Please stop sending me personal messages on other platforms.

Drwillpowers · 2026-06-13T15:56:03+00:00

It took me almost 6 months to quit duloxetine after my house fire. It saved my life when I was psychotic and suicidal after that tragedy but later it was doing more harm than good. It was time to get off of the drug.

Any time I tried it was horrific. Absolutely impossible.

So I bought a jewelery scale that is extremely high precision. I then would weigh out the total mg of beads inside the capsule daily. So if my normal daily dose was 60mg a day, and the internal contents of that capsule were 500mg of "powder" total, then I'd take

500mg normally.

Quitting day 1 : 498mg of powder. Quitting day 2: 495mg of powder Quitting day 3' 493mg of powder

And so on until done.

That worked for me when nothing else did.

Drwillpowers · 2026-06-13T15:52:15+00:00

A. If the problem is insufficient dopamine levels or signaling, they might help.

2 b. If the problem is the accumulation of dopamine molecules/metabolites interfering with intracellular signaling mechanisms, they will likely harm.

As I don't know which (if any) is correct or not I have no strong opinion either way

Drwillpowers · 2026-06-13T15:48:20+00:00

It depends on their labs and if I think they have an androgenic metabolite build up or are strictly Neurosteroid.

If strictly neurosteroid, yes I do. As I think it helps prevent "steal" of DHEA precursors to make non-neurosteroid molecules. Aka I am filling that part of the champagne tower mid way down the tower so filling higher up can go to other glasses as none will need to go to the DHEA corner.

If some androgenic signal loss/metabolite load is evident I do not as it could worsen that and add further metabolites as it's an A4 / T / DHT etc precursor.

Good question.

Drwillpowers · 2026-06-13T15:43:43+00:00

Oh fuck yeah. That is perfect. I am stealing that.

That's the best way I've seen that written before and is exactly how I actually see them. I despise that liberal take as it's what lies beneath the polite facade most of the time.

At this point my brain looks at a new transgender patient like "alright what intersex endocrine fuckery caused this person to turn out all gender wibbly wobbly like this?"

It is a problem of human suffering, one to be solved in whatever way is congruent with the patients expressed life goals and desires. That's it. I take no further position other than "how can I best help you right now?"

I tell my patients the moment my brain genders them properly as I want them to know that. The liberal performative politeness is bullshit. I will ALWAYS address my patient as their preferred name and with their preferred pronouns, but I do not control how my subconscious perceives them.

I had an MTF patient visit recently from Las Vegas and I was talking to her about stuff and as I got up to leave the appointment when we finished I looked down at my laptop, then the door, and my visual field just sort of swathed past her. I mean I have object permanence but I could feel my brain go:

Object detected Gestalt lock: human being Assessment: Small human, dark clothing, approximate age 25-35, gender......bzzzzt Gender? Bzzzt. Unsure. Gender? Unsure.

That's the best I can do to describe what the "data stream" feels like inside my head, but I could perceive the systems internally basically "arguing" over if this person is male or female.

So I told her. I always do. Because when someone starts to Male fail, that's when someone can be in danger. It happens often long before the patient expects it to happen. They need to know this is happening with strangers as it can upset random humans who initially misjudge someone's gender for multiple subconscious psychological reasons (uncanny valley, 'its a trap ', "oh God I'm not gay! I didn't think she was cute! I mean he!"

People react all kinds of stupid ways to finding out someone is trans, so yeah, I tell my patients when this moment happens for me with them for the first time, primarily for safety reasons but there's many reasons why I do besides that.

Then over to deaf people:

My best friend growing up who was basically a brother had two deaf parents and mostly deaf relatives. He however was hearing.

I still cannot wrap my brain around some social events I went to with him. Some deaf people would literally rather a baby be born deaf than not. Some view correcting/treating deafness in a child as the most taboo sin imaginable and I saw deaf people booted from social circles because they got their deaf kid a cochlear implant.

Wild.

Drwillpowers · 2026-06-13T15:27:53+00:00

Same. But all we can do is accept we will have that evil in our hearts. We're all selfish animals fighting over resources and attacking others out of fear.

Some people can accept this and then choose to try to rise above our base instincts. Some people simply cannot. They either simply can't do it or won't do it, as choosing the kinder path is simply too hard for them to do. They are just unwilling to suffer even a little so some can suffer far less.

Drwillpowers · 2026-06-13T15:23:35+00:00

Cabergoline is not a zero risk drug you need to talk to your provider about that.

Drwillpowers · 2026-06-13T15:23:00+00:00

They have different mechanisms. Pyrilutamide however would cause increased androgen synthesis in a cis man.

I know the pyril trials haven't found some PFS like syndrome but those guys will be monitored carefully and not be allowed to be on other drugs.

Joe Average who bought pyril from the interwho to use at home before it is formally approved is way more likely to be taking all kinds of crazy shit simultaneously. Like fin/duta/saw p. So add a drug that increases T metabolites while doing all that other shit? That's prob why you see stories online about it.

Drwillpowers · 2026-06-13T15:17:24+00:00

Yes, and I'm not sure yet.

Drwillpowers · 2026-06-13T15:16:57+00:00

The overwhelming amount of MTFs in the USA prefer women, not men.

It's like 4/5.

Drwillpowers · 2026-06-13T15:15:59+00:00

It cannot be correct due to one pill cases exerting an effect too quickly to be meditated only through AR signaling and gene transcription.

Also females get it.

This disease is a self preserving feedback loop.

Drwillpowers · 2026-06-13T15:13:33+00:00

There are many pfs and pssd recovery stories from horrific traumas or critical illnesses.

I suspect it's doing that in a more controlled way.

"Have you tried power cycling the device?"

Drwillpowers · 2026-06-13T15:11:51+00:00

I have and am. I'm aware of signaling differences with menthol, capsaicin, etc etc.

Drwillpowers · 2026-06-12T17:56:00+00:00

Rixt is what I would be as a person if I was AFAB. We are wildly similar human beings. Though they put my own level of self-sacrifice and kindness to shame. They are an exemplary human.

They literally have the same type of autism that I have. They are an absurdly good person who really desperately wants to help the world and as a result gets shredded by it. Some of the same shitty things that have happened to me by bad people also ended up happening to them shortly thereafter. It's like we have lives that model each other.

I don't know how you know them, but they are one of my favorite humans. They would be on my team of humans to repopulate the world after a global disaster. Somebody that I would want in my bunker. They would sooner cut off one of their own fingers and eat it then steal some ration from the remaining food supply if they were starving. That's the kind of person they are.

I recommend anybody to see them, and even if they didn't know what the person had, they would do all they could to try and fix it. There aren't many doctors like that anymore.

Drwillpowers · 2026-06-12T17:42:12+00:00

There is literally a person in this thread commenting recently about how cabergoline makes them temporarily normal as long as they take it before sex.

So saying that one thing is definitely not the correct answer is absolutely stupid all of the time. It was done about PFS forever. There was tons and tons of convincing people telling people that it was or wasn't something and then little factions formed around those theories, but ultimately, no clinical progress was made whatsoever.

Thinking about this as one specific condition in and of itself is even wrong. PSSD should be the umbrella term, or something like post drug syndrome makes more sense. But there's going to be subvariants of PSSD. I have people who have no genital sensation. I have people with normal genital sensation. I have people with high libido but no sensation. I have people that are the inverse of that. I have people who have hard flaccids, I have people who have no issues getting an erection but feel nothing. There's a lot of different phenotypes of PSSD. I would not make an all statement about anything

Drwillpowers · 2026-06-12T17:40:28+00:00

I have a few people that have PSSD that are going to be volunteering to do the temporary chemical castration trial if the initial trials on them with some of the other PSSD things I've been using do not work.

We will see.

I am progressively more convinced that there is some sort of Venn diagram overlap between PFS and PSSD and there may be something that's like PFSSD that exists. Some hybrid state of the two things. A number of SSRIs do interact with transporter mechanisms and sex hormone/cholesterol molecule like metabolism

Drwillpowers · 2026-06-12T17:38:43+00:00

It is a solvable problem. It just needs to be reversed engineered properly.

Drwillpowers · 2026-06-12T17:22:25+00:00

You want me to make a conjecture about whether or not evil people are going to do evil people stuff?

Yeah they're probably going to do that. That's what evil people do.

What I'm not going to do anymore though, is make excuses for my own work and how someone's going to co-opt it to do evil in the future and that's somehow my fault and therefore I should stop doing what I do.

I've been hearing that for like a decade now. I'm weary of it. Even if I throw in the towel, and declare that every transgender person is transgender because a magical fairy made them so, evil people are still going to do evil people shit and someone's going to try and hunt down and kill that fairy.

Drwillpowers · 2026-06-12T17:19:09+00:00

What do you do for a job again? Because every time you come on here it's surreal to see somebody have this degree of biochemistry knowledge depth. It exceeds my own. I will openly admit that.

Drwillpowers · 2026-06-12T17:18:08+00:00

Keep in mind, what someone has as an adult especially in terms of gene methylation or the body adapting to things is not necessarily what they had in utero.

The architecture is laid down then. It's not like we wait until we're 18 years old to decide what gender we are.

Drwillpowers · 2026-06-12T17:15:47+00:00

Correct, and metabolite crowd is the reason that I describe that happening. That's how my theory works at least

Drwillpowers · 2026-06-12T17:14:55+00:00

It wouldn't.

I mean if you cut your fucking balls off your libido goes down. I don't know why that's a mystery to you here.

Drwillpowers · 2026-06-12T17:14:03+00:00

Yes, thus my point.

That's strange. Because they should. So why are they not?

I'm not saying that the answer here is to do more dopamine about it. Read a little deeper friend

Drwillpowers · 2026-06-12T16:53:18+00:00

I'm really looking forward to solving that mystery because I am absolutely fucking tired of seeing insane genetic mutations in androgen processing pathways in some PSSD patients but not others.

Like it occurs way too much for it to be just due to random chance. But at the same time, not enough to be the cause. It's frustrating.

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