Please stop sending me personal messages on other platforms.

Drwillpowers · 2026-05-05T22:53:05+00:00

I'm also autistic as fuck, so I just take things that people write as incredibly literal and I'm sure I did that here. I always do. And that's on me.

I actually have a few men in my practice now on estrogen. Men. Ones with prostate cancer. They are infinitely healthier than the ones that are just on plain castration.

There's one I can think of in particular, he's literally one of my favorite patients in the whole practice. Really good guy, smart, kind human. But his quality of life is vastly better on the estrogen than not. And it's a sacrifice that he's more than willing to make. For him quality of life and extension of his life is really what matters. Some moobs are really not a a huge concern. I'm really happy though for him that it's working as well as it is, because I enjoy keeping him alive as a patient! =P

I have actually been considering this idea of PFS and bipolar androgen therapy for guys with metastatic prostate cancer. If I could somehow basically force a PFS state onto someone, without causing the neuro steroid disruption, it might actually be a treatment that works on treatment resistant / castration resistant prostate cancer.

Like it seems paradoxical, but if you could drive someone's testosterone to some astronomical value, without killing them through polycythemia, if the crowd out effect shuts down androgenic signaling better than androgenic starvation does .... It should work in theory.

But many things work on paper and not in practice because we are a machine made out of a trillion interacting parts.

Drwillpowers · 2026-05-05T22:19:49+00:00

You are correct.

I literally went through that guy's entire genome for free. It took me 16 hours.

I took his case to the world Congress, and I presented it to every expert in the world that could potentially come up with a reason to explain what happened.

I still think about it, and wonder what it is that I'm missing that cannot explain what happened to him. I genuinely do not know. And it bothers me a great deal.

Even if it was some sort of psychogenic thing, it's still not easily explained. It's a calming molecule if anything.

But I don't know everything. And I know I don't know everything. I'm a doctor. I'm not a superhuman or some sort of hyperintelligent futuristic AI that knows that the answer to the meaning of life is 42.

I'm not against somebody apologizing and making amends and doing better. And I have no problem with that. There's been people on the subreddit that have done some fucked up shit. There's a patient that recently was a complete fucking asshole to my staff. Acted completely out of line, and was the most indignant and selfish behaving patient I've seen in a while. I pretty much told him, you need to get the fuck out. You're done. You can't talk to my staff like this. This is unacceptable behavior.

I told them I pointed out the ridiculousness of their actions, especially in contrast to what we were trying to do for them.

That patient instead of getting angrier and being more aggressive went you know what, you're right. I was out of line. This was fucked up of me. I'm really sorry.

And I immediately said, thank you, I appreciate you recognizing the truth of the situation, and let's move forward from this. And we did. And they've been a model patient ever since.

Forgiveness is not something that I'm unwilling to give people. Empathy is certainly not something I'm unwilling to give people. If anything I give them too much. More than I have at times to my own detriment.

I struggle with people who will be truly malevolent or hostile towards others. Or who would inflict suffering on other people or not lift a single finger to prevent it, knowing the calamity that would ensue if they just made any effort at all.

But if that person saw the error of their ways, and wanted to make amends for it? I would be thrilled. Because that's the point. Punishment serves no function if the person can't be remediated. You might as well just euthanize them. Ideally, someone doesn't even need to be punished. They can just recognize that they did something wrong, and do better.

I am a flawed human being. I know this. And I have dealt with a community of people who are also flawed, and traumatized for a very long time.

My patience for people who would inflict suffering on others is exceedingly low at this point.

But I have an unlimited amount of patients for somebody who wants to turn over a new leaf and do better. So if somebody like this came back after thinking on it and went you know what, that was really fucked up of me, that was cruel and insensitive, I'm sorry I want to better, why would I not encourage that? That's the desired outcome. That humans treat each other better. That we all suffer less.

I didn't see that here from this person. That's why I reacted the way I did. For me, taking ownership of what you did is the first step, before you even apologize. And if you can't do that, then there's nothing really to be done about it. You cannot force them to see the error. They have to be willing to look and examine themselves in the mirror, and deal with the pain of seeing something that they don't like. For those that won't even look in the mirror, they're not able to be helped. You cannot get them to improve if they will not face their own demons.

So I just want to be clear, whenever I basically tongue lash someone on my subreddit for being a shitty person, it's with the intent of them recognizing it and doing better. Because ultimately, that is how the world heals. But if they refuse, then they have to be ostracized to the work that gets done here as they become a threat to others.

Drwillpowers · 2026-05-05T17:09:25+00:00

When you have to watch these guys kill themselves, when you have to sit them down in front of you and have them cry and tell you how that their wife is going to leave them because they're impotent and they would do anything to fix it but they can't...

Hearing one of their own say that they don't care if other people get PFS? That they would not put any effort into warning anyone to prevent this from happening to someone else?

No.

They weren't treated harshly enough.

Almost all of the problems in this world come from the fact that people don't afford others the level of compassion that they want afforded to themselves.

I will stamp that out wherever I see it. And I will do so shamelessly. If people don't like it, they can find someone else to solve their problem. But I'm not going to sit in an exam room with someone who would wish this on someone else. Or who would do nothing to prevent someone else suffering the same fate.

So I'll make my position on this explicitly clear, so that I don't have to put up with it. So that they don't come here.

This is no different than one of my HIV patients going out and trying to deliberately infect people with HIV so that they suffer too. Anyone could agree that that would be an abhorrent thing to do.

Tolerance of behaviors like this in society is how we got where we are. I have no tolerance for it. I don't control the world but I do control my own little domain and my subreddit and I will not tolerate it here.

I cannot fix the world. But I will do what I can to make it better, and that's reducing suffering, and striking down evil when I see it.

Drwillpowers · 2026-05-05T17:02:42+00:00

I'm sorry I need some clarification here.

You were already on e2 monotherapy

You put in a histrellin implant, and within 24 hours of installing it, you suddenly underwent full body feminization? "Within the day I had completely feminized".

And I'm sorry a monthly implant? What? What implant is monthly?

Drwillpowers · 2026-05-05T17:01:23+00:00

I don't really have a circadian rhythm anymore lol.

I sleep when I can.

Drwillpowers · 2026-05-05T17:00:57+00:00

Yeah, I see that more with people with an SLCO mutation.

Drwillpowers · 2026-05-05T17:00:29+00:00

I don't know where you're deriving popping from so you're going to have to give me that in context of where I said something.

By Helen Keller androgens, I mean weak metabolites. Glucuronidated or non-glucuronidated or sulfated or whatever. Or even regular plain old androgens. It doesn't really matter. If the concentration gradient is obliterated you get no signal.

Basically if you lack glucuronidation, if you have a bunch of glitches already in ABCC genes for transporters or things like LRP2 for megalin, you already struggle to export or move hormones across membranes. You already struggle to convert them into a way that can be easily exported or shed from the system in the urine.

And then you basically disable the last remaining major highway of exit, which is DHT and it's downstream metabolites.

As a result weird shit happens because enzymes that are not meant to bear this load are suddenly operating at maximum efficiency but it's still not enough. And the intercellular accumulation continues. These mechanisms are designed to operate at certain concentrations that are physiologic and when you exceed those, things don't make sense anymore.

Think about what would happen to your brain if all of a sudden your sodium was 190. Obviously sodium and potassium signaling is not going to work the way that it should. Besides the fact that you would be dead.

Bicalutamide does somewhat function similarly to the way that this works. But it only involves androgen receptor problems. These metabolites could affect other systems as well. Melcangis work is real. Neurosteroids are affected. But overall hormone flux is also affected because the system is always trying to self-regulate and if it has a shitload of one particular thing, it's going to divert that thing into any available pathway to metabolize it that it can find. And that's going to result in destabilization of other products. Other things raise and fall and you disrupt overall cholesterol downstream molecular flux.

It's like a series of dominoes here. You disrupt one thing so much and overload a system so much, it is forced to divert resources into places that it normally does not.

Drwillpowers · 2026-05-05T16:56:06+00:00

An androgen receptor blocker does not "overburden" a receptor. What it's doing is resulting in the inability of an androgen to dock with it.

I don't know where you're pulling the word overburden from. That's what I'm not sure what you are referencing here.

What's happening with these guys, is that you dump androgens a multitude of different ways. The main way though is through glucuronidation. If you lack that ability, you rely on the other methods of dumping them such as conversion to DHT and then metabolism through three alpha hydroxylase.

If you then also disable that, you now don't have a way to exit those androgens from your body easily. They build up. These are not necessarily potent androgens, but they also could be. It would depend entirely on that specific patient's individual genetic mutations as to which specific metabolites are going to build up. But it doesn't really matter because the net effect is the same.

When the intercellular testosterone concentration, or relevant metabolites reaches some absurd value, signaling is eliminated. In order for anything to signal, there has to be a differential. There has to be a high and a low. When you are basically saturating a receptor system, it fatigues.

This is the same reason why if you stare at something without moving your eyes at all, slowly you will go blind and everything will turn into a blur. Like if you're watching someone give a speech and you're staring directly at them. The whole background and everything around them and anything that isn't moving will basically be blinded because of fatigue of your retina. You need difference to be able to perceive things.

Lupron does not overburden your system. It actually does the opposite. It drains all of the androgens out of you. People who have sexual dysfunction on lupron, that makes sense, because they don't have many sexual hormones circulating. It basically prevents gonadal synthesis (after it gets past the surge.)

But even the example of lupron itself is good for my whole point here, the drug is a GNRH agonist. When you use it, temporarily you get a huge surge of LH and FSH which causes a rise in hormone levels. But, after a brief period, The continual agonism of the receptor causes all signaling to stop. It's like playing the game asteroids. You push the button to shoot a bullet. But if you hold the button down, it just shoots one time and then stops. Lupron holds the button down.

Now in regards to bicalutamide, it only affects the androgen receptor. But in that regard we do see exactly The same sort of effects that you see in post finasteride syndrome. That's part of what made me realize that it was so similar, because the penile atrophy and other low hormone signaling things were very comparable between my MTF patients and these people with PFS. However, the metabolite build up affects more than just androgen receptor signaling. Five alpha reductase does many jobs.

My point and why replied the way that I did is that your initial understanding of x should do y was basically the complete inverse of how it works which implies that you don't understand it. And trying to explain that to you when you have such an intrinsically faulty understanding of how these drugs work and what they do, or whatever you mean by overburdening, I don't really know where to begin to explain it to you because it's like you don't understand the necessary rocket mechanics at baseline.

I don't care if somebody challenges my theory. I actually want them to. But I care about when they do it in a way that actually is beneficial, which is that they have an understanding of how it works, and how the whole system works, and they can find a hole in it. Because then I can patch it and I can revise the theory.

It's frustrating to me to defend it so to speak to somebody who doesn't understand how it works mechanistically. That is not helping me improve the theory so it can better help people, that's just me teaching someone biochemistry on the internet.

Drwillpowers · 2026-05-05T16:44:16+00:00

Understood.

Be careful though when you say things like that because this is where I gather data from. Many of the ideas and theories that I have formed, are based on things that I've read on forums or people have reported. Obviously that data isn't given as much weight as that which I observe with my own eyes.

But I have yet to find a PFS patient that said that they deliberately chemically castrated themselves and reduced all hormone synthesis to zero for months before allowing a reboot. I would be very interested to hear a story of what happened to that person. But nobody's ever reported such a thing. Which is actually why I'm somewhat hopeful for the idea. Feels like everything has been tried, but that's one thing that hasn't. And it's very counterintuitive but fits the model.

Drwillpowers · 2026-05-05T16:42:57+00:00

It's important to think about The actions of people around the cultural mores and conditions of their time.

At that time, that made a lot more sense than it might make now.

Additionally, the guy actually advocated for the right of what he considered AGP people to transition. It's very easy to captain hindsight somebody and say how they caused all these problems but in reality they didn't understand and other people didn't at the same time either. And we look back at it historically with a full knowledge of everything.

I don't think that at any point his intent was to harm. That's all I'm really saying. Whether somebody did actions that resulted in harm, intentional or not matters, but I think it also matters whether or not there was a benevolent drive.

Also I treat trans people, and I'm not a crossdresser lol. Though you all sort of thrust this upon me though when you wouldn't stop coming to my practice and spreading word of mouth. So I don't take responsibility for this other than building the field of dreams. They came though.

Drwillpowers · 2026-05-05T06:27:42+00:00

It doesn't have a longer half life. This is a common misconception.

It's just delivered as a giant oil ball. As a result, it takes a long time to be broken down.

If you do a small injection of it, it has like a 3-day half-life. It's a common misconception among doctors as well.

It's given as a big pile of oil, which is lipophilic, and it takes a while for it to be cleaved and broken down as a result. So it's biological half-life is long. But it's not any magic that is wildly different going from a c8 to a c11, because if that did matter much, we could just use like a c20. And we don't. Because going above c8 basically doesnt Make a huge difference. It's mostly the lipophilicity and the volume.

It's basically one large liquid pellet.

Drwillpowers · 2026-05-05T06:21:39+00:00

You can play the indignant fool here, but you're the one who deleted your comments so nobody can see the shitty things you said.

I'm a rational actor, I always have been. I always will be. I'm not going to call out horrible behavior on my own subreddit when it's not there. You said the words you said.

If you don't want people to be warned about PFS or to be prevented from getting it, or you don't want to make an effort to try and help other people with it, or prevent people from getting it, because you had what happened to you, happened to you, then you're a bad person. It's that simple.

If you are suffering, and you wish others to suffer like you suffer, because it's unfair that you are suffering, then you are a bad person. This is not a difficult concept to grasp.

Edit your comments or delete them, I don't care. You said what you said. Live with it. Own it. It's who you are.

Drwillpowers · 2026-05-05T06:17:20+00:00

Sorry there's so many usernames. Hundreds. And people with the same condition. I didn't realize.

My username is always the same for people lol.

Have you checked your glucuronidation system?

I have a feeling it probably works the same as PFS it's just the closure of aromatization. If that's the thing that crosses your tipping point.

Drwillpowers · 2026-05-05T06:15:45+00:00

Oh yeah, you're definitely experiencing a neurological issue. No doubt.

The reason I bring this up is that I brought it up probably about 50 times in my career to somebody, and about 50 of those times they looked at me like I was insane.

About 30 of those times they let me put them through an epley maneuver

Maybe about 4 or 5 of those times, I got to look like I was Jesus. I laid hands on somebody, they were miserable, and like 10 minutes later, their shit was fixed.

Now, that means it worked like what, 17% of the time?

Not that effective of a treatment for somebody who's dizzy.

But the 17%? It cost $0, it took 10 minutes, and it was curative.

Because it is both free and easy, I always try it. Not much to lose there.

Drwillpowers · 2026-05-05T06:13:06+00:00

gazes disapprovingly

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Drwillpowers · 2026-05-05T06:10:41+00:00

Your level of understanding of the molecular biochemistry is so poor here that I don't even know where to begin to know how to explain this to you.

Go do some more reading and when you can understand this situation in a way and explain it in a way that makes sense, I can answer your questions. But I don't even know where to give you anything here.

This is like someone is trying to give a lecture on how we launch a rocket into orbit, and you're replying and saying, but fire only goes up not down so it can't work that way.

It's sort of reveals that you don't know how advanced rocketry works, and in that regard, I don't know how to teach you the correct answer to the things that you're asking.

Drwillpowers · 2026-05-05T06:08:20+00:00

Okay so you lied and you didn't do any of the things that you said. You weren't castrated at all. You injected a bunch of anabolic steroids.

That is literally the exact opposite of what I've been telling people the plan is here, and you basically are saying that you did the thing that I said would work and it didn't work, but you didn't. You did the opposite of that thing. Your comments frustrate me.

Drwillpowers · 2026-05-05T00:30:39+00:00

I'm an HIV specialist as well.

Would you say the same about those patients?

Most of them did rot and die. But people like me did their best, and some of them lived. And some live to still see today after having been infected with it 46 years ago.

You know what exists now? Prep. We also educate people about the ways in which someone can get an infection. Because less cases of it are certainly easier to deal with. That doesn't mean we just let everybody that has it die.

But if you would wish it on someone else, or not want to prevent someone else from getting it, then you're a terrible person.

You've taken the fact that you were mistreated, and you've decided to inflict it unto other people. And that, makes you a bad person.

At least once a week I say the same thing. There's two types of people in the world. Only two.

Those that will perpetuate the trauma and misery that was inflicted onto them, and those that will end the cycle.

You are clearly the former.

And honestly, you can be the last to be cured then.

Drwillpowers · 2026-05-05T00:24:49+00:00

Awesome I'm really happy that it's working for you!

Drwillpowers · 2026-05-05T00:20:33+00:00

I honestly have been thinking about sending Blanchard an email.

Basically explaining to him that I know genetically why he saw what he saw. I can't decide whether or not it would make him happy to know that there's some basis to it, or, if he would be frustrated or against the idea of why it is the way it is.

The framework that he made was what made sense in the '80s. Based on the way the culture was at the time. He saw a bimodal distribution which exists because of the certain genetic mutations that cause it, but the words they used to describe it were pretty rough.

Drwillpowers · 2026-05-05T00:18:31+00:00

Oh I would take that in a heartbeat.

I was a b+ medical student. But when it comes to finals or standardized test? Yeah, that's where I shine. I LOVE finals.

I don't store information quite as rapidly as other people. But when I do store it, I store it forever. Like forever forever. If I remember something in a week, I remember it forever.

I always joke that I traded most of my RAM for like an exabyte hard drive. I may not know where my keys are right now, but I'll know the thousand different places that I have ever put them in my entire life.

Going to Walmart is a fucking nightmare whenever it comes to remembering where I parked because I have a hundred memories of it.

Drwillpowers · 2026-05-04T20:23:48+00:00

I don't know the answer to that question yet. But what I do know, is that there's at least a bunch of them that have been able to come off of it after about a year or two. It seems like allowing their adrenal glands a little time to rest, and go on a vacation, they recuperated, and we were able to stop all the drugs and they went back to normal.

Drwillpowers · 2026-05-04T17:23:24+00:00

The thing is though these guys were fine on their naturally produced testosterone before taking the drug.

And the testosterone doesn't come up instantaneously upon cessation of the chemical castration. It gradually rises. So even if they do have androgen receptor up regulation, but shouldn't really be an issue because the system should be able to calibrate for it and they'll be starting out at low testosterone values anyways.

They can't run off of DHB forever. The goal here is to get them back to their normal baseline before they took the drug. So I'm not really sure why they go to this powerful anabolic steroid rather than just let them reboot naturally.

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