In order to counter confirmation bias around dr. Powers' theory, just want to document my own case which seems to fall outside the main pathway proposed by dr. Powers. Note that this is not to refute his theory, but merely to serve as an extra datapoint to get to the bottom of this disease asap; we should report all data, not just the ones that confirm the thesis.
3a-adg: 11µg/L
serum test: 589 ng/dL
Note that my persistent symptoms that I still have: anxiety, panic attacks, brain fog, anhedonia, depression are more aligned with the 'neurosteroid' phenotype of pfs.
My story that I posted in a comment on this subreddit before:
Hi dr. Powers,
I just want to provide my anecdote that aligns perfectly with your theory.
First time I took finasteride I took 0.5mg for two days. In those two days my libido, focus and vigor went to ridiculous levels, it honestly felt like I was on cocaine. Then, after that 1mg dose spread over two days, I got gynocomastia symptoms. Puffy, burning nipples, which I had during puberty as well so I recognized the feeling and quit taking the finasteride. 1 month later I tried again with a lower dose. This time I took one dose of 0.5mg finasteride once. Got the cocaine experience again for two days, then gyno about 4 or 5 days after. Then I tried a third time a couple of months later, now with like 0.25mg once. Same thing happened. Noticeworthy is that the puffy nipples stayed persistently after this and the little gyno mass I still had from puberty had grown a bit. Then like a year later I took a crumb of a pill of finasteride out of the blue, don't know why, probably got spooked by how fast my hairloss was progressing. 5 days later, I got panic attacks, heart palpitations, anxiety, anhedonia and brain fog and have never been the same since. Only neurological symptoms, no sexual.
Interesting as well; half a year ago I took HCG (250iu eod) and drove my free T to pretty gnarly levels of over 1000 pmol/L and I never had any gynocomastia issues then.
Your theory of the DHT and aromatase pathway being the only clearance pathways for testosterone in some people seems like the only logical reason for my extreme sensitivity to fin that is totally absent when doing HCG. Unfortunately I am not able to get any WGS or urinary T tests since they are not available in my country and doctors are unwilling to provide them to me. But just from the outside this might be another valuable datapoint for you.
Cheers and thank you so much for all you have done for us. You make us feel a little less alone.