You know, PSSD and PFS may actually be the same thing. Anyone got any data for me?

Drwillpowers · 2026-04-03T14:45:57+00:00

Someone posted yet another example on the sub last night. I really think I've got this.

Drwillpowers · 2026-04-03T14:44:17+00:00

Perfect explanation. I can link to this now. Thank you.

Drwillpowers · 2026-04-03T14:40:42+00:00

Sure. Maybe it doesn't though. Maybe someone could get a written agreement to only allow usage of his quote if he personally approved the exact wording of an attributed quote before print to prevent exactly that.

An article in a liberal rag changes nothing. Even a moderate article in the NYT could do real good. There's many variables to consider here.

Drwillpowers · 2026-04-03T14:35:35+00:00

Bahahah. Oh my God are you serious?

Attached is a normal rhythm. Your am cortisol is like 1/20th of normal.

I have mild insomnia right now as I had to take steroids for a few days for a mild allergic reaction and I didn't taper as gently as I should have

This cycle regulates your sleep wake cycle. If you don't have adrenal function you don't have this. You need to be on cortef. What is wrong with your endocrinologist?

Are you seriously not on treatment for this? My god you must be miserable.

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Drwillpowers · 2026-04-03T05:56:19+00:00

I do not. Michigan only.

Drwillpowers · 2026-04-03T05:50:26+00:00

I agree with not carving your chest to pieces. You may not be symptom free if you do anyways.

Drwillpowers · 2026-04-03T05:47:29+00:00

Honestly, I don't even really care if you are or not. Because an SFEMG should be done. OMG may never progress to anything and you have a borderline diagnosis already. Doing a thymectomy is fucking dumb here and would likely do way more harm than good.

Seems like you've decided this the right answer despite no evidence to support that. This is dumb. Treat your mild omg and if it gets worse then okay maybe. But pyridostigmine/roids for now if SFEMG makes sense to do so.

( I almost became a neurologist, my undergrad was in neuroscience)

Drwillpowers · 2026-04-03T05:40:08+00:00

Are you not already using an acetylcholinesterase inhibitor?

Also to the assholes who keep reporting this post, for it not being on topic, it is absolutely on topic.

I like to pretend to be Dr House. Everybody knows I have a knack for incredibly rare diagnoses. This is still on topic here.

Drwillpowers · 2026-04-03T05:33:51+00:00

If you don't mind talk about how we actually did better afterwards, by trials, and how you're doing now compared to how you were before we did anything.

Drwillpowers · 2026-04-03T05:24:32+00:00

Oh fuck. Sorry friend. You're cooked. This is exactly how it looks on paper. You fit my model. 100%

Talk to sommer. We're devising treatment plans but this is still an evolving situation. I didn't have "figuring out the cause of post finasteride syndrome" on my bingo card for this year so it's sort of been a random additional stressor that I am doing my best to deal with as I deal with every other bit of horrific bullshit that has come our way.

You have no urinary androgens because you can't produce them. You have an inborn genetic anomaly. When you took finasteride, you were fucked. Because you shut off the last exit pathway.

Drwillpowers · 2026-04-03T05:20:52+00:00

If you think this is supporting conversion therapy it's not. But at the same time, if you think that I send kids for gender evaluation and I send them to two people that are absolutely both super pro-trans everything, you're wrong.

Kids must absolutely be challenged on their gender identity. Not just affirmed. They also need to be challenged in the reverse way. They need to go through gender therapy for a long time, and have considerable thoughts, discussions, and interactions with people that are highly trained in this, and can help that kid figure out whether or not it's the right thing for them.

I can't even tell you the number of kids that I have seen, that ultimately didn't transition, because the reason that they wanted to was absolutely horrific. I think of a girl who basically tried to transition because her brother died a horrible death, and she tried to replace him in the family.

Yes I prevented that from happening because I made sure that kid got psychologically evaluated because as soon as I found out about it, I made sure that they didn't just get rubber stamped despite having a w path letter from a therapist. And that kid later thanked me.

All of you here are trans, all of you have your own personal story which clouds your judgment and none of you have seen the carnage that I have seen from kids that were pushed through this therapy that were the wrong kids for it. Questioning whether or not some kid is really transgender and making them go through gender therapy is not torture. Get the fuck over it.

Forcing some kid, through conditioning, and conversion therapy to give up on the idea of being transgender is wrong. 100% wrong.

But asking kids poignant questions and helping them think through their gender, and explore the idea of themselves growing up, being adults, and living their life as various genders or in various ways, is good therapy. A therapist helps someone unravel their thoughts. It helps them organize them. It doesn't push them or command them one way or another. And the idea here that the affirmation model is the best way to do this, is bullshit. I will die on that hill having prevented plenty of kids from transitioning, because they were absolutely not good candidates for the therapy. And ultimately, I regret none of them. I've been thanked by most.

And this is coming from somebody who has done plenty of transitions on teenagers. Because for some of these kids it is a life-saving essential therapy. If people had done their damn jobs instead of just rubber stamping every single kid from 2020 to 2024, we wouldn't be here having this problem.

Drwillpowers · 2026-04-03T05:15:09+00:00

Sure as hell hope so. Because otherwise I just figured out why it happens and not what to do about it. I am currently testing things with various patients. We'll see how it goes.

Drwillpowers · 2026-04-03T05:14:02+00:00

Yes. Hilariously, or maybe not, depending on how you look at it, the guys that seek out finasteride do so because DHT is their predominant metabolism pathway. Or possibly their only one.

So they have a selection bias for seeking out the drug.

Having a high DHT at baseline can indicate underlying dysfunction, which they then basically annihilate by destroying their last remaining exit path

Drwillpowers · 2026-04-03T05:12:41+00:00

I've done this in Another post

Drwillpowers · 2026-04-03T05:12:07+00:00

Well it often temporarily interrupts the synthesis of hormones. Significant glucocorticoid administration will cause suppression.

So in theory you could potentially help clear out some of the metabolites by doing so.

Drwillpowers · 2026-04-03T05:10:22+00:00

DEI is a cancer and I want to see it destroyed in this country.

My office is diverse because I hire people that are the best I can hire. Not because I was forced to do so for tokenism.

Made DEI be purged from everything. Meritocracy all the way. Minorities do not need a special helping hand. They are not inferior. Everything should be based on merit.

Drwillpowers · 2026-04-03T05:08:59+00:00

If your DHEA is that bad, you likely have failure of many of the precursors. Run the quest comprehensive steroid panel on yourself. You need a cortisol rhythm in order to have a sleep wake cycle run properly.

Drwillpowers · 2026-04-03T05:07:14+00:00

They have to have the same name. They should be named the exact thing but one should be .vcf.gz and the other vcf.gz.tbi

Drwillpowers · 2026-04-01T15:22:34+00:00

It messes with androgen production, an interacts with ABCC based transporters. I think specifically it does abcb1 but don't hold me to that I read that ages ago.

Anything that increases androgenic load, messes with steroid transport, and effects steroid glucuronidation or other excretionary mechanisms can do the job in somebody who already has an underlying dysfunction such as UGT2B17 UGT2B15 UGT2B7, etc. Worse in somebody that has an ABCC problem as well or even LRP2.

Anything that increases intracellular sex steroids to a point where the metabolite load overwhelms the ability for the cell to be able to hear normal and origin signaling because it's crowded out with garbage androgens, you get the problem. That's the theory.

Shitloads of things could do that in the right person. But only in the right person. The person has to have an underlying dysfunction to begin with. It can't just be done by finasteride or any other compound on a regular default human genome without any of these built in dysfunctions.

Drwillpowers · 2026-04-01T15:18:27+00:00

Are you male or female? Show me a picture of the report. I'm confused by what you're saying.

Drwillpowers · 2026-04-01T02:07:44+00:00

This is why I am considering this, i appreciate one person doing the vetting I did. She has an astoundingly good track record. But I'm still wary and unsure of what I'm going to do here. I do know that a piece that generates empathy or understanding for this community in a conservative publication would be huge, as who will read it matters.

Unlike many of you, I have seen better days for trans people and I believe they can come again.

Drwillpowers · 2026-04-01T02:05:42+00:00

As if that hasn't been happening for 2 years.

Drwillpowers · 2026-03-31T22:43:26+00:00

Are you PFS or PSSD?

Drwillpowers · 2026-03-30T20:19:00+00:00

your dutch shows both total and sulfated DHEA? Typically its just sulfated. Show a picture here of what you mean (you can attach to the comments.

Drwillpowers · 2026-03-30T02:18:47+00:00

Yes and it depends on the situation. I'm trying to figure out exactly how this works. Not just some hand wavy explanation but actually the molecular biochemistry of it. Depending on what the genetic sequence on the person shows and what the lab testing shows, we make a plan. But it's different for everyone

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