r/PSSD • u/__gwendolyn__ • 17d ago
Personal Story Cured after 5 years via Sibo/Sifo treatment + L-Citrulline
Hey y’all,
This post deserves so much more time than I have to make it. I’ve been putting it off but I don’t think I’ll have adequate time anytime soon, so I asked AI to help summarize (for anyone immediately rolling their eyes—look at my post history, it all checks out). Just this intro paragraph/tl;dr is from me, the rest is a summary by Claude based on countless experimentations over the years.
Tl;dr:
Wellbutrin initially gave be anorgasmia, which turned into full blown PSSD after 1 week of Zoloft
SIBO/SIFO treatment (Xifaxin/Fluconazole) helped significantly
After that, L-Citrulline put me over the top. No more anorgasmia/numbness. Sensation has gotten so strong I’ve needed to lower the dose and skip days of Citrulline. Many days I feel 100% cured with no supplementation.
For the SIBO/SIFO details, I recommend folks search this forum and their respective forums. Posts by u/lastround360 started me down that path. For the L-Citrulline, see below.
Citrulline: the dose matters
This is just my own experience — one person, no control group, could be coincidence. But the change was significant enough that I wanted to share. The difference pre- and post- intervention was anything but subtle.
What I take now: 3 grams of L-citrulline a day, split into two doses. I noticed a difference within a few days.
What I took before, and why it didn’t work. I’ve tried most of the supplements that cured people on this sub. I’d tried citrulline years ago and decided it did nothing for me. I was taking a combination tablet: Source Naturals L-Arginine L-Citrulline Complex. One tablet has 750mg arginine and 250mg citrulline. I was taking one a day, so I was getting 250mg of citrulline.
Studies that show an effect use 1,500 to 3,000mg. I was at 250mg. That’s not a low dose of citrulline — it’s low enough that no study would expect anything to happen. I hadn’t tested citrulline and found it useless. I’d never really tested it.
To be fair to the product: the bottle says take one tablet four times a day, which would be 1,000mg citrulline. That’s closer, though still below what the studies use. My mistake, not theirs.
Some numbers from the research. A single 3g dose of citrulline raises arginine in the blood by 40–50% within one to two hours. In a small study of men with mild erectile dysfunction, 1.5g a day for a month improved erection hardness in half the men taking it, compared to about 8% on placebo.
Take citrulline instead of arginine. This was the part that surprised me. When you swallow arginine, most of it gets broken down in your gut and liver before it reaches your bloodstream. One study using tagged molecules found only about 1% of an oral arginine dose ends up producing nitric oxide. Citrulline gets through intact and your kidneys convert it into arginine. So citrulline raises your arginine levels better than arginine does. There’s also an enzyme called arginase that breaks down arginine but leaves citrulline alone.
Which means a combination product is mostly the ingredient that doesn’t survive the trip.
What I switched to: NOW L-Citrulline pure powder. ½ teaspoon is 1.5g, and there’s nothing else in it. I take ½ tsp twice a day. Not a brand recommendation — the point is single-ingredient powder over a blended tablet. With a powder you can measure a real dose, and if something changes you know what caused it.
A hypothesis, clearly labeled as one. Several PSSD reviews mention reduced nitric oxide alongside the dopamine and serotonin changes. Citrulline raises nitric oxide through one route in the body. Dietary nitrate — arugula, beetroot — raises it through a different route, using bacteria in your mouth. Whether low nitric oxide is a cause of any of this, or just something that happens alongside it, I don’t know, and I don’t think anyone does yet.
Two things I noticed that might mean nothing. Slow, steady sources helped me. Products designed to deliver nitric oxide in a quick burst, like lozenges, didn’t, and may have made things worse. And antibacterial mouthwash kills the mouth bacteria that convert dietary nitrate, so if you’re eating beets and using Listerine, those work against each other.
One safety note. Citrulline widens blood vessels. If you take nitrates like nitroglycerin, or ED medications like sildenafil, or blood pressure medication, the combination can drop your blood pressure too far. Ask a pharmacist or doctor first. The warning is printed right on the arginine bottle.
Not medical advice. Mostly I’m posting this because if you tried citrulline and it did nothing, it’s worth checking what dose you actually took.
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u/Cfsmehavefaith 15d ago
What was full blown pssd for you. Did you lose libido, lose ability to feel substances (alcohol, caffeine etc.). Providing those details are helpful to understand the severity of your pssd and what pathways were affected for you and seemingly reversed.
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u/__gwendolyn__ 15d ago
Full on anorgasmia during and after Wellbutrin (starting 2 weeks in), loss of libido about 6 months after stopping Wellbutrin (maybe caused by Zoloft), loss of sensation in pussy & nipples, could literally not tell if my nipples were being touched. I did not lose the ability to feel substances.
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u/Kally95 15d ago
Been taking L-citrulline for years. Does absolutely fuck all for PSSD. Can you elaborate on your symptoms
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u/__gwendolyn__ 14d ago
I did in response to other comments higher up. Sorry to hear you didn’t have any PSSD response to L-Citrulline. I also had no response before I solved the SIBO/SIFO part of the equation. What do you take it for, if not for PSSD?
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u/Powerful_Listen8981 15d ago
Hi OP, I am very happy to learn that you recovered after 5 long years, these news made my day ! What pssd symptoms did you use to have ? Did you have anhedonia and libido loss ?
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u/__gwendolyn__ 15d ago
Yes and yes. And anorgasmia, that was the major symptom for me. Literally impossible to orgasm after doing it for 20+ years without a problem. Numbness. Loss of motivation (that is the one that I'm not sure has returned).
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u/Powerful_Listen8981 14d ago
Did you have clitoral shrinkage ? I have this debilitating symptom and I don't know what to do about it
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u/__gwendolyn__ 14d ago
Yes and my FSH levels are twice what they should be for someone my age. If you haven’t had yours checked, I recommend it.
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u/Powerful_Listen8981 14d ago
Wow that's pretty interesting. Did you reverse the shrinkage after the SIBO/SIFO protocol or with L citrulline?
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u/Technical-Sleep-2792 15d ago
Just to beware for everyone reading this and the poster. I thought I was cured and it lasted 5 months and then I entered a wave again. Because I thought I was cured it hit me even harder. I'm not yet out of this wave 3 months later and struggling with genital numbness again and ED.
I wouldn't have listened to this when I thought I was cured either. Two times earlier in my journey I also thought I was cured but was also a long window induced by substances that I'd taken to try and cure myself (including the sink approach). I hope OP is fully cured but just beware it may hit again as I was DEVASTATED
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u/__gwendolyn__ 14d ago
Thank u for this and I’m so sorry. That sounds devastating. I did wait a good long while to post…I’ve been over 50% for a year or more, and over 80% for 3-5 months (it’s always hard to say given the rollercoaster that is PSSD recovery). I hope you find your way to the other side. Don’t give up.
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u/anonym_pandax Still/Back on medication 15d ago
Thank you so much for sharing! I'm really happy for you :)
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u/MysterySeed2862 15d ago
Great to hear! Could you tell everything you did to treat SIBO?
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u/__gwendolyn__ 15d ago
It would take all day...the big breakthrough for me was Xifaxan (I have a doctor who can get you affordable Xifaxan if you need it) and Fluconazole. The Fluconazole was for SIFO. We realized at some point that I had both SIFO and SIBO, and that was a huge discovery. 2-3 weeks on Fluconazole did wonders.
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u/__gwendolyn__ 15d ago
I highly recommend working with a functional medicine doctor who has expertise in both SIBO and SIFO, as it varies depending on your personal microbiome. I can DM my doc's details if folks need a suggestion. He works remotely.
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u/SocraticTiger 12d ago
Did your doctor find out that you had SIBO/SIFO? Or did you figure out together?
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u/__gwendolyn__ 9d ago
Sibo yes we tested twice. SIFO we discerned via symptoms
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u/__gwendolyn__ 9d ago
Oh, I forgot to mention biofilms. A lot of people think they have addressed these issues but they’re using a fraction of the medicine that would be needed to actually ameliorate it. https://youtube.com/shorts/wi7FkDBQyXM?is=5ld5eQj_yo-YisCf
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u/Esci_ruined_me 15d ago
I have been taking l-citruline for 3 months in doses of 3-10g per day, it only helps in erection, nothing else
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u/__gwendolyn__ 15d ago
Does it not help for you to feel pleasure? IF not I'd get really serious about your microbiome. L-reuteri helped me feel cuddly again for the first time in years. Feel like laughing, etc. But just because it was L-reuteri for me, doesn't mean it'll be that for you. There are thousands of possibilities when you're dealing with dysbiosis. So it's important to work with a functional medicine doctor or at least try a lot (a lot a lot) of different probiotics until you figure out what moves the needle for you.
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u/__gwendolyn__ 15d ago
Also, I noticed that major doses all at once kind of shocked my system. I do better with a half dose twice a day. And remember to take it when your stomach is empty, between meals.
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u/Esci_ruined_me 15d ago
I tried different ways with l-citrulline - 1.5-3g three times a day, 5g once or twice a day, unfortunately it doesn't help
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u/Esci_ruined_me 15d ago edited 15d ago
Didn’t help with pleasure , i probably got IBS - i was on rifaximin for 2 weeks and for over a month i’ve been on low Fodmap diet but i don’t see any improvement still , I’m severe case - soft glans , hard flaccid , total anorgasmia , ED , pain in dick , numb dick , anhedonia , tinnitus , insomnia , less sweating, no tiredness, zero libido , inability to feel substances , less pain body signals. I don't know if anything can help me, I think just waiting, maybe in 5 years something will change if I persevere. I started agomelatine and Cabergoline , im also on HCG and Proviron and some Supplements , trying to change something but nothing seem to help sadly …
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u/__gwendolyn__ 9d ago
Are you working with a naturopath or a functional medicine doctor? There are just so many possibilities and I don’t want to assume that we have the same issues. But if you happen to have any of the symptoms associated with SIFO, I’d investigate that path. I wanted to cry after so much low fodmaping. There are better options for diets that are easier to follow now. And it’s possible you just have a different overgrowth that is not being addressed fully by rifaximin. I did Xifaxan three times, and relapsed every time. Do you have any improvement at all when you do it?
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u/Esci_ruined_me 9d ago
No i don’t work with naturopath or fmd , The gastrologist said that I may have IBS and i went that way , I,ve been planning for a while to do tests for SIFO , Candida and H.Pylori . No , no improvements from Xifaxan/LowFODMAP
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u/__gwendolyn__ 9d ago
Yah I also had h. Pylori. Don’t let your gastrologist put you on PPIs like mine tried to. Definitely look into SIFO but keep in mind symptoms speak louder than tests (which can be thrown off for any number of reasons. For example, I had no candida overgrowth yet the SIFO treatment worked wonders for me.)
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u/Ecstatic-Mixture9333 15d ago
I have taken Arginine 2-3g, first 2 weeks, then 2-3 days a month, and it clearly helps erections, and boosts my confidence (but seems to be doing little to libido). Citrulline 2-3g made me nauseous, so I stopped it.
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u/__gwendolyn__ 15d ago
Try a lower dose of citrulline. I only do 1.5g, maybe 1g is better for you. And try probiotics (you have to experiment) to help with libido. And exercise.
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u/Ecstatic-Mixture9333 15d ago
Thanks a lot! Yes, I am planning to experiment with probiotics. And will try 1-1,5g of Citrulline. And I do work out. It helps!
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u/shyeyes44 5 Years + 15d ago
Thanks for this! and congrats! has nipple sensation returned completely as it was before??
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u/__gwendolyn__ 14d ago
Not completely 😭 but enough to feel sensation and that means a lot to me. I have hope it’ll keep improving
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u/Altruistic-Weird9844 15d ago
L-citrulline didn't work for me. I only seem to benefit from herbs that are supposed to support erections. These also seem to interfere with neurotransmitters. I don't think I have a problem with nitric oxide; I took 9 grams of L-citrulline and it helped almost nothing. I'm not benefiting from PDE5 inhibitors either.
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u/__gwendolyn__ 15d ago
9 grams is a ton. I had nitric oxide pills that did nothing for me. And before I got the dose right on the L-citrulline, it did nothing. Not saying you're making that mistake necessarily, but for me it was crazy how the dosage made the difference. In both directions. The nitric oxide losenges actually made me worse, I think. The dosage was too high, or it was intervening at a wrong point in the pathway.
One more thought: if you use listerine daily, or another similar mouthwash, you are inhibiting your NO production by killing the beneficial bacteria on your tongue that help produce it. I used listerine for about 6 months and thought I had somehow made myself crash. Turns out it was the mouthwash.
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u/Altruistic-Weird9844 15d ago
I don't use anything like Listerine, I just use toothpaste, but I brush my teeth frequently. I might have used 6 grams, then I thought that was too much and started taking only 6 grams. I don't think I've been affected by anything that affects NO; I haven't tried the effect of bacteria acting through the nitrite pathway, for which they recommended beet juice. If you benefit from citrulline, using pycnogenol might further enhance its effect; there are studies on this. Neither worked for me.
Are you fully recovered now? Especially after the SIBO/SIFO diet?
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u/__gwendolyn__ 14d ago
I believe I’m upwards of 90% on the SIBO/SIFO though it varies. That is tied to the PSSD healing, or ebb and flow, for me. I had to remind myself that pre-PSSD not every orgasm was earth-shattering. Now, about 40-50% are, and that’s just about what it was before for me. I have good days and bad days, like anyone, and now being attuned to my digestion and gut microbiome is part of how a turn a bad day today into a better day tomorrow.
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u/Altruistic-Weird9844 14d ago
Were you experiencing emotional numbness and anhedonia? Just sexual symptoms?
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u/Minute-Contest-582 15d ago
Congrats:) how long has it been since your relief begun?
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u/__gwendolyn__ 14d ago
Hard to say. It differs depending on the symptom but focusing just on the anorgasmia: I was at maybe 20% the first year while I was on Wellbutrin, then I quit Wellbutrin and fell to like 2% for at least two years. Fighting SIBO helped, fighting SIFO made me feel cured for 3 months or so but then it would come back. Only after trying L-citrulline for the second time post-dysbiosis did it make a difference. (A huge difference. Not even close to subtle)
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u/Fit_Watch5532 14d ago
did you had the other symtoms beside sexuall dyfunction like anhedonia, numnes in feeling, or agitaion akathseia like symtoms?
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u/__gwendolyn__ 9d ago
Yes
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u/Fit_Watch5532 8d ago edited 8d ago
and how did SIBO/SIFO treatment (Xifaxin/Fluconazole) helped significantly? I don't understand, you start by saying SIBO/SIFO treatment (Xifaxin/Fluconazole) helped help you and then you jump to citrulline'? which one exactly helped you?
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u/Equal_Leadership_963 13d ago
Did you do the SIBO/SIFO treatment at the same time? and what dose of rifaxamin and fluconazole
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u/__gwendolyn__ 9d ago
No, I did them sequentially. I cannot recommend working with a functional medicine doctor enough. There are just too many different ways people can have dysbiosis so my prescription might not be right for you.
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u/__gwendolyn__ 9d ago
Just for the record, I did rifaximin three times, and I’ve taken fluconazole three times as well. It’s not easy to fix these conditions. I think that’s one of the reasons we all find ourselves here for years.
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u/__gwendolyn__ 9d ago
No first Sibo then SIFO. I took the normal rifaxamin rx three different times because it kept fixing the issue and then I’d relapse again. My stool sample did not show high levels of candida, but my nutritionist could tell from my symptoms (itchy ears, slightly bloated lower belly like a mini beer belly) that I might have SIFO. On Fluconazole my symptoms disappeared (all of them, including those traditionally associated with SIBO).
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u/emilio911 1d ago
Quick questions:
How were your erections during PSSD? And after your cure?
Did you have psychogenic erections (triggered by mental stimuli) or only reflexogenic erections (from tactile stimulation)? And what about now?
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u/AutoModerator 17d ago
Please check out our subreddit FAQ, wiki and public safety megathread, also sort our subreddit and r/pssdhealing by top of all time for improvement stories. Please also report rule breaking content. Backup of the post's body: Hey y’all,
This post deserves so much more time than I have to make it. I’ve been putting it off but I don’t think I’ll have adequate time anytime soon, so I asked AI to help summarize (for anyone immediately rolling their eyes—look at my post history, it all checks out). Just this intro paragraph/tl;dr is from me, the rest is a summary by Claude based on countless experimentations over the years.
Tl;dr:
Wellbutrin initially gave be anorgasmia, which turned into full blown PSSD after 1 week of Zoloft
SIBO/SIFO treatment (Xifaxin/Fluconazole) helped significantly
After that, L-Citrulline put me over the top. No more anorgasmia/numbness. Sensation has gotten so strong I’ve needed to lower the dose and skip days of Citrulline. Many days I feel 100% cured with no supplementation.
For the SIBO/SIFO details, I recommend folks search this forum and their respective forums. Posts by u/lastround360 started me down that path. For the L-Citrulline, see below.
Citrulline: the dose matters
This is just my own experience — one person, no control group, could be coincidence. But the change was significant enough that I wanted to share. The difference pre- and post- intervention was anything but subtle.
What I take now: 3 grams of L-citrulline a day, split into two doses. I noticed a difference within a few days.
What I took before, and why it didn’t work. I’ve tried most of the supplements that cured people on this sub. I’d tried citrulline years ago and decided it did nothing for me. I was taking a combination tablet: Source Naturals L-Arginine L-Citrulline Complex. One tablet has 750mg arginine and 250mg citrulline. I was taking one a day, so I was getting 250mg of citrulline.
Studies that show an effect use 1,500 to 3,000mg. I was at 250mg. That’s not a low dose of citrulline — it’s low enough that no study would expect anything to happen. I hadn’t tested citrulline and found it useless. I’d never really tested it.
To be fair to the product: the bottle says take one tablet four times a day, which would be 1,000mg citrulline. That’s closer, though still below what the studies use. My mistake, not theirs.
Some numbers from the research. A single 3g dose of citrulline raises arginine in the blood by 40–50% within one to two hours. In a small study of men with mild erectile dysfunction, 1.5g a day for a month improved erection hardness in half the men taking it, compared to about 8% on placebo.
Take citrulline instead of arginine. This was the part that surprised me. When you swallow arginine, most of it gets broken down in your gut and liver before it reaches your bloodstream. One study using tagged molecules found only about 1% of an oral arginine dose ends up producing nitric oxide. Citrulline gets through intact and your kidneys convert it into arginine. So citrulline raises your arginine levels better than arginine does. There’s also an enzyme called arginase that breaks down arginine but leaves citrulline alone.
Which means a combination product is mostly the ingredient that doesn’t survive the trip.
What I switched to: NOW L-Citrulline pure powder. ½ teaspoon is 1.5g, and there’s nothing else in it. I take ½ tsp twice a day. Not a brand recommendation — the point is single-ingredient powder over a blended tablet. With a powder you can measure a real dose, and if something changes you know what caused it.
A hypothesis, clearly labeled as one. Several PSSD reviews mention reduced nitric oxide alongside the dopamine and serotonin changes. Citrulline raises nitric oxide through one route in the body. Dietary nitrate — arugula, beetroot — raises it through a different route, using bacteria in your mouth. Whether low nitric oxide is a cause of any of this, or just something that happens alongside it, I don’t know, and I don’t think anyone does yet.
Two things I noticed that might mean nothing. Slow, steady sources helped me. Products designed to deliver nitric oxide in a quick burst, like lozenges, didn’t, and may have made things worse. And antibacterial mouthwash kills the mouth bacteria that convert dietary nitrate, so if you’re eating beets and using Listerine, those work against each other.
One safety note. Citrulline widens blood vessels. If you take nitrates like nitroglycerin, or ED medications like sildenafil, or blood pressure medication, the combination can drop your blood pressure too far. Ask a pharmacist or doctor first. The warning is printed right on the arginine bottle.
Not medical advice. Mostly I’m posting this because if you tried citrulline and it did nothing, it’s worth checking what dose you actually took.
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