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

[Aries]

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.

SSRIs can raise allopregnenolone so maybe the issue is not the same as with PFS. Maybe even over the sweet spot?

Also, since OP is eugonadal natural now his LH is not crashed. Why is HCG potentially better than endogenous LH? Does HCG regulate steroid conversion enzymes differently than LH/FSH?

Since AAS also increase AR receptor expression, would T+HCG protocol work instead of l-carnitine injectable or HCG mono?

 

[RatAttack]

Since AAS also increase AR receptor expression, would T+HCG protocol work instead of l-carnitine injectable or HCG mono?

This is my line of thinking as well. HCG seems to offer relief to PFS patients by increasing 5ar expression. I don't believe we have those same issues; rather, our AR expression may be reduced in central pathways that govern sexual function (like the mPOA) as well as in peripheral tissue.

A couple PSSD patients have had severe crashes from the use of HCG. We seem to tolerate TRT better.

 

[RatAttack]

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.

I understand that using exogenous hormones will shutdown LH and cause reduced downstream neurosteroids. Can't DHEA, preg, and prog be supplemented in order to increase this deficit?

HCG looks good on paper, but we have had several members experience severe crashes from HCG monotherapy, which makes me extremely wary of trialing it. We have hypothesized that many of us already have reduced ER-alpha expression, and HCG downregulates this further while upregulating ER-beta.

What's the theory behind the use of injectable l-carnitine? Do you have any experience using it yourself?

 

[RatAttack]

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.

I appreciate the honest reply, especially from someone who isn't keen on the use of testosterone and who has tried it extensively himself. As for "short term," what would be considered such a duration? From what I've read, it takes about 8-12 weeks to dial in T alone, and from there, it may take additional time as adjustments are made to correct the thyroid, neurosteroid precursors, etc.

 

[Lokzo]

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

Thanks for the tag man.

Yes, PSSD has been a never-ending battle for me, and I have found MANY short term/temporary solutions, but still not final.

Certain foods such as potatoes starch and such can set me back for an entire week!

 

[Uselis]

Hey man,

I don't have advice just wishing you success with resolving issue. Wanna ask as well if you don't mind: did you abruptly discontinued or did slow taper?

I went down from 20mg to 1mg and along the way my libido increased a good amount. Anhedonia sucks though

I am cutting every two weeks 0.2mg and went from

 

[TheBeard]

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.

What's the risk of trying high dose testosterone and see if it resolves symptoms?

Try injections or high dose scrotal cream for 3 months, if you like it stay on, if you don't just come off

 

[Cymatic]

I have had pssd for 4+ years. Under a doctor’s supervision (doc familiar with treating PFS) I took 3 months of arimidex and clomid and got my total testosterone up around 2500 with estrogen maintaining High normal. I felt physical effects such as leaning out and felt more muscular and dense but sadly did nothing for the sexual side effects.

For me personally the cognitive effects of pssd are more frustrating than the sexual as I’ve had a persistent brain fog, short term memory loss, and amotivation

does anyone here notice improvements in symptoms the day after drinking? I think messing with GABA does things