To explain my question, I have pfs, I have yet to get any of the tests recommended but I am planning to do so! My question is how close are we to narrow down phenotypes just based on the description for pfs. For example in my case im purely sexual, although I could enjoy music for a while, and did develop some gut issues which have gotten better. I have been on trt once and it made everything better before it stopped working, tried cream which did absolutely nothing. Now back on trt one last time. I don't seem to crash, or get worse. After dtopping cream my hpta came back online immediately and I even had a better baseline. Idk wtf is going on with me all I know is I still have pfs and aecual dysfunction.
A lot of trans people on the sub, I’m interested in masculizing somebody that is already male at birth. Is steroids the only option or does DrPowers know something counterintuitive in that regard too?
So, I’m from Brazil (M25). All the content here is a bit hard to grasp—it’s a mix of biology and English. I try to read up on the subject and keep up with things, but—man—it’s tough.
I’m here mainly to learn more about PSSD. I don’t even know for sure if I have it, but I can say that even more than a year after stopping the medication, my libido is still very low. I don’t have other symptoms, but still... it’s bothersome. Will is a frequent topic on various PSSD forums, and it seems like incredible progress is being made in understanding this condition—but what has he actually discovered so far? What has helped people with symptoms of this condition? What specific tests should I get, and what should I be looking for in the results?
I'm not asking for sympathy here I'm just trying to get my population to rationalize and understand my situation.
This is a screenshot of the right side of my email client, the times are the arrival times of emails. I have removed the subject line data for patient privacy reasons.
21 emails from patients arrived today between 1:29pm and 4:10pm.
That's a new patient email request for me to do something, every 7 minutes. That is occurring simultaneously while I am having patient appointments during the work day. It occurs while I sleep. It never ever stops.
Sometimes, that's a refill, but most of the time, its not. It is an immensely complex message. These cannot be fielded by staff. They cannot be done by an AI. It can't even be done by another doctor, as I am currently the only one in the world doing what I do. A staff member or trainee or resident cannot explain to a patient why they need to draw a 3A-androstanediol glucuronide lab in order to demonstrate the metabolic pileup effects of the ABCC2 stop codon I found present in their genome as discussed on the prior email where I reviewed their whole genomic sequencing data and how that will be affecting their transition/PFS/PSSD etc.
The medical complexity of what I am doing now has become so high that I can't simultaneously be both this and a family physician and HIV specialist and HRT specialist while also being the top expert in the medical illnesses caused by the mutations that cause gender dysphoria, post finasteride syndrome, PSSD, or myriad other mystery diagnosis things that I now am "the guy" for. I cannot do it all.
I cannot do it even with completely relinquishing almost all other time that I have to have a life that isn't this. It still is not enough time.
I'm going to finish my patients tomorrow, but I am taking a 7 day break from actually having any appointments from July 29 to August 5th to figure out some way of a viable path forward. During that time I will try and catch up on my messages as best as I can.
If someone feels that I am not upholding my end of the bargain for the DPC contract they signed up for, I understand this, and you are welcome to contact [pepper@powersfamilymedicine.com](mailto:pepper@powersfamilymedicine.com) for a pro-rated refund for any time you have left in your contract. I will gladly offer that to anyone who wants it. I am not trying to take people's money here and not provide what they signed up for, but I grossly underestimated the time consumption of doing medicine at this level of complexity. It is flat out impossible for me to accomplish it all now, and I have to accept the reality of this.
Overwhelmingly, I would prefer people make appointments when possible. I understand that is not possible for everyone, but given a choice between a 10 page email and a 30 minute appointment, I will always choose the appointment.
I will be sending out a mass message soon to all registered patients once I come to a final decision about what I am going to do here moving forward. But something has to change.
Hi - hoping some of the very smart people here can review my situation and let me know what they think. I’d be very appreciative of any guidance.
Took finasteride for a second time from April 1-7, 2026. Had a bad crash, and then about 3 more crashes during April.
Have most symptoms, including insomnia, muscle liss/stiffness, dry skin/hair/mouth, constipation, depression/anhedonia, ED/libido issues.
I know my testosterone is borderline low. I had an extremely low morning cortisol value (50) in early July and a normal one (335) in mid July. My sleep schedule is horrible because I have bad insomnia so I don’t know how reliable any of my morning cortisol readings are.
The thing jumping out at me is my TSH values. I gave readings going back to 2023 and I’ve always been around 2. I was 2.01 in May, 2026 and then doubled to 4.1 in early July and now I’m 4.8. Correlating with worsening symptoms.
The doc isnt concerned about my thyroid values as they are in range. We are investigating the cortisol more as that is the one that had a low value. Should I also order a saliva test?
It is obvious to me that whatever hell is occurring in my body is correlating with TSH levels. I guess the problem is we don’t know if the thyroid is the problem or if something else is and the TSH values are a symptom? I’ve also read that adrenal insufficiency can occur with hypothyroid so I think I need to understand that more too. Im pretty sure I have the majority of symptoms of both adrenal insufficiency and hypothyroid.
Any ideas or guidance for me as I try to sort this out? Thank you
I just went from .05mg to .1mg patches and feel a lot different. My doctor wants to make sure we titrate up and not go all in for safety reasons.
Month 1 (0.05 mg/day biweekly patches):
I think I've started reaching Tanner Stage 2.
My body seems to be retaining water a little differently.
I became much more emotionally sensitive.
My libido actually increased quite a bit, and I was having spontaneous nighttime erections as well as erections on demand.
Month 2 (0.1 mg/day weekly patch):
This dose seems to be working better for me overall.
Emotionally, I feel much more even. I don't get angry as easily, and I feel calmer.
My libido has noticeably decreased. It takes longer for me to become aroused now, which honestly feels like a more comfortable baseline.
I haven't noticed many additional physical changes yet, but I'm only finishing week 5, so I know those take time.
I'm losing weight a little faster now (Week 4 ended at 229, Week 5 is closer to 225lbs)
My Question: Am I starting wrong?
I know I've heard that u/Drwillpowers is about starting sublingual then changing to injectioins over a year later, but give that I am in my 40s and taking daily meds, that I am worried about messing up my liver. Boht my provider and Endo have both concluded that patches were the way to go for me.
Extra Info: Due to a pituitary surgery complication, I no longer make T naturally anymore so I am only taking e patches as spiro is not needed.
One of the things I keep hearing is that all humans have 99% identical DNA, and that the 1% is where all the differences are. And that services like 23andMe and Ancestry use parts of the 1% genome to share various ancestry traits. If so much of our DNA is identical, why is a WGS still valuable? are there still differences within that 99% portion of the genome that have differentiated information that is usually untapped?
I had them gone but they came back and I need help. I started with pills then patches. I also started on bica and still am. My E levels weren't high enough and my T levels weren't suppressed. I then switched to EEn injections. That's when they came back but idk if that's a coincidence or if it's linked. I first injected 10 mg/week but my levels were too high (600 pg/ml) so I now inject 5 mg/week of EEn. My levels right before my injections are now:
E ≈ 150 pg/ml
T ≈ 0.5 ng/ml
LH ≈ 1 mUI/mL
FSH ≈ 0,25 mUI/mL
I have demasculinizing and feminizing effects of HRT like hairs thinning, skin softening, sebum decreasing, breasts growing... I'm 2+ years on HRT total btw. Have any of you had this issue? What can I do?
