Re: Is progesterone therapy still used for some PFS patients?
u/drwillpowers
r/DrWillPowers2026-10-07T16:05:27Z
Dr Will Powers’ own statements and theorizing
Mentions treatments or doses — not guidance
Summary (paraphrased)
Answering a hypothetical about working up genital numbness with completely normal baseline labs, Powers gives a clinical pearl: rule out peripheral-nerve causes of numbness/ED — and reports finding Tarlov cysts impinging the S2–S4 nerve roots more often than expected in PFS/PSSD patients, which he believes can contribute. He then lays out his "abacus" model of health: layered rows of beads, with aging and illness adding beads that narrow the viable pathway — people can run for years on a single-bead-wide path until one more insult collapses it.
Key points (paraphrased)
- Tarlov cysts impinging S2–S4 found more often than expected in PFS/PSSD patients; possible numbness/ED contributor.
- Clinical rule: with normal baseline labs, rule out peripheral-nerve causes.
- "Abacus" multi-hit model: layered beads narrowing the viable pathway; one final insult collapses it.
- The most vivid statement of the multi-hit/threshold framework.
- Post-export fresh: posted ~22 hours before the 2026-10-08 curation.
Why it’s in the corpus
A new clinical angle (Tarlov cysts) for the numbness workup plus the multi-hit model's most vivid statement. The abacus image gives the corpus a compact way to convey threshold dynamics.
Context — the post Powers was replying toVerbatim third-party text, shown for context only — not Powers’ statement. Usernames removed.ShowHide
Powers' comment replies to [username removed], who posed a hypothetical: a post-anastrozole patient with genital numbness and sensation loss, broken sleep and an eyelid twitch — should the workup be a pelvic-floor MRI or a trial of estradiol valerate? The OP ([username removed]) had asked whether progesterone therapy is still used for some PFS patients.
(Comment text and parent context recovered from the r.genit.al mirror on 2026-10-09; this comment post-dates John's 2026-10-07 export.)
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