Re: Pssd and desperate…

Replying to a PSSD sufferer who theorized that TRT injections had depleted his androgens and caused penile shrinkage, Powers lays out the excess model in plain terms: the problem is too many androgens, not too few — but trapped intracellularly as accumulated metabolites, so serum levels can look normal while intracellular levels run extremely high. He argues the common inference (shrinkage implies androgen lack, by analogy with androgen-blocked transgender patients) is backwards. He explains "windows" from androgen injections as a transient improvement in the ratio of clean testosterone to accumulated metabolites, which then worsens as the new testosterone converts into more uncleared metabolites. He adds a case note: a patient who appeared not to fit the theory was re-examined — a missed UGT2B7 defect found on the BAM file — showing low epi-testosterone with high urinary testosterone and shunting toward E3 metabolites. He closes by noting most cases involve UGT2B17 plus transporter problems, and by asking for volunteer (non-patient) data to confirm the pattern generalizes.