PFS Help - High E, High T, Cognitive Symptoms

[CloudsInTheHead]

Big thanks to anyone who takes the time to read/skim this and offer advice. I'll be updating this thread with results from any of my therapy attempts.

Background
I began taking oral finasteride (1 mg every 2-4 days) in 2017, when I was 23, and quit in early 2020. Side effects set in very soon after starting, but due to a combination of hair loss anxiety, poor judgment, and denial, I stuck with the treatment far longer than I should have and now seem to be stuck with persistent issues.

Symptoms
My primary symptoms are brain fog and mental/physical fatigue. Specifically, my memory, concentration, and processing speed all feel dramatically reduced. I can function decently when I’m alone, but I struggle in social settings or noisy/dynamic environments of any kind. Emotionally, I feel apathetic and detached—I used to worry obsessively, but now very little registers. I’ve also noticed changes to my vision, including light sensitivity (I wear sunglasses just about everywhere I can) and haloing. These symptoms are most bearable in the morning, though I usually wake up feeling hazy and unrested, and tend to worsen as the day progresses.

Curiously, I never noticed any sexual changes while on the drug, but I did notice a drop in labido after quitting (the bloodwork in the next section will shed some light on that). Since I’m not experiencing the usual, more debilitating issues (e.g. ED, strange ejaculate, numbness, penile shrinkage), I’m not especially bothered by this.

Blood Test Results
Below is blood work gathered before, during, and after fin. I don’t have samples from all three times for all tests, unfortunately.

Note: The total and free testosterone tests used different methodologies at different times and have significantly different reference ranges, so I adjusted the results to all be relative to a single reference range (the range from the after fin test).

Normalized Numbers

Test	Before Fin (2016)	During Fin (2018)	After Fin (2021)	Before-After Change	Reference Range
Total T	741	808	682	-8%	264 - 916 ng/dl
Free T	182	175	113	-38%	50.5 - 198 pg/ml
SHBG	34		48	+41%	13 - 90 nmol/l
DHT		22	55		30 - 85 ng/dl
E2			38		0 - 31 pg/ml
TSH	.808	1.23	1.319	+63%	0.4 - 5 iu/ml
DHEA			328		138.5 - 475.2 ug/dl
Prolactin			17.4		0.4 - 15.2 ng/ml
LH			10.6		1.7 - 8.6 miu/ml
FSH			5.0		1.5 - 12.4 miu/ml

Sleep Test Result
I had a sleep test performed and was diagnosed with mild Upper Airway Resistance Syndrome (AHI = 3, RDI = 12). UARS is a bit like sleep apnea, except insteading experiencing apneas and hypoxia, sufferers enter a lighter stage of sleep due to increased breathing effort. I assume I was experiencing some degree of this prior to finasteride usage, and that the hormonal changes may have exacerbated it. The result came as a surprise to me, since I don't suffer from insomnia nor do I snore or have most sleep apnea risk factors.

Failed Therapies

• 5a-DHP - this had pretty much no perceptible effect on me, though I’ve only tried using it a few times (five drops before bed or in the morning).
• Lion’s Mane - If it’s doing anything, it’s subtle.
• Dim - nothing noticeable.
• Choline - nothing noticeable.
• GABA - nothing noticeable.
• A few supplements I’m failing to recall that were similarly unhelpful.

Ideas and Questions
Regarding the hormonal shifts, elevated estrogen seems to be the primary issue. If I understand correctly, estrogen tends to raise SHBG and prolactin, and those can have downstream effects on thyroid function. The question is what can be done to persistently lower it. Arimidex? Proviron? Has anyone been in a similar state and had any luck correcting the issue?

Regarding sleep, I plan on trying a CPAP or BiPAP as a stopgap solution and aggressively treating my nasal congestion/looking for long-term fixes.

 

[Mister]

You going to try proviron?

 

[CloudsInTheHead]

You going to try proviron?

Yes. I've already played with it a little, and I plan to do more in the future.

General update for anyone curious: I tried APAP, BiPAP, and even ASV for the OSA/UARS, along with a huge number of allergy/congestion therapies (nasal sprays, nasal dilators, antihistamines, hypoallergenic sheets, etc). The machines supposedly lowered my AHI and RDI to subclinical levels, but subjectively made me feel worse if anything. I'm convinced that insomnia is a central part of my issue, but I don't think OSA or UARS is responsible.

After dismissing OSA I tried some supplements and sleep aids. Phenibut basically had no effect on me, even in fairly high doses, which is kinda strange though apparently not so uncommon. I have found magnesium threonate to be somewhat helpful, but it's hardly a miracle.

On the hormonal side I tried anastrozole and letrozole to treat the high estrogen. Letro lowered my E to about the bottom of the healthy range (~10 pg/ml), but didn't improve symptoms. Given my high testosterone, reasonably high DHT numbers, and lack of common estrogenic issues, I'm no longer convinced estrogen is a problem. I also used anavar for a week or so, and as mentioned, took a few proviron tabs recently. Neither had any noticeable effect, but I plan on revisiting the proviron.

Because I was curious about dopamine and neurotransmitters, I gave bupropion a shot for about a month. It initially gave me a little extra nervous energy, but quickly became useless. It also raised my already elevated prolactin significantly.

Just recently I took a urine cortisol test and received these totally screwed up results:
Morning: 6.4 (7.8 - 29.5)
Afternoon: 6.5 (23.4 - 68.9)
Evening: 26.8 (6 - 19.2)
Before bed: 82.5 (2.6 - 8.4)

I'm waiting on the results of a second saliva test for confirmation, but this is really promising to me, since I have so many symptoms of adrenal issues (low blood pressure, high white blood cell counts, fatigue, weird sleep, bad reactions to food, and really positive response to coffee).

I have hydrocortisone and progesterone in the mail. The plan is to prioritize adrenal treatments, and if those turn out to be a dead end, I'll give more attention to androgens and HCG.

Hope this is helpful and that 2022 is a year of significant progress for all of us.

 

[Mister]

Good luck bro, sounds like a good theory and plan. Keep us updated.

 

[Dehdly]

@CloudsInTheHead - where are you at with this now?

 

[CloudsInTheHead]

@CloudsInTheHead - where are you at with this now?

I have some updates to report, though not as many as I'd like. It's been a fairly busy few months.

First off, I didn't have much luck with progesterone. I tried Dr Will Powers' progesterone experiment and just didn't notice any obvious changes. Curiously, I did get really good sleep the first night after stopping the treatment, but that could be entirely coincidental. Maybe I'll revisit this one later and stay on the protocol for longer than five days, but I'm just not expecting much at this point. I also tried 'proviron' at 100mg/day for five days, but it appears the drug I received was fake (blood tests showed no increase in free testosterone or DHT at the end of the work week). I'll definitely be revisiting this (more on that at the end). Concluding my list of relatively minor discoveries, I was able to successfully use phenibut as a sleep aid after upping my dose to about 2 grams. Unfortunately, I haven't found that this really helps much with energy the following day. It kind of makes me feel hungover instead, actually.

On the plus side, hydrocortisone seems to treat (to some extent) my fatigue and "brain fog" (though I've only tried using it a few times at relatively low doses and for one or two days at a time due to fears of causing/worsening adrenal insufficiency). I had two saliva cortisol tests performed, and both came back with values at the very bottom of the range or very near the bottom of the range, so this seems logical, but my serum cortisol was actually fairly normal, so there's more to explore here.

Which brings me to my current plan... I've purchased more proviron from another source, and I've also ordered danazol. Danazol is interesting because it not only has a strong affinity for SHBG, but also for CBG, which is basically SHBG for adrenal steroids (mostly for cortisol). Saliva cortisol tests measure unbound cortisol, whereas my serum cortisol test measured total cortisol, so I'm wondering if high CBG could explain the disparity in the results. The regulatory mechanisms for CBG are similar to those for SHBG (estrogen seems to promote it), and my SHBG is elevated post fin, so this seems quite possible. I'm also going to try to find an endocrinologist who's actually willing to work with me, and see if low-dose HCG therapy could be at all useful in my case. My LH is pretty high as is, so I fear it won't, but I think it's still worth my time to see.

Hopefully that's useful. For anyone with similar symptoms, my advice right now is to get a lot of aerobic exercise, keep a very regular sleep schedule, and to fast as much as possible. I skip breakfast and often lunch as well, because food almost always makes me feel worse (maybe this is related to cortisol's effects on insulin?). Nothing has really had a profound impact on how I feel, but those definitely move the needle the most.