I have been absent from this site for a long while now. My story started in 2015 with 1 Finasteride pill which caused extreme brainfog and cognitive sides. My condition has gradually improved over time and been stable for the past couple of years, although I would not consider myself 100% healed yet.
In an effort to heal myself to 100%, I have been doing a lot of research recently - so I wanted to post some findings and thoughts, in the hope that they may be of some benefit to others.
I was always under the assumption that Finasteride had altered my hormone levels, which had caused my cognitive side effects. I always thought that my T / DHT had been knocked out of whack, which was the root cause of my problems.
However, my recent research has taught me that I may have been looking in the wrong place. Whilst 5AR inhibitors of course do reduce the conversion of T into DHT, they also have a big impact on the neurosteroids in the brain. Specifically, 5AR seems to be very influential on the conversion of Pregnenolone (which I will refer to as P) into Allopregnenolone (which I will refer to as AP). AP is a potent neurosteroid, which primarily modulates activity at GABA A receptors in neurons, which ultimately contributes to positive mood, a sense of well being etc etc.
Now, the precursor hormone to P and AP is Progesterone. There have been some significant studies, which have shown that PFS sufferers typically show low levels of Progesterone, P and AP (I have also seen deficient levels in posted blood work of members on this forum).
If you google symptoms of low Progesterone, P or AP, the symptoms actually sound very much like those of a PFS sufferer - anxiety, trouble concentrating, depression etc etc. In fact, low Progesterone levels can even lead in turn to high oestrogen, which in turn can lead to weight gain, gynocomastia, erectile dysfunction and many physical changes that seem to take place in the bodies of PFS sufferers.
So - we know that 5AR inhibitors will block the conversion of P to AP. We know that AP is very important for cognition and mental health and further we know that in PFS sufferers; Progesterone, P and AP are all found at low concentrations. Therefore - my view is that many of the PFS side effects (at least the cognitive effects and quite possibly some of the physical effects) are actually as a result of an interruption in the Progesterone>P>AP cascade, which ultimately seems to have screwed the whole pathway in us PFS sufferers.
I have found this very useful and interesting. My symptoms seem to be in line with those described by patients who have documented low AP levels. AP mainly works by increasing GABA A receptor activity in brain neurons - which has a calming effect on the mind, helps us sleep and increases feelings of wellbeing.
So - I started researching chemicals that artificially stimulate GABA A receptors. Benzodiazipines and Alcohol seem to do this well. This is interesting to me as Alcohol has always calmed my symptoms and even back when I was at my worst, I would sometimes find that after heavily drinking my symptoms were temporarily better - which I always thought was counter intuitive given alcohol is not ‘healthy’. I have also tried taking Xanax (a Benzodiazapine), which also seems to significantly calm my mind when my PFS brainfog seems to be bad.
Another interesting finding is that CBD oil seems to help alleviate my symptoms (at a dose of 40 - 80mg daily). I actually tried this on a complete whim, but when I found it did help, I researched it’s effects and found that it also can help to modulate GABA A activity…
All of this has led me to believe that the Progesterone>P>AP pathway interruption is what effected me. This would also explain why some members of this forum post low progesterone levels whilst T and DHT levels seem to be normal.
I think that Fin interacts with so many different pathways that clearly not everything can be explained by the above. However - I do think this explanation makes sense in getting to the bottom of my symptoms and I wanted to share.
In terms of therapy based off this theory - Progesterone / P & AP are not substances that can easily be obtained and ingested. However, clearly GABA A receptor agonists (such as benzodiazipines or CBD) can be obtained. These may in part offer therapeutic effects to our low AP levels (obviously not recommending this without consulting a doctor however). In addition, I think this could be a new line of conversation that we can have with doctors. I have not heard of many PFS sufferers discussing this line of theory with doctors and getting corresponding blood work done.
I am going to link some articles from an interesting guy who runs a blog and youtube channel about neurosteroids, who explains all of this in more detail than I can.