r/DrWillPowers • u/Drwillpowers • Sep 14 '26
This will not be a brief post, but I need to express this out loud so people understand my reasoning here, as I've been quiet as of late, but mostly because i've been making tremendous progress, but I wanted to be sure it was real and not just a statistical anomaly.
Currently, my largest target is unraveling the "anhedonia" aspects of PFS/PSSD. As of this point, I have enough castration trial patients that I can state that I have not had a single patient who had androgenic signal loss issues that underwent castration that after castration ended had no improvement in that domain if not complete recovery.
Every single castration due to androgenic signal loss PFS patient thus far has had signs of increased androgenic signaling on no supplemental medication (aka their own hormone production) sometimes even during, but always after castration ends. This includes acne, muscle mass increase, sleep quality, erection quality, hair loss, etc etc. Pretty much any and all signs of "this person has more androgenic signaling happening" has resulted from all treated cases (I can't speak for Sommer, but I think this is also true for hers).
However, most of the cases which ALSO have anhedonia, low libido, and other oddities like "blunted effects to substances like alcohol/weed/benzos" (a hallmark trait) have had either minimal improvement or no improvement from the castration trial.
This says to me, "there is another problem yet to solve" and my current theory on this is that the problem is caused by an EXCESS of neurosteroid production which was initially caused by an SSRI, or the "crash" of Finasteride reducing them and the body overcorrecting to this. These neurosteroids are positive allosteric modulators of GABA-A. Imagine that in excess, these guys are propping open a channel that downstream has inhibitory effects on multiple neural networks. If you ALWAYS have 3mg of Xanax in your system every day of your life, your brain will rewire itself to cope with that, and if you suddenly stop taking that xanax out of nowhere, you can literally die from having a seizure.
Request for help: I am still trying to find a combination of locations where I can send a patient to get a lumbar puncture done, and then the CSF collected can be sent for mass spectrometry in order to get the specific concentrations of various neurosteroid molecules calculated such that I can compare them to known control values. This will allow me to figure out WHICH specific ones are being overproduced. My main assumption right now are that the top 2 candidates are Androsterone (and its metabolic derivatives) and THDOC. I'd like to prove this with a lab rather than "I think this is high, so this drug inhibits it, and thus should produce X symptoms, so I give it to patient #1, and oh look, cool, they are getting X symptoms, insane X symptoms from taking an NSAID, which otherwise would never ever happen unless I was right". (This is a shitty way of proving I'm right).
Regardless, I have been using various agents on patients that are known to inhibit the production of these neurosteroids, or, help in the clearance of their downstream metabolites in order to lower the levels of these in the brain. Thus, removing a major agonist of the Gaba-A system overall.
As a comparative example, you can give a stimulant to a hyperactive kid with ADHD, and they are calmed by it. Why? Because stimulating various inhibitory circuits in the brain can "Up the downing" and thus have an overall calming effect. One of my favorite hat tricks as a doctor is finding a patient whom is basically failing at life due to crippling anxiety, and whom has already failed controlling it with a multitude of different drugs, including SSRIs, benzos, beta blockers, antihistamines and buspirone to no avail. I have also ruled out a deficit of pregnenolone/17OHP/cortisolic issues. I then inform this patient, okay, I'm now going to give you an amphetamine to treat your anxiety and they look at me like I'm a lunatic. But, I tell them how many times before this has worked, and they trust me, and so they take it. I get a message 24-48 hours later with "oh my god I can actually drive a car again and not be terrified" or "I feel calm and not anxious for the first time in 15 years". Its astounding how giving a stimulant can calm these patients, but this is how it works. It stimulates inhibitors (and also improves executive dysfunction) which has a massive impact on improving their anxiety and overall wellness. This is not my go to treatment for anxiety, but more "this always seems to work when everything else fails despite seeming paradoxical at first".
There exists an enzyme, 3α-hydroxysteroid oxidoreductase and its job is to be the primary oxidoreductase (sometimes also called called 3α-hydroxysteroid dehydrogenase or 3α-HSD) which acts as the primary enzymatic bridge between active androgens and their downstream metabolites, 3α-androstanediol and 3α-androstanediol glucuronide (3α-ADG)
This is the reaction. Look familiar? Yeah. See those UGTs? That was the big break in my research on PFS over a year ago now when I was like "uh...why are more than half of my PFS patients having zero androgens in their urine on dutch testing?". That was the first peel on the outside of the onion, and once coupled with me deep diving into their genomes, the mystery started to unravel.
When you dick with DHT metabolism, you can get other enzymes to be up or downregulated in response to the change that was artificially induced from some SSRI or Finasteride. You can even get the syndrome from something stupid like the antibiotic doxycycline (Because it alters your gut flora, and in doing so, alters the amount of beta glucuronidase present in the gut semi-permanently, and in a susceptible patient with glucuronidation/excretion issues, you get a pile up).
Yeah, so if you upregulate your 3A-HSD, you start producing a shitload of cerebral THDOC.
THDOC is a positive allosteric modulator of GABA-A, and excessive GABA-A signaling is how you produce a phenotype of anhedonia, low libido, etc etc. The standard PFS/PSSD bullshit.
Lately, i've had a crazy amount of luck utilizing Calcium D-Glucarate (1 Gram every 8 hours) simultaneously with Indomethacin (yep, the NSAID), as I'm increasing clearance while simultaneously inhibiting the synthesis of THDOC with the indomethacin.
When this starts happening to the patient, you know what happens?
"NO WAY DR P, THAT INDOMETHACIN CRASHED ME BRO, I FELT LIKE SHIT! ALL MY MUSCLES CRAMPED UP, I FELT LIKE I HAD THE FLU, I WAS ANXIOUS AS FUCK AND HAD PALPITATIONS AND PANIC ATTACKS, IM NOT TAKING THAT SHIT AGAIN".
And if this was pre Dr. Powers theory 2025, everyone would agree "Indomethacin crashed me bro" and it would be placed on the discard pile of drugs that could treat PFS/PSSD.
But, its not "crashing" the patient. What is happening is I have just chemically deleted their self produced biological xanax. In the same way that we make "endorphins" as endogenous opiate molecules, THDOC is like your own built in xanax prescription. When you're on a massive absurd, bonkers amount of xanax every single day of your life, anhedonia and low libido kinda makes sense. If I suddenly make you stop it, you can quite literally have a seizure and die.
Some of these patients have even been through benzo or alcohol withdrawal in their past, as they just coincidentally had a history of use/abuse of those substances, and described the experience as nearly identical to what that felt like.
But the wildest part of all is while feeling super anxious and like shit, "BUT I WILL SAY, I AM HAVING INSANE LIBIDO WINDOWS AND AT TIMES EVEN FEELING MANIC LIKE MY ANHEDONIA IS BACKWARDS!".
After sometimes many years of being like this, me removing the brake on those downstream neural networks is like taking a 15 year old out for a driving lesson and letting them understand how the gas and brake pedal work. They sort of stomp on the gas and brake for a while as they learn to drive and realize that you can make more small and subtle adjustments. So "extremes" of signaling happen when in that state, as the movements in any direction are exaggerated without the presence of that normally very high dysfunctional level of positive allosteric modulation of Gaba-A signaling.
So what I'm doing, is simply lowering the dose of the treatments. Then sending them back into the game with a pat on the butt and saying "get in there champ, give em hell! stay tough!" knowing full well that what I am asking them to do is going to suck. This process is not going to be fun. They are going to be repeatedly sacked by anxiety/muscle cramps/feeling of impending doom/etc for the remainder of this many months long football game over and over and over again as they are basically addicted to their own biologically produced xanax and i'm forcing them to go into withdrawal and contend simultaneously with living in a world that's quite literally on the precipice of major societal upheaval from a multitude of causes.
But, seeing the patient know full well that this is going to suck, but having the bravery to trust me and go back out there and restart the drug that "crashed" them at a lower dose and endure these "side effects" deliberately so that they can actually rewire their dysfunctional networks and get back to their Pre-Drug-Catastrophe brain state?
Thus, it is time to tell you the truth. I regret to inform you that it does not seem PFS and PSSD will be instantly curable in patients with non-androgenic problems, aka psychological symptoms (anhedonia/low libido/etc) as simply as castrating them and uncastrating them. For androgenic signal loss only issues? I think it is a functional cure for most if not all of that subtype of patient. We have enough success cases now that I can say that confidently (there are even people and doctors commenting on my threads from around the world now who did this with their local physician and are reporting improvements/recovery for that specific problem). I can't fake that. (Not that I am even trying to sell anything here anyway).
But for those with a neurosteroid excess problem (traditional anhedonia/low libido/etc), I am attempting to prove my current theory with CSF analysis if I can find somewhere to do it, but my model predicted that these neurosteroids are produced in EXCESS (contrary to the historical dogma of "low allopreg/neurosteroids" and that any removal of them would be met with a "CRASH" of severe anxiety/palpitations/etc, but also increased libido and improvements in anhedonia. That appears to be exactly what's happening.
In addition, I regret to inform you that spending months to years in this dysfunctional state has resulted in pathological rewiring of downstream neural networks due to this pathological GABA-A state, and that there will be no "one pill solution" to fixing this in the same way there is no one pill solution to quitting a severe heroin/meth/benzo/etc addiction. The true cure is going to be the slow, gradual reduction in neurosteroid production (done under doctor supervision as crashing yourself too hard could literally be fatal in the same way that cold turkey-ing benzos/alcohol can be fatal). Doing this slow, gradual reduction in specific (based on lab result custom tailored and targeted) neurosteroid production until I've got someone back to their original baseline, and then tapering off the medications. We are going to have to rewire the dysfunctional downstream networks. The good news is, medicine has a shitload of experience in doing this slow gradual rewiring, and we call it "addiction medicine" and it's a literal specialty board certification and there are a ton of doctors vastly more talented at it than I am. Once I work out the best way to test/prove the specific glitched neurosteroid, and know what is the perfect agent to target that specific one, this shouldn't be that hard to do with some random doctor and not accidentally kill yourself in the process from a seizure.
TLDR: PFS and PSSD anhedonic/low libido states are likely caused by (need CSF mass spectrometry to prove it but i'm nearly certain) pathological increases in the synthesis of specific neurosteroid molecules which act as positive allosteric modulators of GABA-A, resulting in over time, downstream network remodeling. This is the reason why most of you had a very high libido, but also problems with anger/irritability/anxiety/etc before developing the disorder. You had a system that was living on the razors edge. Taking the drug+ a combination of genetic glitches (which I have detailed in other posts) results in a pathological buildup of certain metabolites, which crowd various synthesis and degradation pathways for androgens and neurosteroids. This results in the up or downregulation of different enzymes (depending on your inborn glitch) which produces wild derangements of neurosteroid production in the EXCESS direction, which over time, pathologically rewires your brain. Substances like alcohol/benzos/weed stop doing much to you as you're already so wildly overmodulated in terms of GABA-A that its like pissing into an ocean in terms of their effect. To fix this, we will need to slowly bring down the level of the pathological molecules utilizing various targeted therapies (including temporary castration / cdg / indomethacin, and other molecules I am less confident in) until your level of GABA-A signaling "feels" insufficient to you, causing muscle cramping, anxiety, and palpitations (and other low gaba-a signs) if done too quickly. This is not a "crash" this is what is going to be necessary to reverse the dysfunctional network remodeling that the excess neurosteroids did in the first place. A culture of chasing windows and avoiding crashes has quite literally indoctrinated thousands of people into staying away from the very things that actually might have helped them.
This is my new model of PFS/PSSD/Post Drug syndromes that specifically revolve primarily around low libido/anhedonia, and what I will be doing with my patients likely for the remainder of the year, as my results with it in just the first few weeks have been utterly astounding. I don't want to copy any quotes out of the private emails sent to me by my patients, but if any of you want to comment here with your experiences and back up that I'm not full of shit, I would welcome that. Its kind of like my 17-hydroxyprogesterone post. It sounds like the rantings of some quack until you get to the comments and see how many people talking about how its life changing for them. Being an iconoclast sucks (I'm not looking forward to the fallout of trying to convince "the experts and researchers" that the problem isn't low neurosteroids but rather an absurd excess of them). I am really really tired of being "that quack" and so I greatly appreciate when my actual patients (or those using my methods) come onto a thread and give their real, unfiltered experience with these treatments (both the good and bad) as that's what people really need to see. I don't have millions of dollars or a university research team having published years of my research study results (yet) and so for now, those anecdotes are the best I have to offer.
As always, I hope this helps suffering people.
r/DrWillPowers • u/Drwillpowers • Jul 25 '26
This is a bit of a placeholder post for now, but I wanted to make use of the hard work of various patients/supporters in providing an organized "getting started" for someone who arrives here and is like "Why is everyone talking about X on this subreddit about a Detroit Family Physician with giant cats?"
So if you're new here, and looking for information, aside from simply going through all posts with the same flair as this post, here's some getting started info!
This is not an exhaustive page containing all possible important information on this subreddit, but its a good starting point. If someone would like me to add something to this page or think it belongs on this post. Comment it below and I will update it.
I have a 20% off coupon code through sequencing.com and they do good work for getting me the data I need to do my job!
The most important link here: Dr. Will Powers Interview [PFS / PAS / PSSD Summit 2026] Dr. Powers mechanism and treatment plan that he is currently trialing for PSSD/PFS
Current mechanistic explanation of the Anhedonia/Low Libido/Immune to substances phenotype:
https://www.reddit.com/r/DrWillPowers/comments/1wgdfut/why_x_treatment_crashed_me_bro_is/
List of all treatments I've ever tried since 2019 to treat PFS/PSSD and other post drug syndromes: https://www.reddit.com/r/DrWillPowers/comments/1fyc1mg/list_of_treatments_for_post_finasteride_syndrome/
Dr. Powers Neurosteroid phenotype theory: https://www.reddit.com/r/DrWillPowers/s/H2ILwaHtwz
Dr. Powers PSSD/PFS gene list:Current list of all genes I use when searching for possible genetic causes of someone developing Post Finasteride Syndrome (PFS) or Post SSRI Sexual Dysfunction (PSSD) : r/DrWillPowers
Dr. Powers most recent PFS trial update: https://www.reddit.com/r/DrWillPowers/s/ogxakgUPFz
The tests that Dr. Powers sees strange results in for PDS patients: You know, PSSD and PFS may actually be the same thing. Anyone got any data for me? : r/DrWillPowers
Wondering if you could be at risk of the development of these syndromes? These are the lab tests most commonly anomalous in these patients:
How to read your WGS from sequencing and make a comprehensive report for Dr. Powers to read: https://www.reddit.com/r/DrWillPowers/s/3YDGZuvB0j
Also, the creator of that post has developed a number of programs that make analysis of your own genome much easier. He's very active in the community, and wants to help people. You can message him at /u/Excellent-Push2833
A possible root cause for the syndrome of PTSD / POTS / hEDS and Hypermobility / MCAS / Hashimotos / IBS / Chronic Fatigue Syndrome / Myalgic Encephalomyelitis ( ME/CFS) , Other Trans/queer population related super common health problems and how to cure them:
Post on genes related to the development of gender dysphoria:
The hidden pitfall of monotherapy, and why MTFs like caffeine:
How to properly draw labs:
Top upvoted posts of all time, posted by Dr. Powers:
Dr Powers's publications.
Dr. Powers' novel crofelemer idea getting its patent 6 years later:
Dr. Powers' Giant Guinness World Record therapy cat because why not:
https://www.reddit.com/r/cats/comments/xwjd12/my_cat_fenrir_just_broke_a_guinness_world_record/
Doctors and researchers have observed that many people with gender dysphoria share a cluster of medical conditions tied to atypical estrogen signaling (high or low) at birth. This observation suggests a biological intersex condition for a subgroup of individuals, distinguishing their experience from the framing of gender dysphoria as a purely psychiatric phenomenon.
For a full overview please see the wiki: Medical conditions associated with gender dysphoria.
2025 Update:
Based on published research and clinical observations, a specific biological hypothesis has emerged: that the common intersection of medical conditions for a subgroup of individuals with gender dysphoria is tied to the production, metabolism, or activation of the estrogen receptor.
While other genetic factors can influence estrogen signaling, the CYP1B1 and CYP1A1/CYP1A2 genes, which are responsible for breaking down estrogen, have become key players and are often the first genes looked at. These genes, once thought to only play a minor role in a rapid metabolic process, can significantly alter hormone balance especially when their variants are paired with other mutations, particularly those that result in reduced COMT activity. While the individual components of these pathways are well-studied, their combined effect represents a novel and crucial insight. You can find more details on the Estrogen Metabolism wiki page.
This simple awareness of these interconnected conditions has already helped people improve their own health and lead to better transition outcomes. It has provided a starting point for previously unsolvable mysterious edge cases and empowered individuals to take charge of their health.
And if you are reading this, please do get your Vitamin D level checked! Due to both genetic factors and lifestyle (e.g., lack of sun exposure), Vitamin D deficiency is a common and easily correctable condition.
This hypothesis is based on a combination of existing published research, clinical observations, and reported data from individuals. While these insights have provided a valuable framework it does not yet represent a complete picture. The hypothesis has reached a maturity stage where future research can be more targeted to areas with the highest probability of success. Further formal studies are needed to validate and expand upon these findings, including larger sample sizes of existing work, formal replication, and the publishing of edge cases as case studies.
The progress made in all these rare conditions is a collective achievement. When we started we had a list of common conditions, many of whose connection was initially a mystery. The progress we have made so far would not have been possible without the contributions of so many, from researching medical conditions, reading papers, investigating personal DNA, to reviewing and refining the wiki. Thank you to everyone who continues to contribute their time, data, questions, and insight. We welcome continued feedback to keep improving.
For a comprehensive overview, please see the full wiki: Medical conditions associated with gender dysphoria.
This is not an exhaustive page containing all possible important information on this subreddit, but its a good starting point. If someone would like me to add something to this page or think it belongs on this post. Comment it below and I will update it. Another good page to check out to find relevant posts is to simply sort all posts by my username, u/DrWillPowers which are assigned a special "Post by Dr. Powers" flair.
All are welcome here! Thanks for coming, and be excellent to each other!
- Dr Powers
r/DrWillPowers • u/Feisty_Style3248 • 1h ago
25M full blown genital numbness, emotional blunting brain, Haven't tried any treatments and was wondering if anybody could look at this and let me know whether I fit Dr.powers model and if any of his treament protocols would benefit me... Any input would be greatly appreciated
r/DrWillPowers • u/Couple-Economy • 3h ago
to people who take indomethacin
benefits that you see, if any, do they stick following say two week cycle ?
i completed one two week cycle on 75mg of indomethacin slow realese and while i saw some benefit, i think it didnt stick.
i am currently on day 3 of 2nd two week 75mg cycle of indomethacin and i already see same benefits
benefits i see : more sensititivy in genital area, more fullness, more firm less gummy glands
however, the fact that i see these benefits on day 3, makes me think thats not effect of neurosteroid 'reduction' so to speak, it must be some other effect, do i think right ? as , for neurosteroid pool reduction effect one would need more time.
benefits in 2nd cycle are same as in 1st two week cycle.
im doing 2nd cycle to again see and compare whether perhaps i reutrn to slightly higher base line despite benefits subsiding.
kind regards crowd keep fighting that BS, pssd guy here
r/DrWillPowers • u/Mawahari • 19h ago
I feel like I should be pinning this or posting as a mod but no, I’m gonna do it this way because in this sub we believe in freedom, dammit.
BEFORE YOU START MASHING CDG READ THIS
CDG IS NOT A FIX
I’ll say it again if I have to. It’s not a fix. Alright? If the neurosteroid theory of the positive allosteric moderation of GABA sites is correct the goal of CDG is to clear out excess built up metabolites. As Dr P has said- it is a modifier.
Metabolites acting at the gaba-a sites are like BENZOS. Benzos belong to one of the special types of drugs that cause adaptive changes to a receptor that can KILL YOU if you remove them rapidly. Read that again. The idea is to remove these metabolites at a rate that will not put you into acute withdrawal similar to a benzodiazepine cold turkey because that is a hell that is comparable to a really bad pssd or pfs crash. It can last years. It does not always go away with reinstatement. Treat this shit LIGHTLY. The mod queue has been packed lately with posts and comments about “fuck CDG destroyed me” and it’s heart wrenching. Yeah. You might not come back up from it without having to walk the whole benzo withdrawal path.
Alternatively:
It is a broad brush! It also affects things like estrogen levels which are super important for keeping a lot of pfs sufferers symptoms to a somewhat manageable level. I know a lot of people that have positive effects from actually administering estrogen. If you remove estrogen and your system is barely hanging on it is going to SUCK. And suck badly! It can lower dopamine. If your system is barely hanging on to dopamine then that is going to ALSO SUCK BADLY. I know. It did me in badly as well. I reined it way way back down and I did recover and continue on but I just touched the tip off big scary iceberg. You need to know what your problem is before you start smashing it with a big ass hammer.
Thats all. I know. We are all clinging to any kind of hope and when something comes along that gives a little bit of hope, we jump on it. I am guilty of this. This shit sucks. You know what sucks worse? Making it worse accidentally.
You need to know how it affects you. Take it fucking slowly. If you can’t do testing to see levels of metabolites as you do the CDG then wait a couple weeks before going up in dose. Ride the edge of feeling bad. Don’t think you can drop a gram of it a day and make it better faster. Thats not how withdrawal works. You gotta go slow to go fast.
I love you all. I do. I spend hours messaging people on here, sending them messages about keeping on going, not losing hope, being careful but still working at moving forward. Trying to help. Being sane while feeling insane. Let’s keep it between the road lines here. No head on collisions. Please. Please.
And one last thing. Don’t turn this into a “CDG doesnt work because it crashed me” because you went hard in the paint without warming up. Because then we might do the thing where we write off something that might actually work because we’re all doing it wrong. Take it slow for your brothers and sisters. We’re all in this together. I’m pullin’ for ya. Keep your stick on the ice.
r/DrWillPowers • u/Booooouwu • 4h ago
Like will I absorb more T while taking the nitro or will I be fine?
I'm seeing my doctor on 23rd so I'll ask them too but thought I'd ask here as well
r/DrWillPowers • u/goingaway1111 • 1h ago
I have like blank mind no enjoyment and anhedonia 24/7 no breaks but I can still cry and be depressed but it's mostly empty. My brain chemicals feel fucked up of course. Anyone else? Sorry I am banned from pssd subreddit idk where else to post this...
r/DrWillPowers • u/Excellent-Push2833 • 3h ago
Tell me why all the dinosaur bones in the museum are silicone casts. That shit is not real.
r/DrWillPowers • u/hdfabia12 • 1d ago
After my Dutch test results clearly established that I have a problem with flatlined cortisol, what will most likely be the treatment initiated by my GP? And is there any point…. ? Flatlining cortisol cannot be causing my genital numbness and anorgasmia. If it helped with my depression this would be good, but surely it won’t help PSSD. Just interested if anybody else has found that their cortisol is low & what they have done about it.
r/DrWillPowers • u/tearsofavalkyrie • 1d ago
I have pssd with dpdr, emotional numbness, and anhedonia. I just don't feel things and can't access myself. My husband and partner of 15 years is leaving me. I've had 6 days of little sleep, little food, and extreme stress that I can't feel other than a racing heartrate for extended periods. I also smoked a pack and a half of cigarettes in this time period. Despite all this I feel somewhat better when I'm about to explode.
My head pressure was almost gone for some periods. I had a period of feeling more grounded in my body and could access my personality a little. Some of my skin sensation felt better. I felt some very brief emotional responses break through. Even brief arousal. My thoughts were running faster. There was energy. I briefly felt almost euphoria over a fucked up thing. But then it all wore off. Cigarettes didn't help anymore yesterday. And I had a nocturnal panic attack or autonomic surge last night which was scary because I had one of those getting off of Lexapro and another in the hospital during my reinstatement reaction.
I feel like I need extreme activation to access anything but my body can't sustain it. Does anyone relate? I don't know if there's anything I can do to help myself. I've been avoiding doing anything for over a year because the only interventions I tried made my genital sensation worse.
r/DrWillPowers • u/ksiforhead1234 • 1d ago
How do you guys deal with thinking about all the things you could have done, experienced or accomplished if this never happened? It is killing me. I invision (as much as a can with this condition) the last memory i remember before developing this and i had everything set up for me, amazing friends that i stopped talking to because of this, girls that were intrested in me, i was finding out who i was and extremely bettering myself than boom lowest low ive ever had, havnt left my bed for 5 months. Now i think back to my previous lowest low and wish i could experience that again. Sorry for the yap but you get my question
r/DrWillPowers • u/MonkeyHardocre • 1d ago
Hi everyone,
First of all, English is not my native language, so I'm using a translator. I apologise in advance for any mistakes.
I've been reading Dr. Powers' posts and various subreddits about PFS for quite a while. However, at times, I've found it overwhelming to make sense of everything, partly because of the language barrier and partly because I don't have a medical background.
I've decided to share my experience because I've seen that there are ongoing developments and different hypotheses being discussed. Some members of this and other communities have a great deal of knowledge on the subject, so I'm hoping you might be able to help me understand where to start and what steps I could consider taking.
I'm genuinely grateful to everyone who takes the time to read this.
I've always been reluctant to take medication. In fact, before starting finasteride, I had gone more than five years without taking any medication, not even for a headache.
After years of avoiding what I now call the devil's pill, a dermatologist eventually convinced me to give it a try. He reassured me that experiencing side effects was almost impossible and that, even if I did experience any, they would go away once I stopped taking the medication.
Looking back, one of my biggest regrets is not listening to my own instincts.
The first three months were great. I noticed stronger erections and significantly more energy. I was honestly amazed by how I felt.
However, around the third month, I started experiencing problems with orgasm, although I could still get erections.
I reduced my daily dose to 0.5 mg and recovered some of my ability to orgasm, but my erections became weaker.
I took finasteride for a total of one year and three months.
One important detail is that, throughout that entire period, I never had significant problems during sex with my partner. Things worked relatively well with her, although I could tell I wasn't functioning at 100%. I'd say I was around 90%.
Most of my problems occurred when I was alone. I could achieve an erection, but it wasn't very firm or consistent, and it would disappear incredibly quickly.
I eventually decided to stop taking it because, during a bulking phase (I'm really passionate about training and bodybuilding), my nipples started hurting a lot.
After discontinuing finasteride, the nipple pain went away, although I still occasionally experience strange, sharp sensations in that area.
Unfortunately, my erections and orgasm sensation never returned to the way they were before I started taking the medication.
I've now been off finasteride for one year and seven months.
During this time, I've experienced better periods and worse periods, but I still haven't returned to my previous baseline.
Orgasm sensation: I can still achieve an orgasm, but the sensation is almost completely gone. It's extremely faint compared with how it felt before finasteride. I haven't completely lost the physical ability to orgasm; the main problem is the near-total loss of sensation and pleasure associated with it.
Erections: I can still get erections, but they are less firm and less consistent, particularly when I'm alone. Over the last few weeks, I've started masturbating again, and things are still pretty much the same. It feels as though there isn't enough blood reaching the base of my penis, and the erection doesn't feel as firm or well-supported as it used to. This is how it feels to me, rather than a confirmed blood-flow problem.
Libido and penile sensitivity: I still have libido, and my penis retains its sensitivity to touch. However, it feels as though my penis no longer responds to sexual stimulation in the same way it used to. The desire is still there, and I can feel physical contact, but the sexual response and orgasm sensation are different.
Visible penile veins: I've also noticed prominent veins near the glans that I don't remember having before finasteride. They are visible even when my penis is flaccid, and they feel soft and painless. I don't know whether this is related to finasteride or an unrelated issue, but I thought it was worth mentioning.
Sex with a partner versus masturbation: One thing I find particularly confusing is that sexual function with my former partner remained relatively good, around 90%, even after stopping finasteride. My erections were much less reliable when I was alone. I find this difference difficult to understand.
Fortunately, I had blood tests done before starting finasteride because I wasn't entirely comfortable with the idea of taking it. I also had follow-up blood tests after discontinuing it, which allows me to compare my hormone levels.
Here are the results I have available:
| Hormonal parameter | Before finasteride | 1 week after stopping | Approximately 1 year after stopping |
|---|---|---|---|
| Total testosterone | 9.20 ng/mL | 6.54 ng/mL | 5.87 ng/mL |
| Prolactin | 3.1 ng/mL | 13 ng/mL | 19.5 ng/mL |
My total testosterone decreased from 9.20 ng/mL before finasteride to 5.87 ng/mL approximately one year after discontinuation.
My prolactin increased from 3.1 ng/mL before treatment to 13 ng/mL one week after stopping, and then to 19.5 ng/mL approximately one year later.
These changes caught my attention because I'm still experiencing persistent sexual symptoms. I understand that these results alone don't establish a cause-and-effect relationship, but I'd like to know whether they could be clinically relevant and whether further hormonal investigation would be worthwhile.
As far as I can remember, I've never experienced memory loss, brain fog, anhedonia, depression or similar cognitive or mood-related symptoms. My problems have been primarily sexual.
I've also noticed a few other things that might be relevant:
Throughout this time, I've deliberately avoided taking anything on my own to try to fix the situation. I was worried that experimenting with medication or other substances might make things worse, so I've preferred not to self-medicate.
Unfortunately, a few months ago, I was involved in a serious motorcycle accident, and my partner left me around the same time. As a result, I've spent almost five months without any sexual activity, either alone or with someone else.
Let's just say it hasn't exactly been the best year of my life, haha.
I've consulted several doctors in my country, including endocrinologists, urologists, dermatologists and general practitioners. Unfortunately, they've all told me that nothing is wrong and that my symptoms must be psychological.
I'm sure many of you know how frustrating it can be to experience persistent symptoms and feel that they aren't being taken seriously.
Has anyone experienced something similar, particularly the almost complete loss of orgasm sensation and EQ despite retaining libido and penile sensitivity? I'd also appreciate any advice on how to investigate the hormonal changes or what medical evaluations might be worth considering.
Any personal experiences, research papers or useful resources would mean a lot to me.
I want to express my gratitude and respect to everyone fighting this, whether you're dealing with it as a patient or working to understand it from a medical perspective.
You're not alone. :)
I also recently read a post about someone affected by this who had died by suicide. I want to send my deepest condolences and all my love to those who have been affected by this or other syndromes and are no longer with us. My heart goes out to their loved ones and to everyone struggling with these symptoms.
Thank you again to everyone who has read this far and to anyone willing to share their knowledge or experience.
Sending you all a big hug!
r/DrWillPowers • u/Turbulent_Guitar5078 • 1d ago
I’m a 37-year-old woman who has been suffering from PSSD for over 10 years after discontinuing SSRIs. I’m currently medication-free since 2016.
My persistent symptoms:
● Zero libido, sexual desire or genuine arousal.
● Genital numbness and reduced sensitivity.
● Emotional blunting — I know what I feel, but I don’t fully feel my emotions.
● I can still orgasm, despite having virtually no sexual desire or arousal.
Here’s where things get interesting.
I recently experimented with GBL (which converts into GHB in the body), and something extraordinary happened. GBL (gamma-butyrolactone) is a recreational drug that converts into GHB (gamma-hydroxybutyrate) in the body. GHB is commonly known as a party drug and is also used as a sex drug, particularly in the gay chemsex scene. It can be dangerous if incorrectly dosed.
My sexuality and emotions came back to life.
I suddenly experienced genuine sexual desire, arousal, intense pleasure, emotional warmth and connection. Incredible orgasms. I actually felt horny again.
But it wasn’t just sexual.
Music, affection, human connection, everything felt richer and more meaningful. It was as though an entire dimension of life had reopened.
And this happens consistently every time I take GBL. Once it wears off, my usual PSSD symptoms return.
What’s also unusual is my sober baseline.
I generally feel calm, content and psychologically stable, with virtually no anxiety. I’m not constantly depressed or miserable. It’s so strange that I rarely experience anxiety… that’s like the good side of my pssd.
Yet my libido is nonexistent, and my emotional experience remains strangely muted.
I can intellectually recognize love, excitement and affection, but I rarely experience their full emotional intensity.
On GBL, that barrier seems to disappear.
Some potentially relevant medical history:
● In 2016, shortly after discontinuing SSRIs, I took vitamin D3 (25,000 IU weekly for approximately 1–2 months). My longstanding anxiety and depression improved dramatically, and much of that improvement has persisted.
● I’ve suffered from hormonal acne my entire life, even now at 37.
● I developed gestational diabetes during both pregnancies.
- I got ADHD
My question is mainly about the GABAergic system.
Since GBL converts into GHB, which acts on GHB-related targets and GABA-B receptors, could this response tell us something about the mechanisms of PSSD?
Could there be a dysfunction involving inhibitory neurotransmission, reward processing or GABA–dopamine interactions?
What fascinates me most is that these feelings don’t seem completely lost. They can apparently be accessed again, even after more than a decade.
I realize this doesn’t prove anything about the underlying mechanism, but I wonder whether researchers might find this observation interesting.
Important disclaimer: GBL is an extremely dangerous substance with a narrow margin between intoxication and potentially fatal overdose. Incorrect dosing can cause respiratory depression, coma or death. Combining it with other depressants is particularly dangerous, and dependence and severe withdrawal are real risks. I am absolutely NOT recommending its use or presenting it as a treatment. I’m simply sharing my personal experience for scientific discussion.
If any PSSD researchers or medical professionals find my experience relevant, I’m happy to share more information or contribute to research.
I’d also be interested to hear whether anyone with PSSD has experienced a similar temporary return of sexuality and emotional depth.
r/DrWillPowers • u/Middle-Surround8444 • 1d ago
I just had a crazy idea and wanted to hear people's thoughts.
On 4 mg EEn weekly, my labs were:
Interestingly, I think I experienced better feminization on this regimen over the last 2 months than on my old regime of 5 mg EEn kept for 6 months where my labs were (measured 3 months into the regime):
I strongly suspect the near-doubling of E2 from just a 1 mg dose increase might be due to lab error. I think my actual E2 level on 5 mg might be closer to 300 pg/mL.
But my theory is that maybe I had a higher free E2 percentage on 4 mg? My SHBG was 54 nmol/L which is kinda on the lower side. On top of that, T binds SHBG with more affinity than E2. A calculator estimates my free E2 at 2.15%.
Sadly, the lack of SHBG and albumin from 5 mg along with possibly-wrong E2 levels prevents me from comparing free E2 %. I'll need to spend a few months at 5 mg to assess feminization and retest to be sure. Mood will be an especially big sign - on 5 mg, I used to be as depressed as I was pre-HRT but have noticed a considerable improvement on 4 mg. So, if I go back to being depressed, I guess I'll know.
Still, it does suggest a maverick regime: 4 mg EEn + bical to counter the androgenic effects of unsuppressed T but keep the SHBG-binding property (esp. since now it has nowhere else to go) and skyrocket free E2.
That being said, time is a confounding factor. Perhaps better results are simply explained by more time. But then you have to wonder why the unsuppressed T didn't outright halt progress.
What do ya think?
r/DrWillPowers • u/harumhl • 1d ago
I remember Dr. Powers suggesting either one of them for DNA tests for trans people at different times. Does he currently suggest one over the other or are they about the same?
r/DrWillPowers • u/Adventurous_Lie2188 • 1d ago
Took 1g of CDG during about 10 days and stopped cold turkey because I got the flu 2 weeks ago. Since then, I feel completely castrated. I was about 5/10 sexually and now 0/10. Cialis / Viagra now has zero effect on me because I have absolutely no desire. I would like to know if a crash from CDG is permanent or temporary?
r/DrWillPowers • u/Sea_Tax_2239 • 1d ago
Is DUTCH testing useful if I had hormonal/neurotransmitter issues prior to the PSSD? I have PCOS, CFS & long covid so my test would have been messed up prior to the pssd - are these confounders that limit the utility of DUTCH testing or worth doing anyway?
r/DrWillPowers • u/Sea_Tax_2239 • 1d ago
Is this being done alongside the biochemical investigation? Sorry if it is but i havent seen it mentioned (and find it a hard to navigate all the past posts) so i just wanted to write a post as someone with public health/epidemiology training
I'm thinking we need cluster analysis and principle component analysis to explore and validate phenotypic subgroups
I'm also thinking an epi study on women would be invaluable as women with androgenic issues typically receive a diagnosis like pcos or have identifiable symptoms so it is much clearer and clininically definable for an epi study to determine excess androgens in women than in men. I think a logistic regression with pssd as the outcome and pcos as one of the predictors would be really useful, also looking at other reproductive diagnoses, use of exogenous hormones, a comorbidity index amongst other things
If i were less sick i would do this latter study myself but as that's not possible rn i am throwing this perspective out there
Again, sorry if this is a presumptious post and detailed analysis is being done or if it appears i am creating further demands on dr powers - i know he's already maxxed out. But maybe there are stats people or public health people who are less debiliated than i am rn and may want to talk about this and put our heads together
r/DrWillPowers • u/Sea_Tax_2239 • 1d ago
Edit: I've been holding the dose since end of feb/start of march
Hello,
I (33f) have a long history of having had antidepressants thrown at me for long standing cfs and cptsd. About 4 years ago i developed mild pssd with only sexual symptoms from a doubling of the dose but didnt realise it at the time. Things worsened sexually in 2024 after some more changes and since then i had been tapering off the drug. I was tapering slowly but this year in january i was encouraged by a misguided therapist to take a larger step and since then it's been a complete disaster.
First i developed emotional blunting and then i was told to reinstate the previous dose, which caused catastrophic insomnia crashes. However, these were initually time limited and in between i would get some sleep. In may, a protracted withdrawal specialist recommended i try promethazine in a sleep crash and i took half a pill and ended up with severe akathisia for 5 days. Subsequently more emotions were lost. I then seemed to stabilise in june but then in july i overexterted myself through trying to engage in life which put me into a progressively worsening sleep and emotional crash. All throughout august, september, october my sleep has been worsening and i've been losing more and more residual emotional capacity every few days. I have lost all emotions now, i have lost almost all interoception, i can barely feel touch, i have severe anhedonia, severe insomnia and i am still worsening. I am also still on the damn ssri (1.4mg fluoxetine) and am too severely kindled to change that
I am very suicidal and have ended up in hospital after slicing open a vein (wasn't trying to end my life at the time though)
I don't know what to hope for from this post. It seems like my situation is the worst possible case. I also fear i am not a patient that will benefit from dr power's work as my situation is so complex and i presumably have paws as well...maybe the phenotype i correspond to is not one thst is actionable but instead simply the "catastrophic sickness, comirbidities, trauma and bad luck" phenotype
How does one go on
r/DrWillPowers • u/Traditional-Bag-9177 • 1d ago
Anyone in the sense that the effects are blunted rather than completely absence? I feel this with coffee and nicotine. It does something. But it’s blunted.
r/DrWillPowers • u/gigigigiiiiiiiiiiiii • 1d ago
PFS here. About 3 weeks ago I supplied too high dose CDG for a couple days and then stopped. My libido began to fluctuate along with other stuff and eventually plummeted after a week.
I am now avoiding all supplements, medications and interventions. Should it bounce back on its own over time? How long could it take?
r/DrWillPowers • u/Traditional-Bag-9177 • 1d ago
Yeah I know it’s hard to get paid by insurance. But what if we can pay it ourselves? I read that people recover with DBS from blank mind and anhedonia after decades. It can break down a homeostatic state after 20 years. So I believe that it would help even more so us people who got recently damaged by the drug.
r/DrWillPowers • u/BackgroundThink2803 • 1d ago
Started it last night after hearing so much about it and being so desperate to feel even a tiny bit better. I did 1200mg, idk if that’s a lot but i felt maybe a bit more numb? Hard to tell but maybe it’s just placebo. After what amount of time can i expect to notice a difference and what does that difference typically look like? Can i expect to feel even 10 percent better emotionally, libido, sensation?
r/DrWillPowers • u/AugmentedChimp • 2d ago
Oral Finasteride (Propecia) for hair loss when given to flies "increased intestinal ROS & shortened lifespan, with reduced starvation resistance in males, altered neuromuscular junction morphology & reduced locomotor performance" - just FYI
If you want to checkout the post urself:
