I am a long time sufferer and I think about taking HCG since nothing helped so far. Has anyone had a good experience with HCG. Did the effects last? Thanks for sharing your information.
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Wouldn’t recommend it. Will only boost LH and FSH I believe, stimulating production of testosterone. Even TRT doesn’t help my PFS. Seems our issue isn’t a lack of test per se.
I agree that TRT doesn’t help. I took testo gel in a low dose for a short period of time and it did nothing or even worsened the situation. After almost 16 yeras of suffering I am so desperate to start an experimental treatment. More than 8 years ago I took tamoxifen and it made my ED much worse to date leaving me with a “very soft” limp dick. I am still trying to figure out how I can reverse that at least but I am unsure what caused the limp dick (estrogen receptor blocking in the dick or estrogen excess in the dick)?
That is also something I would like to know. TRT IMO would not work as it must be converted to DHT by the 5a-reductase, which seems not to work anymore in PFS patients. Also, 5a-reductase is not only converting testosterone, but a whole host of endocrine and neuroendocrine hormones that we so far don’t understand well. Scientists start to think that many of the PFS symtomes derive from a lack of allopregranolone and other neurocorticoids in the brain. This explains symptoms like depression, anxiety, sleeplessness, stress intolerance, lack of libido, problems focusing and exhaustion.
There is a PFS specialist in Germany who is substititing Androstendione, DHEA or humane Choriongonadotropine (hCG) if these values are to low. He says to see quite some success, but can’t do a controlled study due to lack of funding and ethical reasons.
I gonna translate a interview in the next post. Please take his treatment strategy with a grain of salt and a lot of caution as there is still not much data.
If anyone has undergone the treatment I would be curious to hear about the outcome!
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Interview with Prof. Zitzmann Univerity Clinic Muenster, Germany.
The interview is translated with deepl, the part about the HCG treatment is in bold letters:
PHARMACOVIGILANCE
Neuroactive steroids in sight
A conversation with Prof. Dr. Michael Zitzmann on the background of the post-finasteride syndrome
you | post-finasteride syndrome is causing a stir right now. Especially young men, who wanted to counteract hair loss with Finasteride, complain about it. In addition to sexual dysfunction, cognitive and psychological problems occur, which can be so severe that the ability to work is limited and everyday life is often difficult to cope with. Particularly irritating: the complaints persist despite discontinuation of medication and with dihydrotestosterone levels already normalised again. What is the background?
We have talked about this with Prof. Dr. Michael Zitzmann, senior physician at the University Hospital MĂĽnster. Professor Zitzmann is a specialist in internal medicine, endocrinology and andrology as well as diabetology and sexual medicine. He is currently treating over 100 patients with the symptoms of post-finasteride syndrome. They come from all regions of Germany and also from Austria to seek help from him.
Photo: private
Prof. Dr. Michael Zitzmann
DAZ: Professor Zitzmann, the complaints your patients complain about are manifold and at first glance cannot be attributed solely to reduced dihydrotestosterone (DHT) formation. How can they be explained?
Zitzmann: There is a clear causality for these complaints, and it results from the mechanism of action. Finasteride irreversibly inhibits 5α reductase, an enzyme of which we now know three isoforms. Type 1 is mainly active in the skin, type 2 is the form that we find preferentially in the prostate, but also in the liver, kidneys and muscles - and type 3 is mainly located in the skin and brain. Finasteride is a selective inhibitor of the type 2 and type 3 isoforms. Inhibition of type 3 in the skin causes the hair on the head to grow again, but at the same time beard growth and also chest hair decreases. We know that there are receptors for DHT in the brain, and we know that lowered levels of DHT can be associated with anxiety and depression. This could explain psychological side effects.
DAZ: Now the affected people complain that the symptoms persist after weaning. They also do not disappear when the DHT level is back to normal. And even a testosterone substitution does not alleviate the symptoms sufficiently.
Zitzmann: In order to understand this, it is important to realize that the 5α reductase also intervenes in the cortisol and neurosteroid metabolism, which in turn has an effect on the neurotransmitter metabolism (see figure on p. 27). For example, the reduction of progesterone is inhibited in 5α-dihydroprogesterone and subsequently in 3α,5α-pregnanolone (allopregnanolone). Allopregnanolone is a metabolite which has a distinct attenuating, anxiolytic and antidepressant effect. Its failure may explain the psychological symptoms of post-finasteride syndrome. However, these are hypotheses, we don’t know if that’s really the case.
DAZ: Well, it is also being discussed that the occurrence of post-finasteride syndrome could be a pronounced nocebo effect. So it’s all in your head?
Zitzmann: Certainly not that. But it is true that a nocebo effect cannot be ruled out. What is striking is that the affected patients are a special type of people who are very intensively occupied with themselves, who do a lot of research and question a lot of things. Regardless of this, the 100 or so patients who have sought my advice all report the same thing, so that a certain physiological constellation could probably favour the occurrence of these side effects.
"Younger patients suffering from hair loss and baldness are strongly advised to exhaust all other options before using finasteride!
DAZ: Finasteride is indeed used in a higher dosage (5 mg/d) for the treatment of benign prostate hyperplasia, in the treatment of allopecia the dosages of 1 mg/d are significantly lower. Are BPH patients at particular risk of developing PFS?
Zitzmann: That would be obvious. But surprisingly, it is not the older BPH patients who complain of PFS, but the young patients who have resorted to finasteride because of hair loss. Perhaps the neurotransmitter metabolism is more vulnerable here than in old age. It is also possible that the older patients tolerate the side effects better.
DAZ: Do these mostly young patients have to live with their symptoms in the long run, or is there a therapeutic glimmer of hope?
DAZ: Do these mostly young patients have to live with their symptoms in the long run, or is there a therapeutic glimmer of hope?
Zitzmann: It seems as if the neurotransmitter metabolism could be disrupted by finasteride-induced changes in the neurosteroid metabolism. That is why I use appropriate precursor hormones such as androstendione, DHEA or human chorionic gonadotropin (hCG) when a deficiency is detected. This can be quite successful.
DAZ: Does this “hormone replacement therapy” take place within the framework of controlled studies?
Zitzmann: No, that is practically impossible. The ethical and financial hurdles for a placebo-controlled study are much too high. Hardly anyone will be willing to put up the money necessary for such a study.
DAZ: Finasteride is now also being used in women suffering from hirsutism. Do they also have to expect a post-Finasteride syndrome?
Zitzmann: Interestingly, this problem has not yet arisen here. This could be due to the fact that in hirsutism increased DHT formation is reduced to a physiological level again. In men, after all, we lower the DHT levels below this level.
DAZ: In your experience, what consequences must be drawn for the use of finasteride in men?
Zitzmann: Finasteride has a firm place in the treatment of benign prostate hyperplasia. Here, too, side effects must be expected due to androgen deprivation, which in principle corresponds to partial castration. These side effects correspond to the clinical picture of hypogonadism and manifest themselves, for example, in the form of muscle atrophy, gynaecomastia, loss of libido or insulin resistance up to the manifest form of type 2 diabetes.
Younger patients suffering from hair loss and baldness are strongly advised to exhaust all other options before using finasteride.
DAZ: Professor Zitzmann, thank you very much for the interview! |
Prof. Dr. med. Michael Zitzmann, Senior Physician, Specialist for Internal Medicine, Endocrinology and Andrology, Diabetology and Sexual Medicine (FECSM), University Hospital MĂĽnster, Albert-Schweitzer-Campus 1, 48149 MĂĽnster
Translated with www.DeepL.com/Translator (free version)
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