First of all, everything I do is trial and error, and any conclusions I may arrive, are only a best guess and a sympthomatic treatment. Currently we do not have any empirical evidence about the molecular causes, only hypothesis. I am not a doctor, SO PLEASE always work with a doctor to guide what you try. I studied 3 years medical school before I decided to study engineering, this was 5 years before PFS.
Having said that, I am taking since 2015:
HCG: 1500 IU 3x per week (total 4500 IU). I started with 2000 IU 3x per week (6000 total) and when I experience a crash I tried as much as 3000 IU 3x per week. Even in the best periods I was not able to go lower than 1500 IU 3x per week. I know many consider these dosages as very high, but I have been on this for 5 years aprox, OK so far (always with doctors supervision). Also, 4000 IU 3x per week for 6 months is what it is prescribed for hypogonadal adolescents.
Anastrozole: 1 mg x2 per week (total 2mg), in the last years I have experienced better results with 3mg per week. Also when ever I experience a crash tend to elevate de dose till I recover. Anastrozole has been really good for me, with out it HCG ends up failing.
Cialis: 5 mg every 48hs at night.
Vit D3: I use it when I have sex arround 5000 IU. I experience almost a full reversal of symptoms when I tried 100.000 IU at once, which is a normal dose for 3 months, but it only lasts for one or two days. It is not the same if I take another high dose, and you cant take too much Vit D3 due to calcification.
Clonazepam: I use it before sex, very little dose, arround 0,125mg. Before this, I used clonazepam before HRT for about a year, taking about 0,125mg in the morning, 0,125mg in the afternoon and 0,25mg before sleep. This stopped my penis from destroying in just a few weeks when PFS hitted me back in 2014, but it turned me into a zombie and only slowed the shrinking, not stopped it.
In general, I have tried to keep dosages as low as I could, so that I my body does not get used, this is a long run till some cure/treatment is found, if ever.
Avoid Endocrine Disruptors: I have crushed over these years with a few subtances, carnitine, quercetine, Melatonine, some dermatological creams. Also something I have noticed this year with COVID, is that I had a very bad year and crushed a few times without aparent reason. I realized a few weeks ago that chemicals like Lysoform, detergents, cleaning products, creams, fragances, etc worsen the condition. This year these chemicals where EVERYWHERE. Took a week free of all those products and got better, now I took a week away on a farm, and the response was even better. This is the reason why I returned to this forum, to look for some answers regarding endocrine disruptors.
About Symptoms
My main concerns since the beginning was/is penile shrinking/hard flaccid, my reproductive organs semmed to started destroying themselves. I was able to see this with a simple penile echography.
HRT stopped shrinking for me, and have had decent reversals, not to 100% pre PFS, but able to have good sex and enjoy life. Whenever I crush, shrinking and hard flaccid kick in very fast, to prevent further damage I elevate HRT dosage and take benzodiazepines, this usualy works till I figure out what made me crush, and remove it form my life.
Given time, I have always been able to go back to minimal dosage (HCG 1500IU and Anastrozole 2mg).
My best guess About PFS (or my case)
I think we may carry some faulty gene or Fin caused some gene to work badly, probably involving Androgen receptors expression/mechanism, and/or 5 alpha reductase faulty
functioning.
Probably a combination of these to problems. I think this is why (in general) high testo and low estrogen, together with trying not to disrupt ARs have been very good, at least in my case.
Endocrine disruptors (parabens, phthalates, plastics etc) play a very big role in my case, as it turns, these subtances mimic Estrogen, but not in a normal way, these tend to bind to AR receptors and do not let go, maybe causing an estrogenic like effect, that lasts for much longer than regular Estrogen.
I think, and please this is only a best guess, that our faulty ARs over respond to these subtances that are everywhere, when you put finasteride damaging 5alpha reductase, the perfect storm is created, having your ARs responding almost eclusively to estrogen/estrogenic like subtances.
Again, all of this is only a theory, and best guess. After all, sitting arround having my penis destroyed was not an option for me, that is why I tried all of this. I probably forgot many experiencies I had during these years, any question I will be glad to answer.
Regards