Considering TRT As Last-Resort For Post-SSRI Sexual Dysfunction (PSSD)

RatAttack

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If any of you are familiar with PSSD, it's quite similar to post-finasteride syndrome and other lasting disorders of the endocrine system. It's characterized by symptoms such as reduced libido, ED, reduced muscle, cognitive issues, anhedonia, CNS issues, etc. The leading theory is that SSRIs can cause androgen receptor (AR) and esgtrogen receptor (ER) silencing (gene promoter methylation), such that even when blood levels of hormones are normal you still experience the aforementioned symptoms.

I took SSRIs for 8 months when I was 21 (and extremely sexually healthy, I should mention), and since discontinuing the antidepressants 4 years ago, I have been trapped in an unrelenting nightmare.

I was on the paleo diet for a long time and have tried keto and RP diets as well. I may have seen slight improvements at time but nothing to write home about. I've spent a small fortune trying every potential med and supplement under the sun, including preg/dhea, thyroid, k2, etc.

I'm at my wits end here. This condition has single-handedly upended my life. I've watched the best years of my life go by. I'd like your opinions on the best course of action at this point. I've read extensively about pharmacology, physiology, and biochemistry, such that I'm quite familiar with steroid hormones, thyroid, neurosteroids, and other topics discussed here.

Even when I've had "good" hormonal profiles (near top of range free and total T, mid-high DHT, mid E2, high preg, high DHEA), I still have been a far cry from feeling normal, sexually. However, when my hormones are optimized through diet, lifting, etc., I do feel somewhat better (maybe 60-70% normal at times).

Naltrexone and boron - which synergistically raise free T - have provided some windows of relief.

Because I'm able to map my improvements to increased androgen levels -- but because these androgen levels are going to be limited to a certain physiological range no matter how healthy of a diet and lifestyle I achieve - I am strongly considering exogenous testosterone (TRT) to get into the higher ranges (1000-1500 TT). From many studies I have read, androgen receptors are autoregulated centrally. As such, increasing my T levels significantly may enhance AR expression (at least in the areas in which the gene promoters aren't methylated).

Other PSSD sufferers with normal hormonal profiles have benefited from high-dose TRT as well.

Many of you are very knowledgeable regarding health conditions and hormones. Any opinions before I take the leap?

I'm debating whether or not to take HCG, pansterone applied topically to my scrotum, or some combination thereof to keep the pituitary and testicles active. I do have some reservations about HCG, however -- mainly that it's very estrogenic and downregulates er-a (prosexual) while upregulates er-b (anti-sexual) with prolonged use (not to mention leydig cell desensitization).

Sorry for the long post. Any opinions would be greatly appreciated.
 

lampofred

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I was persuaded into trying something similar in effects to an SSRI by a doctor for my fatigue issues and it was terrible. I stopped immediately after just one very mild session but even that is taking some time to reverse, so I can imagine 8 months of SSRIs will take a lot of work to undo. I'm finding that calcium, sugar, gelatin, thyroid, and physical work are helpful. Starch (rice and potatoes) is not.

I have RP knowledge so I will recover, but I feel so sorry for the many people who trustingly do what their doctors say. I don't know if it's malicious intent or just a horrendous mistake, because SSRIs do reduce agitation so it's easy to think that they are treating depression, but I think they are meant to do what baclofen and gelatin actually do, and the confusion between 5HT versus GABA/glycine/other inhibitory amino acids has led to disaster.
 

RatAttack

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Many people developed PSSD from a single pill. It doesn't seem that the length of use is correlated with symptom severity or duration. There is no known cure for the condition at this time. Some people get better over time; others live with this for decades in spite of living a healthy lifestyle.

Interestingly, gelatin seems to help my symptoms a small amount.

The drugs/supplements that have helped the most have been naltrexone (various doses) and boron (9-12mg), presumably by increasing hormones and freeing up those bound by SHBG.
 

lampofred

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Many people developed PSSD from a single pill. It doesn't seem that the length of use is correlated with symptom severity or duration. There is no known cure for the condition at this time. Some people get better over time; others live with this for decades in spite of living a healthy lifestyle.

Interestingly, gelatin seems to help my symptoms a small amount.

The drugs/supplements that have helped the most have been naltrexone (various doses) and boron (9-12mg), presumably by increasing hormones and freeing up those bound by SHBG.

If naltrexone helps then avoiding fluids (eating dehydrated foods and avoiding plain water) and eating more salt (I think Dr. Peat recommends un-iodized) might help.

Listening to this is something else that I'm finding slightly helpful: Delta 0.5Hz - Free Binaural Beats
 

RatAttack

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Injectable l-carnitine, 10mg/kg of LBM daily after carb rich meal.

I've read about l-carnitine increasing AR expression. Do you have personal experience using this? If so, why did you choose this route? Thanks!
 

5a-DHP

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Interestingly, gelatin seems to help my symptoms a small amount.

Glycine, the main amino acid which constitutes gelatin, is a potent regulator of the GABA system [1].

SSRI's have been shown to modulate the activity of CNS 3a-hydroxysteroid dehydrogenase [2][3], the enzyme that converts dihydroprogesterone -> allopregnanolone, with the latter being one of the most potent endogenous agonists of the GABA-A receptor [4].

Changes to the activity of CNS enzymes aren't always reflected by serum levels of the hormone said enzymes produce, which may account for your symptoms despite normal serum values. This is evidenced by the altered levels of csf, but not plasma, neurosteroids seen in those with post-finasteride syndrome [5]. 5a-reductase is one step behind 3a-HSD in allopregnanlone synthesis, and both PFS and PSSD display a large overlap in symptoms, suggesting a shared aetiology.

Naltrexone also modules the GABA system [6], which combined with your response to glycine and the effect of SSRI's on steroidal enzymes may suggest that your problem lies within altered GABAergic tone.

In my opinion, testosterone use would only make this worse due to suppression of the HPTA, and thus the production of all upstream steroids including pregnenolone, progesterone and allopregnanolone due to the downregulation of testicular steroidogenic enzymes- the end product being even more disruption to the GABA system. I'm starting to sound like a broken record re: testosterone use on this forum, but it is not the panacea it appears when it comes to libido, erection and energy problems.

I would first experiment with pregnenolone, progesterone, dhea and maybe even thyroid supplementation (if temps and pulse are low) before resorting to testosterone use. If they fail, you haven't lost anything and testosterone will still be there afterwards.

One last thing: be very careful with hCG. It is not the benign LH analogue as often described online - if it was, the pregnant women from whom it is taken from would have just produced more LH. Its shown to elicit a vastly different response compared to LH at the LH receptor [7], push energy metabolism away from glucose and towards fat oxidation (the primary role of this being to make glucose available for the developing fetus, as hCG is a hormone produced during pregnancy (and by cancerous cells for the same purpose)), and as you mentioned, it is extremely estrogenic. Anecdotally, It took almost a year for my prolactin to come down to baseline following three months of 500iu HCG EOD a few years back.
 
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RatAttack

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Glycine, the main amino acid which constitutes gelatin, is a potent regulator of the GABA system [1].

SSRI's have been shown to modulate the activity of CNS 3a-hydroxysteroid dehydrogenase [2][3], the enzyme that converts dihydroprogesterone -> allopregnanolone, with the latter being one of the most potent endogenous agonists of the GABA-A receptor [4].

Changes to the activity of CNS enzymes aren't always reflected by serum levels of the hormone said enzymes produce, which may account for your symptoms despite normal serum values. This is evidenced by the altered levels of csf, but not plasma, neurosteroids seen in those with post-finasteride syndrome [5]. 5a-reductase is one step behind 3a-HSD in allopregnanlone synthesis, and both PFS and PSSD display a large overlap in symptoms, suggesting a shared aetiology.

Naltrexone also modules the GABA system [6], which combined with your response to glycine and the effect of SSRI's on steroidal enzymes may suggest that your problem lies within altered GABAergic tone.

In my opinion, testosterone use would only make this worse due to suppression of the HPTA, and thus the production of all upstream steroids including pregnenolone, progesterone and allopregnanolone due to the downregulation of testicular steroidogenic enzymes- the end product being even more disruption to the GABA system. I'm starting to sound like a broken record re: testosterone use on this forum, but it is not the panacea it appears when it comes to libido, erection and energy problems.

I would first experiment with pregnenolone, progesterone, dhea and maybe even thyroid supplementation (if temps and pulse are low) before resorting to testosterone use. If they fail, you haven't lost anything and testosterone will still be there afterwards.

One last thing: be very careful with hCG. It is not the benign LH analogue as often described online - if it was, the pregnant women from whom it is taken from would have just produced more LH. Its shown to elicit a vastly different response compared to LH at the LH receptor [7], push energy metabolism away from glucose and towards fat oxidation (the primary role of this being to make glucose available for the developing fetus, as hCG is a hormone produced during pregnancy (and by cancerous cells for the same purpose)), and as you mentioned, it is extremely estrogenic. Anecdotally, It took almost a year for my prolactin to come down to baseline following three months of 500iu HCG EOD a few years back.

Thanks for the reply. Appreciate it.

It's possible that glycine is responsible from the small improvements seen with gelatin/collagen supplementation, but I attributed it to the serotonin-reducing properties of the aminos (I experience the same effects when depleting sero with BCAAS). I've played around with gaba-enhancing drugs and supplements (including 5a-dhp from IdeaLabs) with little symptomatic relief.

As I said, my hormonal panel indicated that I was actually HIGH (outside of the normal range) on both pregnenolone and DHEA. Progesterone was at a good level. When I've supplemented these further (including testicular application of Pansterone (DHEA/Preg), they only seem to make my symptoms worse -- probably by raising estrogen).

I don't think testosterone should ever be a first-line option -- especially for those who don't have serious medication-induced hormonal issues (PFS, PSSD, PAS, etc.). I completely agree that diet, lifestyle, and necessary supplementation can easily fix a sluggish HPTA. However, that does not seem to be the case with these illnesses. They're extreeeemely treatment-resistant.

Trust me - I did not think I would be injecting testosterone at 25 years of age, but I really cannot keep going on unless I find symptomatic relief. All signs point toward higher testosterone mapping onto symptomatic improvement - at least to some degree. I still don't expect it to be a panacea, but any improvement to my baseline would be welcomed at this point.

Regarding HCG, I completely agree. If I do decide to start TRT, what would you recommend to take in addition to the testosterone? I read a couple threads by Haduit, who suggested that using Pansterone (topical DHEA/Preg) may keep the testicles active. Could this be used as a substitute for HCG? I know HCG doesn't backfill pathways, so its only use is really keeping the pituitary active. Of course, a PCT restart could achieve this same goal, so I don't think it's highly necessary.

Any thoughts on the "optimal" TRT regimen, if you had to create one?
 
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If naltrexone helps then avoiding fluids (eating dehydrated foods and avoiding plain water) and eating more salt (I think Dr. Peat recommends un-iodized) might help.

Listening to this is something else that I'm finding slightly helpful: Delta 0.5Hz - Free Binaural Beats

dehydration is really really dangerous, I do not believe that RP is a Fan of dry fasting or such at all.
 
Joined
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Messages
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Glycine, the main amino acid which constitutes gelatin, is a potent regulator of the GABA system [1].

SSRI's have been shown to modulate the activity of CNS 3a-hydroxysteroid dehydrogenase [2][3], the enzyme that converts dihydroprogesterone -> allopregnanolone, with the latter being one of the most potent endogenous agonists of the GABA-A receptor [4].

Changes to the activity of CNS enzymes aren't always reflected by serum levels of the hormone said enzymes produce, which may account for your symptoms despite normal serum values. This is evidenced by the altered levels of csf, but not plasma, neurosteroids seen in those with post-finasteride syndrome [5]. 5a-reductase is one step behind 3a-HSD in allopregnanlone synthesis, and both PFS and PSSD display a large overlap in symptoms, suggesting a shared aetiology.

Naltrexone also modules the GABA system [6], which combined with your response to glycine and the effect of SSRI's on steroidal enzymes may suggest that your problem lies within altered GABAergic tone.

In my opinion, testosterone use would only make this worse due to suppression of the HPTA, and thus the production of all upstream steroids including pregnenolone, progesterone and allopregnanolone due to the downregulation of testicular steroidogenic enzymes- the end product being even more disruption to the GABA system. I'm starting to sound like a broken record re: testosterone use on this forum, but it is not the panacea it appears when it comes to libido, erection and energy problems.

I would first experiment with pregnenolone, progesterone, dhea and maybe even thyroid supplementation (if temps and pulse are low) before resorting to testosterone use. If they fail, you haven't lost anything and testosterone will still be there afterwards.

One last thing: be very careful with hCG. It is not the benign LH analogue as often described online - if it was, the pregnant women from whom it is taken from would have just produced more LH. Its shown to elicit a vastly different response compared to LH at the LH receptor [7], push energy metabolism away from glucose and towards fat oxidation (the primary role of this being to make glucose available for the developing fetus, as hCG is a hormone produced during pregnancy (and by cancerous cells for the same purpose)), and as you mentioned, it is extremely estrogenic. Anecdotally, It took almost a year for my prolactin to come down to baseline following three months of 500iu HCG EOD a few years back.

Was your hCG use post cycle or as monotherapy? How long did you take it? What did it to your labs, T etc?
 
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If any of you are familiar with PSSD, it's quite similar to post-finasteride syndrome and other lasting disorders of the endocrine system. It's characterized by symptoms such as reduced libido, ED, reduced muscle, cognitive issues, anhedonia, CNS issues, etc. The leading theory is that SSRIs can cause androgen receptor (AR) and esgtrogen receptor (ER) silencing (gene promoter methylation), such that even when blood levels of hormones are normal you still experience the aforementioned symptoms.

I took SSRIs for 8 months when I was 21 (and extremely sexually healthy, I should mention), and since discontinuing the antidepressants 4 years ago, I have been trapped in an unrelenting nightmare.

I was on the paleo diet for a long time and have tried keto and RP diets as well. I may have seen slight improvements at time but nothing to write home about. I've spent a small fortune trying every potential med and supplement under the sun, including preg/dhea, thyroid, k2, etc.

I'm at my wits end here. This condition has single-handedly upended my life.

@Lokzo I think member Lokzo can help you here because he has also suffered with PSSD
 

5a-DHP

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Was your hCG use post cycle or as monotherapy? How long did you take it? What did it to your labs, T etc?

I've used it for both purposes, though the experience in question was using it as monotherapy - 500iu EOD for three months.

Put my total testosterone at 21 nmol/L (8 - 30), estradiol at 170 pmol/L (40 - 155) and prolactin at 600 mU/l (86 - 324). It also tanked my adrenals, leaving me with undetectable progesterone and below-range serum am cortisol and dhea-s, all three of which were fine pre-hcg.
 
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5a-DHP

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As I said, my hormonal panel indicated that I was actually HIGH (outside of the normal range) on both pregnenolone and DHEA

As I said, serum levels =/= systemic hormonal status, intracellular activity and overall steroid turnover. You shouldn't take the preg and dhea if they make you feel worse, but likewise, you cannot claim said hormones are fine based upon serum readings -- especially for preg, which exerts most of its action as a paracrine and autocrine hormone within the CNS.

Trust me - I did not think I would be injecting testosterone at 25 years of age, but I really cannot keep going on unless I find symptomatic relief. All signs point toward higher testosterone mapping onto symptomatic improvement - at least to some degree. I still don't expect it to be a panacea, but any improvement to my baseline would be welcomed at this point.

Then try it. As long as you stay within the realm of bio-identical hormones and away from compounds like the 19-nors your endogenous testosterone production should come back online if you ever want to stop. On the surface, it does come across like you're only here to have people tell you what you want to hear - that starting testosterone will help, that its the right answer, etc. That's fine - its your body, you're more than entitled to do as you wish - but taking replacement doses of testosterone is nothing like taking preg, prog and dhea.

Regarding HCG, I completely agree. If I do decide to start TRT, what would you recommend to take in addition to the testosterone? I read a couple threads by Haduit, who suggested that using Pansterone (topical DHEA/Preg) may keep the testicles active. Could this be used as a substitute for HCG? I know HCG doesn't backfill pathways, so its only use is really keeping the pituitary active. Of course, a PCT restart could achieve this same goal, so I don't think it's highly necessary.

HCG doesn't keep the pituitary active; it acts as an LH analogue which stimulates the intratesticular testosterone production required for spermatogenesis. Your pituitary, and thus LH and FSH release, will remain suppressed irrespective of hCG use. You should probably take preg and dhea alongside the testosterone, but trying to dial in a hrt protocol with three different variables right off the bat will be very challenging. The studies Haidut posted about preg keeping the testis active alongside testosterone use were in rats, so cannot automatically be equated to humans. Also, the dosages of preg needed alongside high level trt according to the studies in question would be in the range of 500mg per day - not a level you can achieve with pansterone.

Any thoughts on the "optimal" TRT regimen, if you had to create one?

A one size fits all testosterone protocol doesn't exist. Start with 50 - 62.5mg of cyp or enanthate injected e3.5d, get bloods after 6 weeks and adjust accordingly based upon labs and how you feel. You can alter injection frequency, dosage and the ester itself after your first set of bloods until you find something that makes you feel good. Testosterone isn't like preg, prog, dhea, etc, in that you can't be changing up your dose, dosing frequency, etc, every other day on the whim. The esters take time to level out in your system, meaning even if you don't feel good, you have to stick with a protocol for at least five-six weeks so that your bloodwork actually depicts an accurate representation of where said protocol puts your levels. Most people who self-medicate don't do this, and then get stuck in a never ending cycle of changing their protocol on a week to week basis without ever getting anywhere.

Whatever you do, be careful. Whilst playing with hormones is made to look trivial by places like this, reddit, etc, its serious stuff, and you can very easily make your situation much, much worse. Not my intention to fear monger, but you need to be aware of the risks involved.
 
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RatAttack

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As I said, serum levels =/= systemic hormonal status, intracellular activity and overall steroid turnover. You shouldn't take the preg and dhea if they make you feel worse, but likewise, you cannot claim said hormones are fine based upon serum readings -- especially for preg, which exerts most of its action as a paracrine and autocrine hormone within the CNS.

Fair enough.


Then try it. As long as you stay within the realm of bio-identical hormones and away from compounds like the 19-nors your endogenous testosterone production should come back online if you ever want to stop. On the surface, it does come across like you're only here to have people tell you what you want to hear - that starting testosterone will help, that its the right answer, etc. That's fine - its your body, you're more than entitled to do as you wish - but taking replacement doses of testosterone is nothing like taking preg, prog and dhea.

Yes and no. I'm not here for people to tell me to take testosterone. I've optimized my body as much as possible through diet, exercise, supplements (including the ones regularly used here) enough to more than double my free testosterone, yet even that was not enough to increase my sexuality back to a decent baseline. With that said, yes - I am looking for people who have used TRT, especially in combination with other add-ons (preg, dhea, prog, thyroid, etc.) in order to learn from their experiences. The conventional bodybuilding sites/subs centered around TRT (like T nation) often pay little attention to endogenous steroid production.


HCG doesn't keep the pituitary active; it acts as an LH analogue which stimulates the intratesticular testosterone production required for spermatogenesis. Your pituitary, and thus LH and FSH release, will remain suppressed irrespective of hCG use. You should probably take preg and dhea alongside the testosterone, but trying to dial in a hrt protocol with three different variables right off the bat will be very challenging. The studies Haidut posted about preg keeping the testis active alongside testosterone use were in rats, so cannot automatically be equated to humans. Also, the dosages of preg needed alongside high level trt according to the studies in question would be in the range of 500mg per day - not a level you can achieve with pansterone.

Yes, I misspoke. I meant that while HCG would keep the testis active through the LH analogue, it would shut down the pituitary, which could likely be restarted at a later date with a PCT regimen (clomiphene, nolvadex) if needed. Yes - I read the study he posted as well, and the doses were pretty insane (if I remember cited that to preserve testicular size, you had to use something like 12:1 preg:T.

A one size fits all testosterone protocol doesn't exist. Start with 50 - 62.5mg of cyp or enanthate injected e3.5d, get bloods after 6 weeks and adjust accordingly based upon labs and how you feel. You can alter injection frequency, dosage and the ester itself after your first set of bloods until you find something that makes you feel good. Testosterone isn't like preg, prog, dhea, etc, in that you can't be changing up your dose, dosing frequency, etc, every other day on the whim. The esters take time to level out in your system, meaning even if you don't feel good, you have to stick with a protocol for at least five-six weeks so that your bloodwork actually depicts an accurate representation of where said protocol puts your levels. Most people who self-medicate don't do this, and then get stuck in a never ending cycle of changing their protocol on a week to week basis without ever getting anywhere.

Thank you for the advice. I've read similar information on T nation regarding really sticking to a regimen for at least 8 weeks before making any changes.

Whatever you do, be careful. Whilst playing with hormones is made to look trivial by places like this, reddit, etc, its serious stuff, and you can very easily make your situation much, much worse. Not my intention to fear monger, but you need to be aware of the risks involved.

I'm extremely cautious by nature. I hate that I've ended up in this position where I have to consider TRT, but sometimes extreme circumstances require extreme measures. Most of those who have escaped PFS have done so through the use of pretty dangerous steroids as well.

I understand the risks. As you said, though, I think the risk is significantly minimized if you know what you're doing and follow a prudent regimen.

Thanks again!
 

RatAttack

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@Lokzo I think member Lokzo can help you here because he has also suffered with PSSD

Thanks for tagging him. I see many more PFS members than I do PSSD members around here. It would be great to have some first-hand knowledge from someone else who has gone this route.
 

sladerunner69

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If any of you are familiar with PSSD, it's quite similar to post-finasteride syndrome and other lasting disorders of the endocrine system. It's characterized by symptoms such as reduced libido, ED, reduced muscle, cognitive issues, anhedonia, CNS issues, etc. The leading theory is that SSRIs can cause androgen receptor (AR) and esgtrogen receptor (ER) silencing (gene promoter methylation), such that even when blood levels of hormones are normal you still experience the aforementioned symptoms.

I took SSRIs for 8 months when I was 21 (and extremely sexually healthy, I should mention), and since discontinuing the antidepressants 4 years ago, I have been trapped in an unrelenting nightmare.

I was on the paleo diet for a long time and have tried keto and RP diets as well. I may have seen slight improvements at time but nothing to write home about. I've spent a small fortune trying every potential med and supplement under the sun, including preg/dhea, thyroid, k2, etc.

I'm at my wits end here. This condition has single-handedly upended my life. I've watched the best years of my life go by. I'd like your opinions on the best course of action at this point. I've read extensively about pharmacology, physiology, and biochemistry, such that I'm quite familiar with steroid hormones, thyroid, neurosteroids, and other topics discussed here.

Even when I've had "good" hormonal profiles (near top of range free and total T, mid-high DHT, mid E2, high preg, high DHEA), I still have been a far cry from feeling normal, sexually. However, when my hormones are optimized through diet, lifting, etc., I do feel somewhat better (maybe 60-70% normal at times).

Naltrexone and boron - which synergistically raise free T - have provided some windows of relief.

Because I'm able to map my improvements to increased androgen levels -- but because these androgen levels are going to be limited to a certain physiological range no matter how healthy of a diet and lifestyle I achieve - I am strongly considering exogenous testosterone (TRT) to get into the higher ranges (1000-1500 TT). From many studies I have read, androgen receptors are autoregulated centrally. As such, increasing my T levels significantly may enhance AR expression (at least in the areas in which the gene promoters aren't methylated).

Other PSSD sufferers with normal hormonal profiles have benefited from high-dose TRT as well.

Many of you are very knowledgeable regarding health conditions and hormones. Any opinions before I take the leap?

I'm debating whether or not to take HCG, pansterone applied topically to my scrotum, or some combination thereof to keep the pituitary and testicles active. I do have some reservations about HCG, however -- mainly that it's very estrogenic and downregulates er-a (prosexual) while upregulates er-b (anti-sexual) with prolonged use (not to mention leydig cell desensitization).

Sorry for the long post. Any opinions would be greatly appreciated.

I'm in a similar conundrum as you, with post-finasteride syndrome. I got it at 18 and am 27 now, and my libido and cognitive function have never been well during that time.

I have never tried T but have used testosterone prohormones and androsterone (dht prohormone) with moderate success. I just came off an 8 week cycle of 4-super andro and androsterone, both dosed at 200mg per day. Towards the end the effects became much less pronounced. My libido is only decent after I have a beer or twoi, for the estrogen, as normally my very peaty regimine with vitamins and supplements keeps estrogen very low.

Anyways I also begin HCG a few weeks ago after reading that many PFS users are having success with it. Joe Koolaid, another user here, actually completely resolved his pfs with it after 6 months of low dose. The dosage regimine is 250iu 3 times a week. Normal dosage is 200iu each day, so this is about a half dose.

Pregnenelone and creatine also help me. So do 5-adhp, caffiene, thyroid, niacinimide, and definitely glycine. I also take taurine, b6 and magnesium. Sometimes vitamin C and aspirin and k2. Like you, Ive spent a small fortune trying different things but nothing has truly brought my life back, at least not yet. I remain resolved and steadfast in my quest to regain my health, virility, cognizance, and passion, even if it take the remainder of my life. I look forward to seeing your results on high dosage TRT, assuming you choose to utilize it.

P.S. - I have never heard of er-a and er-b. I will look into those, considering I should be prudent while taking HCG. I am aware of leydif cell desensitization- thus the smaller dosage.
 

RatAttack

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I'm in a similar conundrum as you, with post-finasteride syndrome. I got it at 18 and am 27 now, and my libido and cognitive function have never been well during that time.

I have never tried T but have used testosterone prohormones and androsterone (dht prohormone) with moderate success. I just came off an 8 week cycle of 4-super andro and androsterone, both dosed at 200mg per day. Towards the end the effects became much less pronounced. My libido is only decent after I have a beer or twoi, for the estrogen, as normally my very peaty regimine with vitamins and supplements keeps estrogen very low.

Anyways I also begin HCG a few weeks ago after reading that many PFS users are having success with it. Joe Koolaid, another user here, actually completely resolved his pfs with it after 6 months of low dose. The dosage regimine is 250iu 3 times a week. Normal dosage is 200iu each day, so this is about a half dose.

Pregnenelone and creatine also help me. So do 5-adhp, caffiene, thyroid, niacinimide, and definitely glycine. I also take taurine, b6 and magnesium. Sometimes vitamin C and aspirin and k2. Like you, Ive spent a small fortune trying different things but nothing has truly brought my life back, at least not yet. I remain resolved and steadfast in my quest to regain my health, virility, cognizance, and passion, even if it take the remainder of my life. I look forward to seeing your results on high dosage TRT, assuming you choose to utilize it.

P.S. - I have never heard of er-a and er-b. I will look into those, considering I should be prudent while taking HCG. I am aware of leydif cell desensitization- thus the smaller dosage.

I believe that while PFS and PSSD share many of the same symptoms, they have different etiologies. From what I've read, it seems 5ar enzymes are significantly downregulated in PFS, while this is not the case in PSSD. For this reason, I don't think the same treatment approaches necessarily apply. I have talked to JoeKool about his experiences with HCG. Quite fascinating. It appears high-dose mesterolone (proviron) is working for some PFS patients as well. It'll be interesting to see whether these cures can be replicated.
 

5a-DHP

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183
It isn't my intention to give you a hard time. Listen, only you know how you feel, so if you think testosterone will help within the context of your unique situation, just try it. Nobody here has a perfect answer that will sway your decision either way and, given your self-stated cautious nature, no amount of reading will ever make you feel ready, comfortable or prepared to make the jump. You seem relatively well-versed in the area, you've done your research, so you need to either take it and find out or move on and completely forget about it. Hovering somewhere in the middle too apprehensive to act is a surefire way to continue watching life pass you by, as you yourself have already experienced for four whole years.

The hysteria surrounding permanent hpta suppression stems from the bodybuilding community who use synthetic derivatives that leave behind long-acting, hpta-suppressive metabolites. With this in mind: as long as you remain within the realm of bio-identical androgens, the risk of causing significant harm is little to none over the short term. If it doesn't work you can come off and there's no harm done - at least you'll have a definitive answer.
 
Last edited:

sladerunner69

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I believe that while PFS and PSSD share many of the same symptoms, they have different etiologies. From what I've read, it seems 5ar enzymes are significantly downregulated in PFS, while this is not the case in PSSD. For this reason, I don't think the same treatment approaches necessarily apply. I have talked to JoeKool about his experiences with HCG. Quite fascinating. It appears high-dose mesterolone (proviron) is working for some PFS patients as well. It'll be interesting to see whether these cures can be replicated.

Yes I agree that the fundamental dysfunction is probably different. I think 5-ar downregulation is the root cause of PFS, leading to low DHT, low allopreg, and other steroids which are downstream of 5-ar (all types , 1 2 &3). I would imagine that the issue with PSSD revolves around perpetually elevated serotonin. I think the re-uptake mechansim isn't working. Have you tried heavily anti-serotonin treatments, such as caber, lisuride, antibiotics ?

Having low DHT can also result in elevated serotonin, so I can see why the conditions would be similar.
 

Fidelio

Member
Joined
Feb 28, 2020
Messages
89
Don’t take exogenous hormones, you make the problem worse because you crash LH.
Exogenous hormones > crashed LH > low stard1 > broken pregnenolone cascade > no allopregnenolone and other 5ar reduced preg derivatives = crashed libido.
Similar to post-fina syndrome, but less extreme.
If you look on TRT/steroid forums you see a ton of guys with libido issues, caused by their exogenous hormone use.

Use HCG or l-carnitine injectable.
 
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