear that switch down until it sticks in the off position.
So the cell keeps storing and never processes. It fills with fat it cannot use, and that fat does not sit there quietly. It becomes toxic to the cell holding it. It jams the machinery. It gets in the way of the door.
There is a word for it, and in nineteen years of practice I had never once heard it said out loud in a clinic.
LipotoxicityThe door stops opening. The glucose has nowhere to go. It stays where it is — in the blood, circulating, hour after hour, year after year.
Scouring, and being patched over.
Now look at what you take every morning.
Every one of them moves a number.
Metformin tells your liver to make less new glucose overnight. It reduces how much is arriving. It lowers the flood. It has never once touched the switch. And the stomach trouble you were told to take with food is not something that came along with the drug. It is the drug, working where it works. In your gut and in your liver. That is the whole of its territory, and your arteries are not in it.
Your statin works on the material your body is patching with. It is doing its job. It does nothing about why your body keeps needing to patch.
ACE inhibitors — ramipril, lisinopril — block a hormonal signal that squeezes the vessel from the outside. Less squeezing, the cuff reading drops. The wall itself is in exactly the condition it was in yesterday. The chronic dry cough most men develop on these is bradykinin accumulation in the airway. The same interference is happening everywhere else in your body, in places you cannot feel.
Calcium channel blockers — amlodipine, nifedipine — relax smooth muscle so the vessel cannot grip. The number drops. The ankle swelling most men get on amlodipine is venous smooth muscle relaxation in the lower extremities. The same mechanism reaches every smooth muscle bed in the body.
The one that is supposed to close at the moment of ejaculation.
A drug that relaxes smooth muscle relaxes that ring too.
You can see what it does to your ankles. You cannot see what it is doing there.
Tamsulosin, if a urologist has added it, does this deliberately. A vanished or reduced ejaculate is a known and common effect of it. In nineteen years I have lost count of the men who found out by having it happen to them.
Beta blockers — bisoprolol, atenolol — blunt the nervous signalling that both your bladder neck and your penile arteries depend on.
Every one of them moves a number.
Not one of them touches the switch.
So: the ejaculate you have been quietly living with is not the warning. The fading mornings are the warning. What was happening when you started standing there a second longer was the warning before the warning. And the narrowing still going on in your coronary arteries — which no tablet you take is addressing, because none of them are working on the wall — is the disease.
A study published in European Urology in 2006 put a number on the gap. Erectile dysfunction precedes a first cardiovascular event by an average of three to five years. In men whose cuff reading has been well managed the entire time, the event still arrives — because the cuff reading was never a measurement of the artery.
Your symptoms are not embarrassing, and they are not ageing. They are the earliest reading you have of the smallest vessels you own.
That is not a treatment you are on. It is a volume knob.
Four things have to happen, and they have to happen together.
The door, and what has been sitting on top of it.
Once I understood the mechanism, the requirements wrote themselves.
If the switch is stuck off, something has to flip it back on. If years of trapped fat are sitting over the doorway, something has to clear it. If glucose is still arriving faster than the cell can ever deal with, something has to slow it down. And if that trapped fat has already been damaging the wall from the inside, something has to clean that up.
All four. At the same time.
Flip the switch back on
Wakes the burn switch inside the cell so it stops storing fat it cannot use.
Clear the door
Strips the fat off the doorway so the glucose already circulating finally has somewhere to go.
Slow what is arriving
Cuts how fast sugar arrives with every meal, before any of it reaches the switch at all.
Clean up what is left
Neutralises the damage the trapped fat has been doing inside the artery wall itself.
Miss one and you are back where you started — which I know, because I missed three of them for two months and felt nothing.
Four jobs. Four different parts of one problem. Not four ways of saying the same thing about blood sugar.
So I built it.
Two years of getting the ratios wrong before this was the version I would put in my own mouth.
I am not a formulator. I am a surgeon. But I could not find anything that did all four in doses that matched the papers rather than the shelf, and I was not prepared to start the cascade I had been writing for other men for fifteen years.
So I spent two years on it. Working out which four compounds, at what doses, in what form. Testing it on myself first, then on a small number of men in my own follow-up lists who had run out of road and were being offered surgery they did not want.
It is called Rejuva Labs.
Four compounds. Each one has a job.
Berberine, bitter melon, true Ceylon cinnamon, turmeric. Four different plants, four different jobs.
Everything below is what each of the four is actually for, because I am sick of men being handed a bottle and told it supports wellness.
Berberine — the switch
It reactivates AMPK directly, inside the cell — the thing that has been stuck off. Not upstream in your liver, like your metformin. It does not manage the sugar arriving. It goes at the reason the cell stopped dealing with it.
But the wall cannot act on that yet, and this is where everybody who tries berberine on its own gives up, as I did. Berberine stops new fat collecting. It does not shift the years of it already sitting in there. And while it sits, it is still in the way of the door. The switch is on, and nothing changes.
Bitter Melon — the door
It clears that fat off GLUT4. Off the door itself. Local, and immediate. Not in three months. And it works independently of insulin, which is the part that matters, because it acts on the glucose that is already circulating — the glucose doing the scouring.
Together they do what neither does alone. The door opens, the sugar that has been sitting out in your blood finally gets in and gets used, and the wall stops being scoured every hour of every day.
True Ceylon Cinnamon — the speed
Cinnamomum verum. Not the cassia sold as cinnamon in your kitchen cupboard, which does nothing for this and taxes your liver at a daily dose. It inhibits alpha-glucosidase and slows how fast sugar arrives in the first place. Less pressure on the wall with every meal, before any of it reaches the switch at all.
Turmeric — the clearing up
Its active compound, curcumin, neutralises the free radicals that lipotoxicity has been generating inside the cells of the artery wall itself. Not the sugar in the blood. The tissue. The tissue that has spent a decade being scoured and patched over.
And then the question that cost me two months.
Left, a gut that absorbs. Right, fifteen years of Type 2.
Because none of the above explains why the berberine I bought in a high street chemist did absolutely nothing.
It is not the compound. It is that it never arrived.
Years of high blood sugar damage the lining of your own gut — shorter villi, weaker junctions, the exact surface a capsule or a softgel has to absorb through. So most of what you swallow passes through undigested. An oil-filled softgel is no better; the oil was never the obstacle. The damaged surface is.
A man with fifteen years of Type 2 has, by definition, the least absorbent gut of anyone being sold a capsule — and capsules are what he is sold.
So it is liquid. It goes straight into your bloodstream, without ever needing to pass through your gut.
I started on the 15th of November.
The first week, I thought I had wasted two years.
Days one to six, nothing.
I will be honest about this, because I think it matters more than the good part.
Nothing happened. Days one to six, nothing. And I had the particular humiliation of being a consultant urologist standing in his own bathroom at seven in the morning, taking notes, with nothing to note.
By day five I had started constructing the explanation I would give myself for why it had not worked.
Then:
Morning erections back.
Not every day. But present, for the first time in over a year.
I did not tell my wife. I wanted three more days of it before I said anything to anyone, including myself.
Slept through without getting up.
First time in two years.
Mornings every day. Full stream returning.
My wife asked what I had changed.
"Different approach," I said.
"Whatever it is, keep going."
The part I could not argue with.
Repeat bloods. Blood pressure down from 144 over 88 to 126 over 78, on the same dose. HbA1c 49 to 43.
My GP reduced one of the pressure tablets. My metformin stayed exactly where it was, and I want to be very clear about that. I did not stop a single thing on my own.
Then I went to a colleague I trained with for a flow study, because I wanted a number that had not come out of my own head.
He looked at the trace. Looked at his notes from six months earlier.
"David, what did you do?"
I told him. The switch. The fat. The door. Why the small vessels go first, and why nothing either of us prescribes has ever been aimed at the wall.
He was quiet for a while.
"I have hundreds of Type 2 men on amlodipine that I've also written tamsulosin for. If what you're describing holds up—"
"The mechanism is real. It just isn't on a prescribing pad."
He started recommending it to his diabetic patients.
I am not the only one this has happened to.
These came in through my colleague's list and my own follow-ups. I have their permission.
Type 2 fifteen years, ramipril for nine of them. What finished me off was that nobody ever told me the tablets might do that. It just stopped one month and I assumed that was me finished. I never said a word to my GP about it — you don't, do you, not in ten minutes about your bloods. Eight weeks on this and it's back. Not what it was at 40. But back. And my HbA1c came down nine points at my review and I changed nothing else.
I'd been told twice it was just my age. Twice. By two different people. I'm 55 so what am I supposed to say to that. My wife found this and I told her it was very likely a scam, which it is my job to say. First fortnight, nothing at all, and I said I told you so. Week three I stopped having to stand there waiting for it to start. Week six my consultant asked me what I'd changed and wrote it down.
On amlodipine ten years and my cuff reading was always the thing everyone was pleased about. Meanwhile I'm getting up three times, it dribbles out, and nothing comes at the end. I mentioned the last one once and got told it happens. That was the whole answer. It happens. Four months on this and I get up once, sometimes not at all, and the morning glory is back, which I hadn't had in about four years and had stopped expecting.
Six years on tamsulosin. Six years of nothing coming out and I never once brought it up, with anyone, including my wife, and I'm not proud of that. It got at me a great deal more than I let on. I didn't feel like a man and that's the truth of it. Worked with my GP to come off the tamsulosin slowly while I started this. Rough patch in the middle. But it works again. First time in six years.
What this costs, next to what it has already cost you.
I paid full price for my own first three months and I would have paid five times that.
But I know most men reading this are not in that position, and the men who need this most are usually the ones who have already spent everything they had on things that did not work. Men who have been at this a decade. Men on a fixed pension with four prescriptions a month and a repeat form they no longer read.
So when this went out beyond my own follow-up lists, I asked for one thing: make it reachable for the men who actually need it.
That is less per day than a coffee. Less than the petrol I burned driving to a conference where nobody said the word lipotoxicity out loud.
You want a minimum of 30 days for anything to clear, and I would say 60 to 90 before you judge it.
The guarantee nobody in my profession has ever offered you.
I have written thousands of prescriptions. Not one of them came with a promise.
If tamsulosin takes your ejaculate and does not fix your flow, nobody refunds you. If ten years of a calcium channel blocker manages your cuff reading while your calcium score climbs to 287, nobody refunds you. Nobody who wrote you a prescription has ever had a single thing riding on whether it worked.
90-day money-back guarantee
Use it for three months. Track your cuff reading. Track your HbA1c at your next review. Track your mornings. If the trend lines do not move — send the bottles back, even empty. Full refund. Email the order number, that is the whole process.
That is how confident I am, and after two years of building it and eight weeks of taking it, I think I have earned the right to be.
You may not be able to order next week.
Two pallets left in the whole aisle. That is the Ceylon cinnamon.
I need to warn you about this because it has already happened twice.
We ran out for nearly three weeks earlier this year. It is the true Ceylon cinnamon — Cinnamomum verum only grows in one part of the world, the harvest is small, and I refuse to substitute the cassia that everybody else uses because it does not do this job and it is hard on the liver at a daily dose.
I would rather be out of stock than ship the wrong cinnamon.
But I do not want you coming back in a fortnight, finally ready, and finding that message.
Your arteries are not going to wait while a container sits in a dock. Every day at those levels is another day of scouring. Another patch on top of a patch. One step closer to where the 58-year-old was.
I am not against blood pressure medication.
Keep taking every one of them. That is not what this is about.
I want to be extremely clear, because this is the part that matters most and it is the part that gets misread.
These drugs save lives. They prevent catastrophic stroke and hypertensive emergency. If your GP has prescribed one, please do not stop it without that conversation.
Do not stop your metformin either. I did not stop mine. My GP took one tablet away, eight weeks in, on the basis of a repeat blood test — that is the correct way round, and it is the only way round.
But they do not repair the wall. They move a number while the process that narrows the vessel carries on underneath it — expressed first in the smallest arteries you have, which are the ones in the bedroom, and last in the ones that matter most.
Your symptoms are not failing you.
They are warning you.
Two paths.
I have watched men take both. I have sat in the follow-up appointment at the end of both.
Path 1 — Manage it
Add tamsulosin for the flow. Add tadalafil for the erections. Add a second pressure tablet when the first one plateaus. Turn the volume down on each organ as it starts to complain, and keep the cuff reading somewhere everyone is happy with.
The 58-year-old took this path and every one of his numbers was fine on the morning of his cardiac event.
Path 2 — Go at the wall
Four jobs at once: the switch, the door, the speed, the clean-up. Stay on every tablet you are on while you do it.
Give it 60 to 90 days and let your own repeat bloods tell you whether anything moved.
And when you are deciding, ask yourself the question you already asked at two in the morning: if it's happening there, where else is it happening?
One last thing.
I think about what I nearly did.
I nearly wrote myself tamsulosin on top of everything else. I nearly accepted a dry orgasm as the cost of a well-managed cuff reading, while my mornings kept fading and it kept taking longer to start.
I would have joined my own 58-year-old. Four prescriptions for four separate problems, and nobody — including me, including the man who knew exactly what all four had in common — stopping to ask the question.
Eight weeks.
That is how long it took for my pressure to come down further, my HbA1c to drop six points, my mornings to come back, and my flow to return to where it had been at 45 — while staying on every tablet I was already taking, until my own GP took one of them away.
You are not too late. Your tablets are doing what they were designed to do for your numbers. Not one of them has ever been inside the cell.
Every day you leave it is another day of scouring. Another patch on top of a patch. One step closer to where he was.
Please deal with the switch now, while the vessels that are still open are still open.
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Frequently Asked Questions
Answered by David Miller, FRCS (Urol)
Week 2: getting up less.
Week 3: mornings started coming back.
Week 8: HbA1c down 7 points at my review.
Give it time.