This might be the key! Androgen function in the spotlight.

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fuckthisisscience
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This might be the key! Androgen function in the spotlight.

Unread post by fuckthisisscience »

Long story short: I’m convinced that sexual hormones (especially Testosterone and Estrogen) and/or their cellular transmission are the problem regarding PSSD. My hypothesis: Steroid supply will lead to symptom relief. There are a few positive treatment reports. Let me explain:

Hey guys I’m a med-student and will finish my studies in half a year (7. year for me now). I’ve been interested in PSSD (and sexual health and psychatry in general) since 4 years. Been reading numerous scientific articles about every possible aspect of the development of PSSD. I know your struggle since I watched countless patient experience reports here in the forum. After finishing my studies I want to do research on PSSD and I already know where to start.

I’ve read quite a few theories about the development of PSSD: Serotonin-transporter/receptor related stuff, Dopamin, glutamate, Acetylcholin (Betanechol!), pelvic floor dysfunction and so on.

In my opinion the most common symptoms fit perfectly the ones of testosterone deficiency:
  • low/no libido
  • erectile dysfunction
  • lack of penile sensitivity
  • psychiatric: irritability, depression, anxiety, sleep and motivational problems, brain fog, memory problems
  • muscular/joint pain
  • sensitivity to cold temperatures and so on…
I’m convinced, that for some reason there is too little sex hormone effect at the effector tissue (testes, penis, brain, skin etc.). I want to point out, that T in normal range doesn’t necessarily mean, that the appropriate effects are triggered. There are numerous possible faults that this might not be the case: receptor problems or abnormal cellular mechanisms being two examples. So that there might be normal hormone levels, but the effector tissue isn’t reacting properly due to a potential SSRI-damage. We know this effect from the so called ‚Androgen insensitivity syndrome‘, where the cells are not able to respond to normal levels of androgens. Therefore supraphysiological T levels (above the reference range) might be necessary to reverse symptoms. Down below I cite a user from Reddit, that successfully treated his PSSD this way!

Unfortunately, there are only a few studies addressing the problem SSRI and sexual hormone production/reactivity. One study shows that application of common SSRI lowers Testosterone (and other hormone) levels in cellular models (link below). Again, I want to cut it short, so I’m moving on.

There is good chance, that by raising T levels the symptoms can be reversed. As far as I know, few sufferers tried Testosterone treatment: I know three patients that healed their PSSD via testosterone replacement therapy (TRT) (I have quoted two of them at the bottom of the post; or search reddit sub 'PSSD' for 'testosterone‘).

There are several reason for such few PSSD patients trying T-Replacement:
  • just a few get their lab values checked
  • and even if: no doctor would prescribe a patient with normal to borderline low T levels a T-replacement therapy, because in almost every case it is not necessary
And the few who tried might have failed because:
  • they didnt know what to do
  • doctors didnt know what to do
  • taking too low doses (supraphysiological doses might be necessary!)
  • incorrect application form
  • patient stopping application too soon! -> T replacement often shows first effects after a couple of months (sometimes 6 months or more!), but soonest after 3 weeks
[*]this list could be continued...

One more fact is interesting: Many of the (often young!) PSSD-sufferers say, that prior to SSRI-treatment their libido was raging high. That might be due to high T levels in their adolescence/early adulthood. Let’s imagine SSRI slightly decreased their T levels to then normal values, they then would lack their habitual/native values and be symptomatic as long as they get back more T. Just imagine: a lab test would show 'appropriate' levels -> every doc would say, that they're fine! But the latter is just one possible explanation of ‚missing T theory‘.

In our days, testosterone replacement therapy (TRT) is a safe treatment option (for further information see TRT-guide-link down below) . There are many side effect myths about it (prostate cancer, heart failure, infertility and so on). Sure, you have to be cautious and be supported by a doctor, but even young men can be treated by TRT and be fertile at the same time!

Please note: As far as I know, T injection is the best method regarding TRT. There are several other methods (SERMs, HCG injection only, T patches and so on) that were not as effective as one injection per week.

And let me stress this one more time: normal hormonal levels don't necessarily mean, that an androgen application might not help you. In patients with androgen receptor deficiency you may find T values in normal range, too. But they have to be administered high T doses to show some androgenic effects. I dont believe that patients, that suffer from pssd fit in the "normal value" spectrum, that derived from healthy control people with proper androgen (metabolic) function. So in this regard nobody can really tell you whether a midrange value is a desirable one or not.

By the way, to date doctors more and more tend to describe TRT based on typical symptoms than only based on values.

I know that many of you suffered for a long time and I think it is worth a try. You might hold the key in your hands.
But please be sure to consult a doctor and first get blood work done. Ask at least for:
  • LH and FSH
  • Total Testosterone
  • Free Testosterone (very important)
  • Estradiol (ratio between T and Estr. is important!)
If you have any questions regarding the topic/your symptoms/changes with TRT, please tell me (make it short):
  • your age/gender
  • short history (medication & for how long, what reason/condition, how long pssd till now)
  • symptoms and serverity (take the ones I mentioned above as example)
  • were the symptoms steady/fluctuating/attenuating/increasing?
  • sexual drive before medication (low/normal/high)
  • have you ever had bloodwork done (if yes, what has been tested)
Sorry for the long post. Feel free to discuss!

---------------------------------
Links:
SSRI-Androgen study https://www.ncbi.nlm.nih.gov/pubmed/28179152
TRT guide https://www.t-nation.com/pharma/complet ... eplacement

Quote of a positive treatment report via reddit (user: u/HoMcShmoe):
'...Ive been suffering from diminished libido, erectional problems and genital numbness after taking high doses of the ssnri venlafaxine, that I laid off 5 years ago. (...) I ordered testosterone enanthate oil (...) and injected 250 ml intramuscularly 1 week ago. Since then my libido has been steadily improving, im really aroused again and the erectile problems vanished. I still have some numbness but its definitely better.'

2 weeks later:
'Still have vivid sexual fantasies, great erections and penile sensitivity has been improving ever since the first dose. All symptoms I had been having the 5 Years since taking Venlafaxine have been alleviated. So far so really fucking good.'

Quote of a positive treatment report with injection of supraphysiological T doses and HCG via reddit (user: u/mrgoodcat1990):
'I cured my pssd with Testosterone . When I say cures I mean cured, fully restored. I had pssd for quite a few years and thought I was going to die without ever recovering. I had very high testosterone , but still had pssd. I did a lot of research spoke to a lot of people and start taking testosterone. I did plenty of medical examinations before hand to check for any underlying health conditions. After 8 weeks I was fully recovered, bare in mind I am planning to stay on for the rest of my life. (...) I took HCG aswell. I'm 30 years old. I took citalopram.'
Last edited by fuckthisisscience on Sun Mar 29, 2020 8:02 am, edited 5 times in total.
- Medical Student - finishing in late 2020
- interested in PSSD (and sexual health in general), no sufferer
--> Androgen hypothesis
- wanting to research PSSD
- been reading numerous scientific articles about possible aspects of of PSSD
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Optimist
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Re: This might be the key! Androgen function in the spotlight.

Unread post by Optimist »

So I'm speaking to an Endo on the 25th, what exactly should i say to him?
fuckthisisscience
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Re: This might be the key! Androgen function in the spotlight.

Unread post by fuckthisisscience »

Hey Optimist. Tell me (please make it short):
  • your Age
  • short history (medication & for how long, what reason/condition, how long pssd till now)
  • symptoms and serverity (take the ones I mentioned above as example)
  • were the symptoms steady/fluctuating/attenuating/increasing?
  • sexual drive before medication (low/normal/high)
  • have you ever had bloodwork done (if yes, what has been tested)
- Medical Student - finishing in late 2020
- interested in PSSD (and sexual health in general), no sufferer
--> Androgen hypothesis
- wanting to research PSSD
- been reading numerous scientific articles about possible aspects of of PSSD
lw77
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Joined: Wed Aug 01, 2018 11:29 am
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Re: This might be the key! Androgen function in the spotlight.

Unread post by lw77 »

Hi @fuckthisisscience, welcome to the forum.
Your theory is very interesting, we would be happy to hear more. As you may know, recently there have been strong contacts between the communities of the sufferers (PSSD, PFS, PAS, etc ...). The actual hypothesis, which is emerging above all from epidemiological evidence (surveys) and which unfortunately we cannot yet confirm from a clinical point of view (at least for PSSD), is that there may be a common denominator between the various syndomes that could reside in some type of alteration of the androgenic signal (specifically at this time the hypothesis seems to be that of an overexpression of the androgen receptor with a simultaneous desensitization of the same). In such a moment, whether the problem is the same in the various syndromes, or not, it is fundamental to try to create a homogeneous community anyway. We need large numbers of people actively contributing, otherwise we will not be able to do anything but go on with more or less scientific speculations, which will not lead to any benefit. This would be very sad because it could cause a second mockery for us, that is that even when appropriate diagnostic and therapeutic tools were present we could not benefit from it simply because we will not yet know what the problem is and therefore we simply will not know where to use them. This is why I hope that as many people as possible do the survey on propeciahelp and that we can guarantee the maximum degree of collaboration possible between the communities, possibly creating a unique one that has good credibility. Spending all the time complaining about how and how much our lives have been ruined can be fair and understandable, but to a certain extent. It is necessary to combine concrete actions that can produce concrete benefits. Our friends of the PFS fundation are more than happy for our participation in their initiatives, we are in close contact with them. There are natural differences of opinion (as it is obvious and natural that it is in huge groups of people), but it is necessary to try as much as possible to put them aside and find a common way of action. At the moment the main effort cannot be only to find this or that remedy that can give someone a minimum of benefit at random, because unfortunately it is a strategy that is proving ineffective for the vast majority of people.
That said i'll check more in detail about the androgen insensitivty syndrome.
Glad the forum is back, let's try to use it on purpose.
Best LW
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Optimist
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Re: This might be the key! Androgen function in the spotlight.

Unread post by Optimist »

28

Escitalopram for 3-4 months for anxiety and depression. PSSD for four years. Currently taking olanzapine and adderall.

Low to no libido, erectile dysfunction. If I stop masturbating for a few days I can get an erection to porn. But usually no erection. Muted orgasm.

Symptoms have very slightly improved I think after 4 years

Very high sex drive

No bloodwork done
anacleta
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Re: This might be the key! Androgen function in the spotlight.

Unread post by anacleta »

fuckthisisscience wrote:
Sun Mar 22, 2020 8:11 am
So that there might be normal hormone levels, but the effector tissue isn’t reacting properly due to a potential SSRI-damage. We know this effect from the so called ‚Androgen insensitivity syndrome‘, where the cells are not able to respond to normal levels of androgens.
have you also investigated the possibility of restoring the correct peripheral receptor functioning (if this is the problem) instead of taking doses of hormones?
lw77
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Re: This might be the key! Androgen function in the spotlight.

Unread post by lw77 »

Soon, we hope, our friends Axolotl and Awor will be able to release on Propeciahelp their hypothesis about the etiopathogenetic mechanism of PFS on Propeciahelp, it was a long and demanding job full of interesting ideas, extremely rigorous from a methodological point of view. It would be very important that when we PSSD was released we would examine it because we can provide important feedback.
Trazohell
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Re: This might be the key! Androgen function in the spotlight.

Unread post by Trazohell »

Beside the dna methylation one of the most promosing theories out yet.
Accutane, Finasteride and SSRI all have antiandrogens effects and the people end with less or more the same symptoms.
I definitely want to try TRT, but it's expensive because I have to pay myself and I'm afraid to fuck me even more. After Tribulus it took me a long time to regain some libido, although it was better on the Tribulus than without it.
June 2015 - April 2016 Fluoxetine
April 2016 - March 2017 Fluvoxamine
December 2017 9 days Trazodone
After Trazodone PSSD: loss of libido & spontaneous/night/morning erections, prostate/pelvic pain, genital numbness, lower sperm count, Anhedonia
fuckthisisscience
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Re: This might be the key! Androgen function in the spotlight.

Unread post by fuckthisisscience »

Optimist wrote:
Sun Mar 22, 2020 5:06 pm
Escitalopram for 3-4 months for anxiety and depression. PSSD for four years. Currently taking olanzapine and adderall.
Olanzapine itself is a drug which is known to reduce libido and sexual functioning. If I where your Endo, I'd probably blame your symptoms on the medication and not prescribe you TRT. Sorry to say that. You may ask yourself (and your psychiatrist) first, whether the medication is absolutely necessary.
- Medical Student - finishing in late 2020
- interested in PSSD (and sexual health in general), no sufferer
--> Androgen hypothesis
- wanting to research PSSD
- been reading numerous scientific articles about possible aspects of of PSSD
fuckthisisscience
Posts: 14
Joined: Sun Mar 22, 2020 7:03 am
Contact:

Re: This might be the key! Androgen function in the spotlight.

Unread post by fuckthisisscience »

anacleta wrote:
Sun Mar 22, 2020 5:40 pm
have you also investigated the possibility of restoring the correct peripheral receptor functioning (if this is the problem) instead of taking doses of hormones?
Afaik there is no way to do something like this yet. We dont even know, if the receptors are affected. To investigate something like this, you had to do extensive studies in animal/cell models. Just as well it might be possible that one single protein in cell metabolism is changed/lost in function.
- Medical Student - finishing in late 2020
- interested in PSSD (and sexual health in general), no sufferer
--> Androgen hypothesis
- wanting to research PSSD
- been reading numerous scientific articles about possible aspects of of PSSD
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