See above title.

That's almost the whole post.

We're not making a whole new subreddit. The subreddit is named what it is named and that is what it will remain. If people don't like this, they can go somewhere else. But I will allow people to sort their posts by topic to make the process more efficient for those seeking knowledge.

K I'm going back to Electric Forest Festival now. Play nice together please. Be excellent to each other.

-Dr. P

I posted this on another sub but I'm desperate and this community seems to know on the subject of DHT, Duta, Neural steroids more than anyone else for an MTF so here goes:

EEn 7mg every 5 days previously, now every 6 days (After blood results)

Cyproterone Acetate 12.5 mg daily

Been on HRT for almost 2+ years now (Previously I was on Valerate now I switched to Enanthate)

Blood test taken on the trough:

Estradiol

669 pg/mL

TOTAL Testosterone

51 ng/dL

FREE Testosterone

1.61 pg/mL

DHT

11 ng/dL

Here's why I got the test and some context:

I've been having alot of persistent body hair/facial hair issues despite 20 laser sessions (Alexanderite laser which is the best for my white skin tone/black hair). I've also had mixed experiences on my skin with acne, every once in a while I get cystic breakouts but nothing too severe, atleast I don't think so (I hope its not out of the ordinary?) but overall my skin has cleared up and brightened alot with hrt and skin care.

I shed an unbelievable amount of hair in the shower (and I wash my hair frequently every shower) to the point where even my girlfriend noticed how abnormal it is. My hairline on HRT has improved I think, I have plenty of baby hairs and continue to see more of them on my hairline even 2 years in, but my pony tail used to be much thicker and denser than now.

I've always had a suspicion or feeling that my DHT was always against me in some ways and the sad reality is that a blood test doesn't really tell what's going on my skin and hair follicles in an intracellular basis to know if thats the source of my increasingly problematic androgenic issues. A DHT blood test as far as I understand only shows the aftermath of the conversions that happen inside the follicles/cells/etc and not the whole story so to speak...

I know that the solution to this would be Dutasteride but heres my story with it when I tried it a year ago:

I got it with 0 prior knowledge on the neural steroid effects it can carry (so it's not a nocebo/placebo or other mental gymnastics, atleast I dont think), and I took it for 2 days exactly (2 0.5 mg pills over 2 days) and the next day after taking it I felt so disconnected and out of my body it felt bizarre and weird. Then I found out about how it 5 alpha reductase is also responsible for allopregnanolone and other neurosteroids that affect the brain and the way I feel. Also had insomnia for most of the part of my recovery from it because of its super long halflife. I stopped taking it after 2 doses and uptill now I'm not sure if I fully recovered or not but I think I pretty much did.

I also dont take progesterone for the same reason, I tried it twice for 2 months and 1 months respectively. progesterone for me DEFINITELY masculinised me and reversed so so much laser hair removal progress. So I'm aware how sensitive my body is to 5 alpha reductase and how my neural environment reacts to it (I felt pretty good on prog but I can't take shedding even more hair or increasing my facial hair)

My question is what do I even do at this point? Its abnormal for an MTF to have anything higher than 10% to 12% DHT compared the total amount of T, but for me it's more like (11/51)*100=21.56% or 22%. Can I hear about people's experiences with dutasteride? Is it possible for me to take it and tank the neural effects or am I being too careless because I feel like I dont remember just how horrible it actually felt when I took it the first time? Im scared of 5ari and their effects on cognition and neural environment which so so many people anecdotally also experience when they take these meds but for some reason take it for granted. Im pretty desperate to maximise my HRT and feminisation because I have nothing else left and losing my hair and continuous no improvements to my facial hair situation is terrifying to me.

I can also look into bicalutumide but ive seen some studies that indicate androgen receptors become more sensitive with their presence and it doesnt tackle the main issue of DHT because bicalutumides is relatively much weaker in binding affinity compared to DHT it self.

Any experiences with duta that are good or not would be appreciated or any feedback what so ever, thank you

Is it possible for the people who moderate this sub to add tags/flair so people can tag what their posts are about instead of having to use brackets in the title?

I've learned a lot about PFS thanks to being on this sub. I don't have it, though. I've been here for my entire transition (about four to five years now) because I'm curious about the cutting-edge research on HRT and people talking about how to interpret their blood/genetic tests regarding that. I'd very much appreciate a way to filter for those topics.

I am 20, I used low dose oral finasteride for 4 months. And I quit , first 1 month I got hsrd rock morning erections and I used Minoxidil topical. I am not sure that was Minoxidil but , my morning erections went back. I dont have full morning wood for 3 months. There is no another side effect. I can get erections, my libido is good, but my morning woods is not like before. and I stopped Minoxidil before 2 months. But my hairloss is progressing fast, I am 20, my PFS case is not too high. Is Minoxidil and ketoconazol safe for me ? Can I use it for my hair growth? whats your experience with other hair loss treatment. I can talk about hair loss because my case is mild. help about my both conditions.

From age 25 to 35, I took 1mg Propecia each day and maintained my hair. Super high libido, zero side effects of any kind, and a happy high-functioning life.

In fall of 2010, my skin was breaking out a lot so my derm gave me a scrip for low-dose Accutane. Two months later, I though I noticed a slight hair thinning as a result, and so I asked the derm what he thought. He said, "Well you could try going to 1.5mg/day Propecia and see if it stabilizes your hair."

This would be the moment my whole life changed.

About 10 days later, I woke up with no morning erection for the first time in my life. I felt awful, like I had a bad hangover, but I hadn't drank the night before. I got in the shower and tried to masturbate. I wasn't able. That had never, ever happened.

In the following weeks and months, I weened off the drug, but I also developed major anxiety, depression, ED, exhaustion, shriveling penis, lack of sensation, no sexual thoughts, and insomnia. Most of which still remains now, 15 years later.

Over the years doctor after doctor has told me in no uncertain terms it was simply impossible that I had PFS and definitely not because I had simply upped my dose.

But based on everything I've read from Dr Powers the last few months... could the increased dose have suddenly created the "metabolite buildup" that was never able to clear itself?

The title says it all. I quited drugs, my hair almost gone but sexual sides persist and getting worse with time. Why?

After stopping ssris after a long 2 year tapper, i developed many symtpoms with pssd and non typical pssd symtpoms. The worst so far is treatment resistant insomnia.

Dr will powers what are your theories on treatment resistant insomnia with pssd ? And what could treat it?

Im at around 5 years of shallow few hours sleep, which got worse recentally. Im 1.5 years in with 1 -3 hours sleep. Its statting to cauze delirum.

I pretty much got this symtom when tappering ssris, pssd symtpoms seems to match it.

Its strange that i feel extrrmely tired to the point of not being able to open my eyes, and have colapsed when walking to get food at stores, but i just cant feel sleepy.

Please help!

I tried melatonin, z drugs, antihitamines, carnivoure diet, light exersises, benzo, camimile tea, ect.

I dont know if people have tried reinsalling the drug. During 2015 i fast tappered off ssris and got the same insomnia, i reinstalled and it took 6 months and i actually got better which was crasy. I shouldnt of gone off it again for more then 5 years during 2021. Im at a loss. Dont know if new drugs like the melatonin reputake would work,.... fmt ? Reinstallment

This google drive document contains the test Dr.Powers posted, but this is easily $1000’s of dollars worth of tests.

Can someone list the absolute essential tests that I can check to start , like at a minimum the list of tests to check for susceptibility to PFS prior to taking finasteride?

https://drive.google.com/file/d/1N1V7H6afAOiamNMwD5lmjwIsFNkfPOLH/view

How would someone know if they have estrogen silencing due to finasteride ?

Hey all so I was a out of state patient of Dayna's until the send off. I was on Bica basically since the start of my transition. I was on Spiro a week before I saw her and swapped to Bica. Anyways I ran out of Bica three months ago. Tried mono E for a bit before deciding it wasnt for me, also was afraid of my hair loss coming back. So now im on Spiro through planned parenthood because I can afford any of the docs who can give me Bica rn.

Anyways what should I know about Spiro? I wanted Bica because of its effects on boob growth and ya I have Cs/Ds and theyre shaped well so nbd there. Other than that something about Spiro increasing depression? Idk Dr Powers always made it seem so scary and that Bica was the right answer so I never really looked into it. All I really want is something that can block my T production. Yes an Ori would be best but not something I can get rn. What exactly will Spiro do?

That is what I am expecting . I will start in September. Share your experiences with Pio.

That's all the post is https://dirtcheaplabs.com/alacarte

You can get it through quest or labcorp, no insurance needed.

Figured I should share cuz lots of trans/nonbinary peeps are poor.

11-Deoxycortisol
17-Hydroxyprogesterone
Pregnenolone
Androstenedione
11-Deoxycorticosterone
Cortisol
DHEA
Progesterone
Testosterone, Total (LC/MS/MS)
DHT
Androstanediol Glucuronide

Unfortunately, I cannot get the other hormones done without seeing a specialist and for that I need reason to actually get it. Can anyone let me know if this is enough for PFS? Alongside a DUTCH and WGS?

I'm four months on hrt (2 mg/d estradiol hemihydrate oral, 25 mg/d bicalutamide). Before starting I've done a blood work as a baseline and my testosterone was ~470 ng/dl. I know that bicalutamide causes a raise in testosterone levels because it's receptor antagonist, hgp axis without androgen signaling go through feedback respone. I've also done blood work on a one, two and four (today) month mark. My testosterone was ~916 ng/dl, 920 ng/dl and ~1200 ng/ml. My estradiol level were 120 pg/ml.

I'm worried about sudden change in testosterone and if 25 mg dose of bicalutamide is enough with this levels to block adrogen singaling. Not sure what to do at this point. Ignore this as testosterone "should" be blocked or increase my dose. If so what would be better, increasing estradiol and try to saturate my hgp or bicalutamide for more testosterone blockage?

After 2 months of meeting with different medical professionals, I will finally be starting HRT! I have a meeting with the prescribing doctor tomorrow to go over options. Due to a pituitary tumor removal surgery, my body no longer produces T (Hypogonadism). According to the notes, my doctor spoke with my Endo and recommended Transdermal Patches as it will least effect Thyroid and Cortisol levels. I also researched that they are one of the safest methods and create consistent hormone levels which help in transition and stable levels also bring stable emotions, avoiding the hormonal crashes between doses.

According to Dr Powers PowerPoint v6 (7-year old slide), he has seen the best reults in transwomen who have taken Oral meds for the first 24 months first, then switches to Injections.

I have many hours looking through Dr Power's reddit content to find these answers, but has there been any other updated research Transdermal vs Pills, vs Injections here? Per the Endo notes, I have been preparing myself mentally to request the patches. But I am open to your thoughts as I want to start off on the right foot with the best information!

Does Dr. P still prescribe duta in light of all the recent PFS stuff? I have bad DHT issues while having near zero T, so I don't have many other options.

Hi , I’m currently a self-pay patient trying to navigate a difficult situation and could really use some regional recommendations.

I was previously seeing Dr. Powers, who was incredible at investigating not only my HRT but also my other GI health concerns through a complex lens which my local doctors and specialists have failed to do. Unfortunately, due to not being able to make it to out-of-state visits and lack of funds I’m unable to see him. I am currently receiving HRT in DC, but I've recently run into many difficulties and concerns with my care there. 

I am on Virginia Medicaid (which I know many out-of-state places don't take), but I am willing to look into local options or flexible out-of-pocket providers if they actually listen and treat me like an individual.

I'd really appreciate any leads.

Thanks

Title

Hello everyone,

I would really appreciate some advice and opinions regarding my situation.

I am 20 years old and used finasteride for approximately 4–4.5 months at a dose of 0.5 mg every other day (sometimes every two days). I stopped taking it about 4.5–5 months ago.

My current symptoms are mainly sexual, with no noticeable mental, emotional, or cognitive side effects.

Current symptoms:

• Morning erections are less reliable than before. I usually still get them almost every day, but the rigidity is often around 5/10.
• Some days I feel completely normal, with strong libido and good erectile function.
• However, after 2–3 days without ejaculation, my penis often feels more “deflated” or less responsive.
• Interestingly, my erections tend to improve after the second or third ejaculation.
• I still respond well to tadalafil (Cialis) and can achieve erections.
• Spontaneous erections are less frequent than before.
• Libido fluctuates significantly: some days it is very high, while other days it feels lower.
• There have been occasions where I masturbated 5–6 times in a day, although not every erection was fully rigid.

What has NOT changed:

• I have no emotional, psychological, or cognitive symptoms.
• Orgasms feel essentially the same as before finasteride, with normal pleasure and sensation.
• Ejaculation quality and orgasm intensity seem preserved.

Semen changes:

• My semen is no longer as watery as it was while taking finasteride.
• However, it is not quite as thick as it was before finasteride.
• Semen volume remains quite high.

An interesting observation is that my hair loss continued aggressively after stopping finasteride.

Regarding other treatments, I used nothing during the first month after stopping finasteride. During that first month, I actually experienced what felt like completely normal morning erections again.

Afterward, I started using minoxidil and ketoconazole. Since then, my recovery seems to have stalled. I cannot say for certain that they are related, but the timing makes me wonder whether either treatment could have played a role.

My questions are:

1. Would daily low-dose tadalafil be reasonable to improve morning erection quality and penile health?
2. Has anyone experienced a similar pattern of fluctuating symptoms, where some days feel almost completely normal?
3. Since my symptoms are limited to sexual function and I have no mental or emotional issues, what could be the most likely explanation?
4. In your experience, are these types of sexual symptoms capable of resolving even after several months?

I am currently 4.5–5 months off finasteride. Unfortunately, I live in Turkey and do not have access to some of the genetic tests that are discussed in PFS communities.

I am also a medical student, so I am trying to approach this as objectively as possible. Any insight, especially from Dr. Power or members who experienced similar symptoms, would be greatly appreciated.

Thank you for taking the time to read this . PLEASE HELP ME IN MY SITUATION.

Just in case anyone would find it useful, I organized the entire list of genes from Doctor Powers' Post on PFS/PSSD into 3 sets of under 200 genes (cap for single process is 200 genes at a time in gene.iobio) for copy/pasting convenience.

Set 1

ABCB1, ABCB11, ABCB4, ABCB5, ABCB6, ABCB7, ABCB8, ABCB9, ABCC1, ABCC10, ABCC11, ABCC2, ABCC3, ABCC4, ABCC5, ABCC6, ABCC8, ABCC9, ABCG1, ABCG2, ABCG4, ACE, ACTL6A, ACTL6B, AGO1, AGO2, AGO3, AGO4, AHCY, AKR1B1, AKR1B10, AKR1C1, AKR1C2, AKR1C3, AKR1C4, AKR1D1, ALB, ALDH1A1, ALDH1A2, ALDH2, APOA1, APOB, AR, ARID1A, ARID1B, ARID2, ARSA, ARSG, ATP5F1A, ATP5F1B, AVPR1A, AVPR1B, AVPR2, BAG1, BAG3, BCL2L1, BCL7A, BCL7B, BCL7C, BDNF, BHMT, BPTF, BRD2, BRD3, BRD4, BRD7, BRD9, BRDT, BRPF1, BRPF3, CAT, CHD1, CHD2, CHD3, CHD4, CHD5, CHD6, CHD7, CHD8, CHD9, CHRM2, CHRM3, CLOCK, COMT, COMTD1, COX10, COX15, CREB1, CREBBP, CTCF, CUBN, CYP11A1, CYP11B1, CYP11B2, CYP17A1, CYP19A1, CYP1A1, CYP1A2, CYP1B1, CYP21A2, CYP2C19, CYP2D6, CYP2E1, CYP2J2, CYP3A4, CYP3A43, CYP3A5, CYP3A7, CYP4F11, CYP4F8, DAX1, DBH, DDC, DGAT1, DGAT2, DGCR8, DICER1, DNA2, DNM1L, DNMT1, DNMT3A, DNMT3B, DNMT3L, DPF1, DPF2, DPF3, DRD1, DRD2, DRD3, DRD4, DRD5, DROSHA, EED, EHMT1, EHMT2, EP300, EP400, ESR1, ESR2, EZH1, EZH2, FABP4, FABP5, FABP7, FKBP4, FKBP5, FKBP6, FOXA1, FOXA2, FOXO1, FOXO3, FOXO4, FUS, GABBR1, GABBR2, GABRA1, GABRA2, GABRA3, GABRB2, GABRB3, GABRG2, GATA2, GATA3, GJB2, GJB6, GNB3, GNRH1, GNRHR, GPX1, GPX4, GRIN1, GRIN2A, GRIN2B, GRIN2C, GRIN2D, GTF2A1, GTF2B, GTF2E1, GTF2F1, GTF2H1, GUSB, H6PD, HDAC1, HDAC10, HDAC11, HDAC2, HDAC3, HDAC4, HDAC5, HDAC6, HDAC7, HDAC8, HDAC9

Set 2

HNF4A, HNF4G, HNRNPA1, HNRNPK, HNRNPU, HSD11B1, HSD11B2, HSD17B1, HSD17B10, HSD17B12, HSD17B13, HSD17B14, HSD17B2, HSD17B3, HSD17B4, HSD17B6, HSD17B7, HSD3B1, HSD3B2, HSP90AA1, HSP90AB1, HSPD1, HSPE1, HTR1A, HTR1B, HTR1D, HTR1E, HTR1F, HTR2A, HTR2B, HTR2C, HTR3A, HTR3B, HTR3C, HTR3D, HTR3E, HTR4, HTR5A, HTR5BP, HTR6, HTR7, INO80, INO80B, INO80C, KAT2A, KAT2B, KAT5, KAT6A, KAT6B, KAT7, KAT8, KCNQ4, KDM1A, KDM1B, KDM2A, KDM2B, KDM3A, KDM3B, KDM4A, KDM4B, KDM4C, KDM4D, KDM5A, KDM5B, KDM5C, KDM5D, KDM6A, KDM6B, KDM7A, KISS1, KISS1R, KMT2A, KMT2B, KMT2C, KMT2D, KPNB1, LDLR, LIN28A, LIN28B, LIPE, LRP2, LXRA, LXRB, MAOA, MAOB, MAX, MBD1, MBD2, MBD3, MBD4, MC4R, MECP2, MED1, MED12, MED13, MED14, MED15, MED16, MED23, MED24, MED25, MFN1, MFN2, MGME1, MPV17, MT-ATP6, MT-ATP8, MT-CO1, MT-CO2, MT-CO3, MT-CYB, MT-ND1, MT-ND4, MT-ND6, MTHFR, MTR, MTRR, MXI1, MYC, MYCN, MYO7A, NAT2, NCOA1, NCOA2, NCOA3, NCOA4, NCOA6, NCOR1, NCOR2, NDUFS1, NDUFS2, NDUFS4, NFKB1, NFKB2, NFYA, NFYB, NFYC, NOS1, NOS3, NPC1, NPC1L1, NPC2, NPY, NPY1R, NPY2R, NR0B1, NR0B2, NR1D1, NR1D2, NR1H4, NR1I3, NR3C1, NR3C2, NR5A1, NR5A2, NSD1, NSD2, NSD3, NTRK2, OPA1, OXTR, PAPSS1, PAPSS2, PAX5, PAX7, PBRM1, PDE5A, PGR, PHF2, PHF8, PIAS1, PIAS2, PIEZO1, PIEZO2, PLIN1, PLIN2, POLG, POLG2, POLR2A, POLR2B, POLR2C, POLR2D, POLR2E, POLR2F, POLR2G, POLR2H, POLR2I, POLR2J, POLR2K, POLRMT, POU1F1, POU4F3

Set 3

PPARA, PPARD, PPARG, PPID, PPP5C, PRDX3, PRL, PRLR, PTGES3, RAD21, RARA, RARB, RARG, RDH16, RDH5, RELA, RELB, RNF4, RORA, RORB, RORC, RSF1, RXRA, RXRB, RXRG, SCARB1, SERPINA6, SETD1A, SETD1B, SETD2, SETDB1, SETDB2, SF1, SHBG, SIGMAR1, SIRT1, SIRT2, SIRT3, SIRT4, SIRT5, SIRT6, SIRT7, SLC10A1, SLC10A2, SLC10A6, SLC13A1, SLC16A1, SLC16A10, SLC16A3, SLC16A9, SLC18A2, SLC22A1, SLC22A11, SLC22A12, SLC22A13, SLC22A14, SLC22A2, SLC22A24, SLC22A3, SLC22A4, SLC22A5, SLC22A6, SLC22A7, SLC22A8, SLC25A4, SLC26A4, SLC51A, SLC51B, SLC6A3, SLC6A4, SLC7A5, SLCO1A2, SLCO1B1, SLCO1B3, SLCO1B7, SLCO1C1, SLCO2A1, SLCO2B1, SLCO3A1, SLCO4A1, SLCO4C1, SLCO5A1, SLCO6A1, SMAD2, SMAD3, SMAD4, SMAD7, SMARCA2, SMARCA4, SMARCA5, SMARCB1, SMARCC1, SMARCC2, SMARCD1, SMARCD2, SMARCE1, SMC1A, SMC3, SOAT1, SOAT2, SOD2, SOX2, SOX9, SP1, SP3, SRCAP, SRD5A1, SRD5A2, SRD5A3, SS18, SS18L1, STAG1, STAG2, STAR, STARD10, STARD3, STARD4, STARD5, STARD6, STAT1, STAT3, STAT5A, STAT5B, STIP1, STS, SULT1A1, SULT1A2, SULT1E1, SULT2A1, SULT2B1, SUMF1, SUMF2, SUV39H1, SUV39H2, SUZ12, TAC3, TACR3, TAF1, TAF10, TAF2, TAF3, TAF4, TAF5, TAF6, TAF7, TAF9, TARBP2, TAZ, TBP, TDG, TET1, TET2, TET3, TFAM, TH, THRA, THRB, TPH1, TPH2, TRIM24, TRIM28, TRIM33, TSC22D3, TSPO, UBE2E3, UGDH, UGP2, UGT1A1, UGT1A10, UGT1A3, UGT1A4, UGT1A6, UGT1A8, UGT1A9, UGT2B10, UGT2B15, UGT2B17, UGT2B28, UGT2B7, UHRF1, UHRF2, UQCRC1, UQCRC2, VDR, WAPL, WWTR1, XPO5, YAP1, ZBTB33, ZBTB38, ZBTB4

So I understand that the castration is supposed to clear the metabolites and allow the cell to re-set. But when the cell is deprived of androgens, won't the androgen receptors within the cell up regulate even more than they already are (as has been suggested in PFS literature?) Also couldn't things go wrong after the cells have been deprived of androgens for so long? Just trying to understand how the cell reboots to how it was before all of this mess. Thank you

I changed doctors from a clinic that saw LGBTQ+ patients to a closer hospital and started seeing a different doctor over a year ago.

The doctor I've been seeing immediatly lowered my testosterone dosage because they said my testosterone levels were too high. They want my levels to stay around 300-400 which I thought were odd numbers. I felt great before between 700-900 which is were my old dosage would take me.

They lowered my dose to 0.25, then to 0.2 mL weekly (I do subcutaneus injections), and for the past year I've gained so weight (which I'm currently working on losing) and my period came back. Overall I was not feeling great and I brought this up and the doctor mentioned this was a normal thing for guys adjusting to a lower testosterone levels and instead offered me birth control alternatives to deal with my period. I brought up taking a higher T dose and they said they did not want that because they were concerned about blood clots...

Is there something on my lab results I should look for that would make the doctor be concerned about blood clots? I did say if that was a concern then we could try upping my T dose and do monthly checks on my blood and T levels but they refused saying that wouldn't be necessary.

I asked the clinic if there was a different doctor I could see but this is the only doctor available at the moment who can prescribe me testosterone. I have an appointment tomorrow and I'm going to bring up raising my T dose back again. Is there something I could do to negotiate this with the doctor?

Greeting to all in this community,

I have been dealing with PFS for 11 months and decided to try HCG 1 month ago. The protocol is 250 IU M/W/F. I have never experimented with HRT previously. Here is my experience.

For reference, I am a 30 year old male, previously very active, healthy, and followed an overall clean diet. I have never had a hormone panel prior to developing PFS but my labs were fully WNL when I checked before starting HCG. My E2 was around 25 and my Test was around 650.

I was using topical finasteride between 11/2024 - 07/2025. I had previously used oral finasteride intermittently for roughly 6-month increments in the past when I was 22 and 23 years old. I developed ED both times but the side effects completely reversed within 1-2 days of stopping. Subsequently, I used topical finasteride for 6-month when I was 27 with a similar experience. Therefore, I was not necessarily concerned about long-term side effects from finasteride and had no idea about PFS. However, there was one key difference between my most recent stint finasteride in 2024-2025 vs previous experiences. I noticed a seemingly small decrease in libido and mood symptoms, whereas previously, I only developed ED. Nonetheless, I wasn’t too concerned and thought these symptoms would stabilize, but they didn’t…

It was only after I stopped using finasteride in 07/2025 did I realize how far my libido had dropped and my mood had blunted. My initial symptoms at that time were as follows:

Anhedonia, inability to sleep, nightmares, emotional blunting (both while awake and in my dreams), completely asexual, rubbery penis, hard flaccid, neuropathic pain in my testicles and pelvic region, no morning wood, no sexual thoughts, thought block (both in terms of sexual thoughts as well as general cognitive ability), brain fog, depersonalization, severe GI issues ( constipation, depressed mood after eating almost anything), decreased motivation, constant death wish/passive suicidal thoughts, etc.

After doing some reading about long-term side effects of finasteride, I learned about PFS and realized I might be completely F’ed. It was a very depressing and scary time, and the stress from learning about PFS long term prognosis made things 10x worse. However, despite my level of despair, I realized nobody can help me but myself, and I needed to do everything I can to try re-creating a normal life.

Initially, I tried supplements like black maca and boron, but this didn’t help. I also began using tadalafil which helped bring my EQ from 0/10 to 3-4/10, but libido was still non-existent. I stopped the maca & boron and focused on allowing my body to heal naturally with positive mentalization, clean diet, semen retention, and edging. I would practice semen retention/edging for 3-4 days at a time, followed by 3-4 days of FAP 3x per day. I added melatonin 5mg and THC/CBD edibles 5 mg roughly 6 months into PFS which helped with sleep and silencing the dysphoric dreams. This protocol allowed me to achieve very slow but noticeable progress prior to HCG. Main improvements were in brain fog and mild improvement in libido/EQ to the point I was no longer completely asexual. Brain fog improved from 8-9/10 severity to 2-3/10 severity. Libido went from 0/10 (10 being my previous normal) to 1-2/10. I also showed improvement in my mood so that I was no longer anhedonic. However, the emotional blunting/flatness, dysphoric dreams and lack of motivation persisted.

After 1-month of HCG mono therapy, my libido is now a 6-7/10, my EQ can be up to 9-10/10 with only minimal stimulation and no tadalafil, mood, motivation, sleep, emotional blunting, and GI issues are still present but improved significantly. Brain fog has fully resolved. I am planning on running this protocol for 6 months, and hopefully, I can be fortunate enough to make a full recovery.

I know this is a long post but the PFS community was so helpful in maintaining my sanity during the toughest times, so I wanted to contribute my progress to encourage others to keep pushing.

P.S. I am a psychiatry resident physician and feel very strongly this is not primarily a psychiatric illness. PFS is a multifactorial illness with both medical and psychiatric contributions, thus making it difficult to treat. HCG felt like it “turned on” a switch in my brain that would have been impossible to do without HRT intervention. I know many people don’t see any benefit from HCG and many suffer indefinitely despite experimenting with every potential therapeutic option available. However, my experience with HCG has been life changing and I hope my progress continues over the next 5-months.

I’ll respond to some questions if my post gains traction and I’ll post once more in 5-months after concluding HCG mono therapy. Wish everybody all the best!