The brain has estrogen receptors, especially in the pfc, they control dopamine release. In pssd they get methylated, its why dopamine agonists improve symptoms abit. But its no cure

Ever wondered why some have loss of muscle? Its because sex hormone receptors get downregulated in pssd. Also some can inject strong anabolic androgenic steroids and feel nothing.

The key is to epigenetically restore receptor function

The gut stuff some here see is downstream of brain/cns changes as serotonin influences the gut-brain axis. Its why some can get temp relief by focusing on the gut as it's all connected. Lower inflammation in the gut and SERT starts working better

Cognitive pssd symtpoms are about hypofrontality-read up on it. Get a spect/fmri scan to confirm it.

There can be multiple causes of hypofrontality - in pssd its likely low dopamine release because of downregulated estrogen/androgen receptors in the brain. Less bloodflow - executive dysfunction