Hi friends,  Does anyone have advice or information on what causes the inability to "finalize" an encounter?
The issue: Is there help for a man who is able orgasm at times. However, he has great difficulty  having an orgasm when he does? Tried the usual suspects including T gel

some help. Could involve some tests and/or meds.

If you watch alot of porn and masterbate to it, you can easily get delayed ejaculation. If that is the case, Google your brain on porn by gary wilson, the cure is quite easy.

I agree withb cj2nels. If you masturbate in a particular way all the time, then that may be the way you always cum. If you take your 'routine' with you to see the provider, then you can enjoy her and an O. No biggie.  

My issues with it are a more complex medical issue. I recently was talking to my doctor and he did lay it out for me. First one is that I have a TBI and then there is my problem of getting another head injury.  The second is my meds…especially seizure meds

...blood pressure and/or anti-anxiety meds can also cause ejaculation problems.  You should ask your doctor to try different meds which can control BP, anxiety and seizures without the side effect.  But doctors only care about effectively treating the medical problem.  They don't give a shit about quality of life issues - they don't want to get sued if they change your seizure medicine and you die just because you want to get your rocks off.

Thanks for all the advice.  Will try as advised.  One thing, porn? Me?

Gentlemen and Ladies, Again, I thank you all for all the suggestions. I have received some of the best advice and knowledge from hanging around here for sometime now. I will now try and return the favors.  Here is how.  
I am going to attempt an experiment.  
Objective:  To seek out, engage , and destroy the enemy (Porn induced Erectile Dysfunction hereinafter referred to as PIED) I'll have a little fun while doing so.
1.  I will check medications with MD as recommended.  They could be the culprits or they may work in combination with Lack of Porn (hereinafter referred to as LOP).  Further, it is the safest approach as medication may be required for some time.  I believe that can be done away with also in most cases.  I have good reason to believe that and will put it up in a later discussion should anyone care  
2.  I Went to "Your Brain on Porn"  as advised above.  (Damn. Another something to get addicted to. Looks I have to beat this one too). Received an overview.
As an experiment, starting with abstention from porn for 30 days will occur, hopefully. (hereinafter AFP 30) , unless I decide not to. I'll submit report re effect of LOP on ED. (Unless I go MIA, by the CIA ,or NSA) So
My fellow Americans, Let's roll.

Recently, I was having issues with ejack and the lady did ask me “do you have problems when you use porn?” For me it does not matter, it’s more about when “everything comes together”. Something else that was interesting with the same escort. I had what is called (I believe) is dry orgasm. The orgasm was so frickin intense (probably the top 2), but I did not ejaculate…but I will never forget that time. I was actually yelling into a pillow to keep the noise down.

Thanks for the advice, so I got 1 regular doctor and 3 specialists and so meds from all four of them. You are right about the neurologist and seizure meds/lawsuit, all she cares about is stopping the seizures not my sexual health. Other doctors send her letters to change my meds…but she does not want to.

If you use Viagra you can have trouble ejaculating.   You'll have a nice boner, though.

Viagra, Levitra, Cialis take longer to work for me than they did 14 or 15 years ago-now at the age of 71-I find that if I take the prescribed dosage ( I have experimented with an extra amount-but get the "Blue Haze" in my vision that is warned about).

Agreed!

My baseline prep now is tadalafil 20mg taken 24-30 hours before a session.   Works pretty well all around.  

I believe that the right chemistry will set of fireworks in any man. From my experience with a mature client V is not the way to go, it will become a problem sooner or later (From what I've heard) I have experienced using cock rings and I must say, with the right provider and a bit of patience this might be your favorite option. You can get one online if you aren't comfortable going to the store or ask your provider if she may pick it up for you.

Recently I went on FLOMAX - for those "mature male urinary symptoms."  I also had a cystoscopy recently as well.  Good news from that is - no cancer, I'm perfectly healthy.  Bad news - and what is I suspect a combination of the Flomax and the invasive procedure I just had . . . I've got "retrograde ejaculation."  If you don't know what that is, it's a nasty little condition where, when you cum, instead of exiting the body in the usual manner - your semen goes into your bladder!  Apparently there's this little valve in your bladder that constricts when you ejaculate, so the semen doesn't take a detour into your bladder but instead shoots out your penis.  Only when you have retrograde ejaculation, the valve doesn't close, and your semen take the path of least resistance, mixing with your urine.  You then pee cloudy piss the next time you go.  I don't know why there's a valve there in your bladder in the first place!  If there was no valve, you'd have to ejaculate in the preferred manner.  Seems like a "design flaw" to me.  Anyway, it's not that I don't experience the sensation of an orgasm, I do.  But I must say it's a big 'anti-climactic" when only one or two drops come out while the majority of my ejactulate is in my bladder.  Still feels good, but it's a little weird and I'm a bit self-conscious about it.  To say nothing of the fact that it makes "certain types of finishes" obsolete.  Anyone else experience this?  Any providers have any magic tricks to cure it?  My doc says there's really nothing I can do except to stop taking the flomax.

Wait, what?  Why the valve -- you explained it -- it's a backflow prevention valve.  If it wasn't there all semen would shoot back into the bladder.

so Hank....it seems the Flomax is the reason for the retro-grade ejaculation. It's one of the side effects.  
Take some time off and see if you notice any differences. But this sounds like nature taking its course.  
My ejaculate just sort of dribbles out. If I haven't cum in awhile, a lot dribbles out.  
I miss the old days when I'd ejaculate for 30 seconds or more. Now, more like 10 seconds....depending on the time between ejaculations. If I'm with a particularly experienced and skillful lady, that 10 seconds can be very intense.
I love when that happens! I think, for what time we have left to enjoy sex Hank, you should fuggedaboutit.
Lick their bodies, hold them close, bring them to the big 'O', and enjoy all the delights the female form offers.
And then, just relax and whatever happens, happens. Let them stimulate you to the heights
of your capabilities. No, we're not going to shoot streams
of cum half way across the room like we used to. But we sure do enjoy the opportunity
to fully appreciate our beautiful and willing lovers. Monger on....my friend.

I have experienced the exact same issue, previously with Flomax, and now with Rapaflo.  My solution - which admittedly may  not work for you-  involves a little planning.  I try to schedule at least 3-5 days out.   I will not take the meds for 3-4 days prior to the appointment.  The symptoms will intensify a bit while off the meds, but I am able to have a very satisfying orgasm (sadly, only one...).  The volume isn't what it was 30,yrs ago, but it is enough for us both to feel pretty damn good.

My urologist says to skip meds on race day especially Flomax and BP meds. Trying this next time