Listen, I know everyone here is eager to be fixed, and I am very much eager to be the guy who fixes you. But each setback or failure we have along the way has resulted in learning something, which subsequently has changed our attack plan, labs to order, or revised the model. We're getting somewhere. I wanted relugolix to be the perfect solution for all and not just "some" of this problem (various people on the drug right now are improved from it, but so are some people from CDG, that aspect of the model [metabolic pileup] appears to be right, but the model is still only partially complete).

As of this moment, I am absolutely certain that my PFS disease model is not perfect, but its insanely better than anything that has ever previously existed, and this case here is about the most perfect example of it that I think I could ever come up with to show you.

Sommer asked for my help on this case. Sommer is not as good as me at treating PFS yet. She is however probably the 2nd best at treating it! She often consults with me on difficult or refractory cases or when the labs are bonkers.

This case is a particularly good one, as it occured from only TOPICAL exposure, which is something that I have been seeking to have examples of to prove when this is all said and done that even a microscopic amount of a 5ARI can push a sensitive system over the edge into catastrophe if they are at baseline, "tickling the dragons tail". This young man was unfortunately propping up his demon core with a screwdriver, and a little topical fin was all it took to pull out the screwdriver and go critical.

I'm sharing his case not asking for input or guidance or anything, I already told Sommer what I think our best course of action is for him, but more like a "Will you look at this insane shit?" banner that you can use to link to someone who doesn't believe you when you tell them these disorders are 100% real, and not "Post-Finasteride Syndrome: An Induced Delusional Disorder with the Potential of a Mass Psychogenic Illness?"

Will you just gaze here upon the absurdity of this man's labs.

Case Presentation:

"The 22 year old male patient began topical finasteride in November 2023 at 0.25 mg nightly (the sum topical exposure is the volume of liquid x drug concentration). Approximately eight hours after the first dose, he awoke with diffuse flu-like body aches, testicular discomfort, and voice cracking; these symptoms subsequently resolved on their own completely. He later restarted at 0.5 mg and experienced similar symptoms with new-onset depression, anhedonia, and brain fog. Over approximately one month, he intermittently stopped and restarted finasteride at progressively lower doses before discontinuing it completely. During this period, he developed absent libido, hard-flaccid symptoms, genital pain, and unusually stretchy skin. Although he remained able to attend school and maintain his social life, his symptoms gradually improved after discontinuation.

He subsequently however developed atopic keratoconjunctivitis and was treated with steroids. Within several days, he experienced a recurrence of flu-like symptoms and stretchy skin, along with tingling, numbness, and an abrupt generalized loss of muscle tone. This created difficulty balancing treatment of his eye disease against steroid-associated worsening of his PFS symptoms.

A trial of calcium D-glucarate produced a temporary window of improvement but was followed by loose stools and hot flashes.

I will review his test results with Dr. Powers and follow up with the patient by email regarding next steps in treatment."

My god look at that mess. Star on particularly important findings, but normal results are still important.

Okay, lets unpack this.

This guy has almost no urinary T, and almost no urinary 5A or 5B metabolites at all. None. Is that because he has no 5A metabolism? No, not even remotely. His serum DHT is HIGH. He lacks the ability to put these molecules into his urine.

His Progesterone and pregnenolone are BOTH elevated, as well as his 17hydroxyprogesterone, indicating that he's piling up there. He also has an elevated 11DOC. I suspect much of his "skin" issues are tissue specific glucocorticoid buildup problems, disrupting connective tissue remodeling, which is also why he can't do normal nightly maintenance on his cornea.

I am still bewildered by the fact that decades have gone by with dudes suffering from this condition but it wasn't until the kooky and eccentric transgender HRT wizard giant cat bioengineering weeb doctor weirdo looked at it and went WTF?!?!? that this was finally noticed.

HOW WAS THIS NOT NOTICED? LOOK AT HIS LABS! LOOK AT THEM! I HAVE A HUNDRED DIFFERENT PATIENT LABS LIKE THIS!

https://preview.redd.it/de575f0mozih1.png?width=498&format=png&auto=webp&s=19f3f8267a221da7d853924ad00c3d93c5870597

Merck, how could you do this to people and none of all the brilliant scientists and researchers and pharmacists and people you employ ever foresaw this or even recognized it as it was happening?

BAH!

Anyway, next time some doctor or dimwit or dimwit doctor gives you the side eye when you try and convince them that PFS and PSSD (and other post-drug syndromes I haven't gone as deep into yet) are real, show them this poor young man's labs.

(I'm gonna help Sommer do everything we can to help this kid, obviously, but his labs this morning just made me want to flip a table).

- Dr. Powers

I am not mad about this.

I only wish that you could experience the dopamine that I get from consuming these fucking things. My god. The frosted m&m one I had today...

I will continue to do my best to restore your ability to enjoy them as much as I do.

We who are about to die of heart attacks salute you.

-Dr. P

Allow me to introduce the newest provider at Powers Family Medicine, Marna Taylor.

An NP, Marna is extremely experienced in the care of the LGBTQ population, with longer clinical experience in treating this population than I have. She is also an AAHIVMS certified HIV specialist.

While I wish Dayna nothing but the best, attempting to "replace" her was a herculean task because of how great she truly was. Dayna was an incredible and beloved provider here, and I was not willing to settle for "good enough" when it came to finding someone to fill her shoes. As a result, it has been a very very long 8 months since she resigned that we searched for a capable provider who I felt fully confident was going to come into PFM and bring the level of clinical competency that this community expects from my practice. There were many great providers that I could have selected for this position during that time, but I did not feel until I met Marna that they were the perfect match for our unique culture.

Everyone reading this knows the care and attention I put into my patients and their health, and I wanted to ensure that I could entrust them to someone who had the skills, experience, and compassion to do this job the way that our oath says it should be done.

Well, here she is. I am proud to introduce her to you.

She is looking forward to meeting you all. She is available for appointments now. Her primary focus is going to be HIV treatment, and primary care. She has some HRT experience, but I plan on spending the next few months training her on the more esoteric things our practice does so that she can additionally be backup for when Sommer or I are not available. This will greatly expand the capabilities of the non-DPC part of the practice, and allow for alternative options for patients who do not opt to continue DPC next year as I hybridize my time between research and patient care.

Additionally, Marna will likely bring with her a rather sizable population of patients who have been #TeamMarna for years now from elsewhere. We welcome these patients who follow her to Powers Family Medicine!

- Dr Powers

Marna on her first day in front of the rainbow LED wall.

Please, I beg of you. If you are a DPC patient and have the direct private messaging email that only DPC members have, do not post this online or share it.

I wouldn't have thought that needed to be in the contract, but I awoke this morning to being inundated with desperate emails from PFS and PSSD patients I've never met before some in languages I don't even speak.

If you need to reach out to the practice, and you are not currently a DPC member, please use questions@powersfamilymedicine.com to do so.

- Dr P

Labs are coming back on the theory that I had a few weeks ago on PSSD patients i've seen.

Some of my PSSD patients are reporting improvement from taking CDG (though some not or are worsened by it). In theory, at least for this phenotype of PSSD, it could help.

If you're not enlightened on this more recent theory of mine, here's some recent posts related to it:

https://www.reddit.com/r/DrWillPowers/comments/1v6nodd/definitive_phenotype_overlap_pfs_and_pssd_normal/

https://www.reddit.com/r/DrWillPowers/comments/1uu1arm/pssd_an_odd_signal_can_pssd_people_keep_an_eye/

If you've ever been to my practice, you know I'm a bit eccentric. I am assuredly a bit of a kook, but I've come to peace with it. I was hanging up some new aperture science art in the "portal" room yesterday after patients. This is not typical doctor behavior, but I've never been good at "typical" so I just keep doing my own thing.

I've got a bunch of schizophrenic relatives, and I assuredly have toed that line at certain points in my life. Part of schizophrenia is basically erroneous pattern recognition. Seeing things where there isn't really a pattern there. That being said, people like that can sometimes literally see things other people can't see, but they really are there. Its cranked up pattern recognition, and crank it up to 11 and it glitches out.

Pattern recognition is basically the thing my brain does best above all other cognitive abilities. One of the oddities I noticed about PFS dudes was that before PFS, a large amount of them were basically GI-Joe clones. They were hypermasculine men compared to your average men when it was a male patient. This was very curious to me, and was one heavily weighted datapoint in the training data for my brain of trying to solve "how does PFS work?".

I have noticed some different patterns in my PSSD patients, but I'm going to hold those cards for now until I'm more confident in them as I know a lot of what I say gets parroted elsewhere. I have learned my lesson on airing my "hrm I wonder" thoughts, as 95% of those are wrong. I'm keeping it now to "hrm, I'm pretty sure this might be".

That being said, I am starting to find consistent lab pattern anomalies in PSSD patients.

A lot (but not all) poisonous chemicals taste bad. For starving humans that thought hemlock didn't taste extremely bitter, they tended to not exist to have more kids. This is called selective pressure. Humans have many redundant pathways as evolution encouraged this to allow for both glitches to be tolerated as well as for them to sometimes be beneficial. Even ones not always directly beneficial for the person's own reproductive capacity can be beneficial for their family or village, so they are selected for anyway and carried on recessively.

This is how you get people who are "fine" but lack a redundancy pathway, but once challenged with a foreign substance, boom, catastrophe.

In the above linked posts, you can see how hormone synthesis and metabolism intersects with neurosteroid synthesis and metabolism. A glitch on one highway can result in traffic buildup on another. Not gridlock, but traffic. But add "an accident" and now no cars are moving.

Theoretically, if my idea on this is correct, an additional risk factor for the development of PSSD would be the same as PFS, overburdening a metabolism system.

How do you do that? Well, you use exogenous molecules. That molecule could be an SSRI that majorly upregulates neurosteroid synthesis until it hits a point of metabolite accumulation and lockout, in the same way that you inject a bunch of androgens (even if they give you a "window") that ends up increased metabolite load over what would normally be physiologically possible. Then the body's feedback loop mechanisms preserve the dysfunctional state, as they keep trying to correct for a problem that evolution never accounted for as it wasn't possible for it to exist without exogenous drugs/hormones.

Pair that problem with an inborn error of metabolism/excretion or transport, and you suddenly get a situation where the rate of neurosteroid/hormone/etc coming in exceeds the rate that it leaves. Once the concentration gets high enough, you get lock out. Signaling ceases. You've turned it up to 11 and the speakers blow out.

I don't think they blow out permanently, but, they will remain silenced until signaling is restored. If signaling is down for a prolonged timeframe, you'll start to see atrophy of the most distal and weak aspects of that system. Just like the collapse of rome, the most distant colonies go down first, and you get small fiber neuropathy, atrophy, and other more persistent symptoms. This could explain why some people "recover" but have some lasting damage that has to be dealt with medically in other means.

The osteoporosis cases with PFS highlight this pretty well. Even if I cure the PFS overnight with a magic wand that wipes out all metabolite build up and restores signaling to normal, the osteoporosis remains.

Alright, before this turns into a rambling rant that sounds more schizo than usual, simple question for the PSSD people here.

Were you using birth control, injectable T? Anything that would boost your overall hormone load at the time of the development of PSSD? If you were not, would you consider yourself pre-PSSD to be a particularly overly libidinous person compared to peers at baseline? Do you look like you have a "lot of hormones" for your gender?

Thanks to everyone who continues to work on this problem, including members like /u/Excellent-Push2833 for making tools to help the community look at their own genomes to save me time and help find patterns. For users like u/mile-high-guy who did something incredibly brave and shared their experience in detail with the community. And For really anyone who is helping with this project. I really deeply believe this is a solvable problem, but that the solution is going to be truly something counterintuitive and will require some outside the box thinking. If the solution was easy, it would have been found ages ago, but nothing good ever comes easy, so lets keep working hard at it okay?

Yes, I know I am supposed to be taking a break but I got this lab result this morning and was like holy fuck its real, so forgive my excited rant.

- Dr P

I'm not asking for sympathy here I'm just trying to get my population to rationalize and understand my situation.

This is a screenshot of the right side of my email client, the times are the arrival times of emails. I have removed the subject line data for patient privacy reasons.

https://preview.redd.it/4r955rjd1ufh1.jpg?width=236&format=pjpg&auto=webp&s=5143385b189858903172eda6c0614ac447177f63

21 emails from patients arrived today between 1:29pm and 4:10pm.

That's a new patient email request for me to do something, every 7 minutes. That is occurring simultaneously while I am having patient appointments during the work day. It occurs while I sleep. It never ever stops.

Sometimes, that's a refill, but most of the time, its not. It is an immensely complex message. These cannot be fielded by staff. They cannot be done by an AI. It can't even be done by another doctor, as I am currently the only one in the world doing what I do. A staff member or trainee or resident cannot explain to a patient why they need to draw a 3A-androstanediol glucuronide lab in order to demonstrate the metabolic pileup effects of the ABCC2 stop codon I found present in their genome as discussed on the prior email where I reviewed their whole genomic sequencing data and how that will be affecting their transition/PFS/PSSD etc.

The medical complexity of what I am doing now has become so high that I can't simultaneously be both this and a family physician and HIV specialist and HRT specialist while also being the top expert in the medical illnesses caused by the mutations that cause gender dysphoria, post finasteride syndrome, PSSD, or myriad other mystery diagnosis things that I now am "the guy" for. I cannot do it all.

I cannot do it even with completely relinquishing almost all other time that I have to have a life that isn't this. It still is not enough time.

I'm going to finish my patients tomorrow, but I am taking a 7 day break from actually having any appointments from July 29 to August 5th to figure out some way of a viable path forward. During that time I will try and catch up on my messages as best as I can.

If someone feels that I am not upholding my end of the bargain for the DPC contract they signed up for, I understand this, and you are welcome to contact pepper@powersfamilymedicine.com for a pro-rated refund for any time you have left in your contract. I will gladly offer that to anyone who wants it. I am not trying to take people's money here and not provide what they signed up for, but I grossly underestimated the time consumption of doing medicine at this level of complexity. It is flat out impossible for me to accomplish it all now, and I have to accept the reality of this.

Overwhelmingly, I would prefer people make appointments when possible. I understand that is not possible for everyone, but given a choice between a 10 page email and a 30 minute appointment, I will always choose the appointment.

I will be sending out a mass message soon to all registered patients once I come to a final decision about what I am going to do here moving forward. But something has to change.

I'm sorry,

Dr. Powers

This is from a really nice, young, pretty healthy guy, early 20s. Post-dutasteride exposure has low libido and sexual anhedonia. Overall, mild post-5ARI symptoms, but persistent, and simply won't resolve with time.

This is the most wildly discordant T:DHT:3AADG result I've ever seen.

Obviously, I will be discussing the usual treatment options, but the more of these I find, the more I wonder how this was never noticed with PSSD or PFS over all the years these people have been going to doctors. I know from posting, shitloads of you have the same or different but similar androgen metabolite labs that are just absolutely fucking bonkers.

When you got some absurd 3A-ADG or other value, when you had zero or absurdly high 11-oxo androgens, 17 keto urine testing, or whatever, some absolute absurdity on lab testing, did your doctor just shrug at it or what?

It's blowing my mind how many of you I can tag an absolutely insane lab value on, and I wonder why all these years nobody ever noticed this shit before. It seems so glaringly obvious in retrospect now.

Anyway, not much to say other than "here we go again". But because this was the most extreme example I've ever collected, I thought it a fine example to show. I see this pattern in BOTH Post-Finasteride/Dutasteride and PSSD, meaning I am getting more and more certain that at least SOME of the people with PFS and PSSD don't have a different condition. Meaning this metabolic feedback loop/accumulation glitch is the exact same disorder, just triggered by a different drug.

We understand there is neurosteroid PFS, androgen signal loss pfs, and "melty" or connective tissue loss PFS. They are similar in mechanism, but different, with different metabolite accumulation/depletion sets due to how many ways 5AR interacts with everything important:

https://preview.redd.it/l9ugkev2qgfh1.png?width=1209&format=png&auto=webp&s=f2322ebf3b7f99154f2e5656f734508d8e8cd8c5

Here's the lab, he's also got a slightly elevated free estradiol, likely from his nuked SHBG (not shown here)

https://preview.redd.it/qdj880klogfh1.png?width=1466&format=png&auto=webp&s=780ebf5c776dbd918ea25c329a7547c5ec0f5e89

I've spoken on my 5ht2C theory of PSSD.

This is not that.

When I came up with my PFS model, I actually made a bunch of models. I created models that would potentially explain the known experimental research findings, and then what I would expect labs or other things to show if that model was correct. Eventually I eliminated all but one. My current theory of PFS which so far, works on labs, paper, and in practice.

For PSSD, I'm still kicking around models. But I have one where the problem is basically PFS wearing a new hat. The drug induces a change in the person where allopregnenolone synth is not decreased but rather massively increased. This overwhelms various degradation enzymes (many of the same ones in PFS) and produces a situation where you have labs that make no sense.

Like a T of 600ng/dl, DHT of 25ng/dl, and a 3A-ADG so high its unmeasurable.

You see, allopreg can actually be metabolized down that pathway.

Progesterone

│ SRD5A1/2

▼

5α-dihydroprogesterone

│ AKR1C2/AKR1C4

▼

ALLOPREGNANOLONE

│ CYP17A1: 17α-hydroxylase

▼

17α-hydroxyallopregnanolone

│ CYP17A1: 17,20-lyase

│ strongly facilitated by POR + cytochrome b5

▼

ANDROSTERONE

│ AKR1C3 / HSD17B3

▼

3α-ANDROSTANEDIOL

│ UGT2B15 / UGT2B17

▼

3α-ANDROSTANEDIOL GLUCURONIDE

While Cortisol is probably the most maligned molecule in the human body (he is your friend, you need him around during hard times, just not ALWAYS). Allopregnanolone is probably the opposite. Its viewed as universally benign and antidepressant and just the thing everyone needs.

What could be expected with too much allopreg in the short term?

Fatigue

Low libido

Low motivation / initiative /agency

Brain fog, poor concentration

Memory issues

De-realization / de-personalization

Emotional flattening

Verbal slowing

Muscle relaxation/weakness

Reduced pain perception

Reduced sensory perception in general

Reduced sexual salience

At odd concentrations, there may be some paradoxical gaba-a effects that are the inverse of above, depending on the situation or other factors

What could be expected at absurd levels?

Extreme somnolence/fatigue

What looks like narcolepsy / chronic fatigue syndrome (dont get me started on ME/CFS, I've got ideas, but PSSD will come first)

Confusion

Slurred speech

Cognitive impairment

Dizzy/ataxia/ambulation dysfunction

Nystagmus

Stupor

Memory loss

Severe interactions with sedating medications

Okay, but, that's what happens when it STARTS.

What happens when you expose a nervous system to that kind of GABAa constant beating? Same thing that happens to chronic alcoholics/benzo users! Adaptation occurs. So what do you get long term?

Tolerance to the sedation, fatigue improves

Consistent cognitive dulling

Anhedonia, emotional flattening

Amotivational syndrome

Sleep disruption despite need to sleep

Intermittent agitation/dysphoria

Increased sensitivity to small neurosteroid fluctuations.

Paradoxical or non-reactivity to benzos/alcohol/progesterone/neurosteroids.

Whenever production of that allopreg falters (due to whatever thing that triggers that to happen as PSSD people try everything) if it drops, you'd experience withdrawal anxiety,insomnia, fear, sensory amplification,m and even seizure risk just like an alcoholic entering delrium tremens.

If i'm correct, adding anything that increases allopreg to these people, such as pregnenolone, progesterone, SSRI's that begin with F, or brexanolone would put them on their ASS. They would struggle perhaps to even walk or move.

I know for years and years, everyone notices the similarities between PFS and PSSD

But what if what PSSD actually is, is the massive overproduction of allopregnenolone and the long term adaptation to that process?

If this resonates with you, let me know in the comments.

But also let me know if you happen to be a PSSD patient with mostly normal androgen labs except an absolutely fucking bonkers 3A-ADG value, or any of the breakdown products of Allopregnenolone on lab testing.

Its been a LONG time that these disorders have gone unsolved. I suspect that for PSSD, it'll be just like PFS. Something paradoxical and counterintuitive. What if the wonderful and benevolent "allopregnenolone" is the problem at the core, and a massive excess of it is what is the true issue, acting as a permanent GABA dampening force on the entire cortex, stripping it everywhere of its ability to be excited/respond/experience/enjoy.

Well, maybe not, we'll see, but I'm working on it friends. I'm tired, but....some of my ideas here are starting to bear fruit. Lab results are coming back with values that are absurd and seemingly nonsensical. I'm on to something! Hang in there for me for now!

- Dr P

PS:

Labs that would be interesting to see on PSSD patients to see if they were odd :

"17α-hydroxyallopregnanolone" - No idea where you'd get this. Would be very convincing if elevated.

ANDROSTERONE - quest used to have it, but it appears that LabCorp is the only one that does now.

3α-ANDROSTANEDIOL - Never seen this in its non-glucuronidated form, but maybe someone has it.

3α-ANDROSTANEDIOL GLUCURONIDE - Quest has this. I think labcorp does too.

In order for these labs to make sense, they need to simultaneously be ordered with a:

Testosterone Total

DHT Total

As if your 3A-ADG maxes out the assay, but you're a roidhead megadosing ball juice every week, that's expected. If your 3A-ADG is 5000+ but your T is 600ng/dl then we have something interesting going on.

Hey Everyone! Hope you enjoyed Electric Forest 2026! I surely did!

As is tradition, this is my annual recap post on the Bitcoin Scavenger hunt, and my attempt to hear the stories of who found things and where they found them! That's my favorite part of doing this, so if you found a wallet, let me know!

This year, I hid 43 containers of bitcoin or cash containing $4000 total in the forest, comprised of 30x $50 wallets, 10x $100 wallets, 2x $250 wallets, and 1 Grand Prize $500 wallet.

I also hid about 250 other "consolation prize" wallets which were various containers as pictured, but all contained at least a $2 bill and a small trinket.

Here's a picture of all the loot before it was handed out!

The guard cats protect the stash!

Did anyone end up with any of my Trinkets? Some were hidden around the forest and some given away. Picture attached to show them:

https://preview.redd.it/tkge6j0rioch1.png?width=1430&format=png&auto=webp&s=505e25449088f13dca55443e97222e7ce83d6540

1. Bitcoin Canister Rupee (came in many colors)

2. Bitcoin Canister Mushroom (also many colored caps)

3. Spinning electric forest keychain fidget with planetary gears

4. Spinning electric forest bracelet (you can wear it like a bracelet, but it will spin continually on your wrist due to the chevron shaped planetary gears between the two parts of the bracelet!)

5. Spiritual Stone of the Forest , aka "The Kokiri Emerald" from Zelda - Ocarina of time. Pretty much every canister had at least a small one of these.

6. Zora Sapphire (zelda)

7. Goron Ruby (Zelda, I mostly made sets of these to give away with the kokiri emerald to people with cool zelda themed stuff or totems).

8. Psychedelic long-cat fidget (gave to cat people!)

9. Fenrir Fridge Magnet - My Guinness World Record holding cat Fenrir works at my practice every day, and we hand these out to people who get excited about taking pics with him. Fen is a very good boi, but I couldn't bring him to EF, so I brought these instead.

10. Electric Forest 2026 Spinning fidget rings, just like the bracelet, but for your finger!

11. Koroks (these came in two flavors, the knitted style one is not shown here)

12. Dragon eggs (there's one in the announcement pic, but I forgot to take a pic of those), so 12 not pictured!

Canisters containing bitcoin had a sticker on them indicating to me their worth so I knew when I was hiding a live one!

Green = $50

Blue = $100

Purple = $250

Orange = $500

Kind of like "rarity" coloration in most video games. Epic loot drops!

I always get asked why I do this. I do it because it's fun. It's a lighthearted adventure / side quest that people enjoy.

At my first forest, I brought bitcoin canisters to hide when it was hardly worth anything. It was my weird nerdy hobby at the time. It hasn't made me absurdly wealthy or anything, but it did allow me to pay off all my debts, which is really nice. 20 years ago I was sleeping in a car for a few weeks eating not much but cup noodles. Now, I have a roof over my head and food on the table. Bitcoin did for me what I hoped it would, and everything that comes after that now is gravy. I'd like to keep paying that karma back year after year keeping up a tradition I started long before it was worth hardly anything, because the spirit of why I did remains the same as it was then. Being a Loanspaidoff-ionaire is great. That has allowed me to run my medical practice at times at a loss but for us to keep caring for some populations who can't always afford care. That's allowed me to do a lot of good when I otherwise would have had to financially bend the knee.

Yeah, some people found the wallets nearly 10 years ago and held onto them and have commented they are worth thousands now, that's great, I love that! But even better was this year I saw a guy comment he found one way back when, maybe 10 years ago, but when he did, it got him interested in it, he bought or mined more, and as a result of that, it changed his whole life and paid for a house. He had a bitcoin tat on his ankle! That gives me so much joy I don't know how to explain it. That happened because he found my canister, and that's really really cool to see how time works by a small action creating an enormous downstream impact years later. .

I'm not going to get into all the things that happened this year good or bad, because there's countless threads about that every year, just with different joys and different sorrows. The world is a big and scary place where wonderful and terrible things happen all the time, most of which I have zero control over. All I can do as one guy is try and bring more joy into the world than suffering. To give more than I have received. That is what I can control, and that's why I will continue to do this as for as long as I can. Rather than putting your effort into conflict on a forum, or judging someone for their misdeeds or different opinions, instead, I challenge you to put it into something that moves the needle in life. Make it so at the end of your life, which I assure you, will someday come, you can face what comes, knowing you were a net benefit to this world while you lived.

There's a little story about this concept inside each of the bitcoin wallet containers, but it's meant only for those who actually find them, so if you didn't, good luck finding them next year. =)

If you met me and my crew, or took pics with us, please share them in the comments. i've attached some pics to make that easier to remember. Sometimes we just had on normal clothes, but if you saw us in our more wild fits, you'd remember. My favorites being me and my fiance's daytime peacock fit, and my night time cyberpunk fit.

https://preview.redd.it/zrwk8xuuioch1.jpg?width=1185&format=pjpg&auto=webp&s=dda9cd67cf3d020433c64c922130adf670e887f4

https://preview.redd.it/ndwmauuuioch1.jpg?width=2048&format=pjpg&auto=webp&s=52e0679b61519301a34a3cf061416d1334bcfe49

https://preview.redd.it/fo6epuuuioch1.jpg?width=2198&format=pjpg&auto=webp&s=a7e7a80b6c2a97578aeef3b591c44564f2f172a3

If you passed the front of my RV, you would ASSUREDLY remember, as we had a lot of fun displays going the whole time. You may have seen our spinning holographic backpack as well, which showed a constant stream of old nintendo games on it.

Dear RV Avenue, pardon my seizure inducing front windshield.

Canisters were hidden ALL over EF. They were hidden on main street, throughout parts of Tripoli, all over the giving tree region (including the hill trees), various spots and trees around Ranch. They were tucked into a multitude of different places in the forest, including the library, the BDSM gingerbread stage area, the towers, the maze, around stages, around art installations, in plant pots, in little alcoves or inside nooks and crannies all over.

The one place I do not hide them is in the luminaria area where people post remembrances of those who have passed simply out of respect. But they could have been found quite literally anywhere within the festival grounds or on main street.

But where was the grand prize hidden? I did it differently this year and hid it actually at sundown on the very first night and it lasted almost 24 hours I think. It was tucked into the hole of the fallen log by the giving tree. You could not "see" this mushroom at night (possibly during the day). You had to have bravery and thrust your arm completely in the dark, deep into a wooden log basically like that old scene from the 1970s flash gordon movie:

SPARE ME THE MADNESS!

Except being stung by a deadly scorpion, your bravery rewarded you the grand prize! Congrats!

This was a Mushroom with a totally unique, psychedelic appearing top different from every other mushroom I hid. I know someone found it, as it was gone by 2am friday night, but it has not yet been cashed in already like many of the other wallets have. Get on claiming your funds friend. The mushroom caps unscrew, there is stuff inside!

The $500 canister was hidden here at dusk on thursday night.

I've attached the list of wallets below, so they can be monitored. all you have to do is search the address on a blockchain explorer website and you can see if the funds remain or have been claimed.

As a reminder, you have until August 1st to claim the funds or I consider them lost and unclaimed and I take them back, so hurry up and claim your money!

Thanks for playing my game again this year. I hope to return and do it again next year at EF 2027 =)

- Will

Bitcoin Public Addresses for funds verification:

(you can look any of these up on https://www.blockchain.com/explorer to verify the funds are really there)

BTC public addresses EF 2026

$50

1J6YFFtqikfSC3USCXKKPin5YyAEzitDjs

1JSAwvM1ejqPKCqYgdLBYBumQk8K5Lmdjd

1HMwAS63KTdgCbQVD7JR4kWLXqpPPJeLbJ

169QMFkoLMrDiEMpNkcRFNdiZfjhvqJqom

1EDRsh5nYM4T2YxNRnjbFLwHgy8jkhdN3G

1Nj8QZrNpCQnZPGee7WzfZTYHdBchCm3GS

1NQeWj7RRwoUkUQTMnztycw7ee6yeL78gT

1Pf5wzRzFHSL3Jcmcrwk2U9ashW1FkgPSo

1KLY46SCsZL97QiqAXqgfMfGgz5Wuw5yrX

1MH2A2DDsQuyeNKaLFiyLXvvnUYPZzoTrp

17rUJSuSt5XURGETbsAFZrQoxJWjYgqEz8

15VQKJAwCGufmCNEyrvQbRGRnimp3RpgFG

1DpUQqfPscw4vXeti8d7kMXLncte9u1gUn

1Fn9iLLKepC5xNJ3kQRHFVFkVnP9JnC5yL

18jo2ffPWWo7wSm7yoUfJWng7fVqRLd8Eu

1MMswJZDrHLWnru4ZwTb9gnUb5yojahdfV

1NrjGZn63h2eyDtmyKCjEZ3RfmT1YpwVYz

14unX4q7KJnaf826SWGTpqpiGzH49HGwTK

1NXQwqZCe1htEwDsvvy7KQMxEmsiBmTGjN

177mqjuAYAX5nT5kni35TU9HAyGLp3FTKT

1M9tWV6e1Y7Y47cXudrqMphuMVs3VNhqFw

17VXcDCkVNXXpBBegQ2aiPuX9wwVJQ1e8T

16wc9E5cztKuQ6sjWzgn3ojSnsomhJE1CL

19HJhUqrEmYL4af4rsrmbJEDCRaKz5gyJs

1BBQUAjLBFpVjau3Qb1QUaFYmEvBJix8cq

1Mdu2mS4wT3iZ2JZnWrzawXTc9TP6pTGNM

1DUpY2Dptx9vGUD8wpcSyUuYJG5hGikTha

18P1evmi9KKKufZnE1ovHVd9x6FFE27q2H

19YmQEAPCEXkZ2EqXyzVfCkRLaVTmcgtrK

1AcBaF1wa5f9ZvyxbYK2ADEHeuRiCqLCf6

$100

1MQTXic8iNEdARbbjXSD9rcMwpLyNE3PVk

1C9JgFb1dEb879vQM88uA4GHHzDy6gcpBC

183zypXA6qurWbzefYqWJcbu2NnKDdCvRa

17R85cNCvLnNbxAXCKem9U5WY5F2LdscYo

15fZMU1Q8LorUmxemoNLkjtyGBhmtRNaob

17D3DZ2WwKqQH2HuF8NTRhEVHrTsBYf23E

1MrnSRLTPbDF24TBunPRHSVCgEvvXpS7iY

1E4aBPdfA3SEMMfM4m3bPnbgwSWnkFt92u

1MhS9futM93nSpRe4soZP5yrYyTX4DcpQQ

1t1Fi6ak33vGZ2ikPaZrV29dv1jhcWwN9K

$250

19GaDHrpDvHT7T8Dqkc8TrY4BBf7GbHEsj

1URwPGJXZhZqLJQJxMgJeCfWva6MTGGScK

$500

1GCWwC4EYDiFpXUL2w8MF2Wd2j5Yv1Uv99

See above title.

That's almost the whole post.

We're not making a whole new subreddit. The subreddit is named what it is named and that is what it will remain. If people don't like this, they can go somewhere else. But I will allow people to sort their posts by topic to make the process more efficient for those seeking knowledge.

K I'm going back to Electric Forest Festival now. Play nice together please. Be excellent to each other.

-Dr. P

Yes, the tradition of hiding a few thousand dollars of bitcoin inside the forest will continue for yet another year. As is tradition, aside from some cool trinkets and smaller prizes, there's $3500 of hidden bitcoin in the forest!

No, this isn't a joke, its real. Everyone always thinks that, but here's a link to last year's post, or the year before that:

2025:

https://www.reddit.com/r/ElectricForest/comments/1l99vp4/yes_the_tradition_of_hiding_a_few_thousand/

2024:

https://www.reddit.com/r/ElectricForest/comments/1dgviof/yes_the_tradition_of_hiding_a_few_thousand/

Why do I keep doing this? Honestly, I don't exactly know, it gives me joy to set up, and people seem to like it, and the tradition even made it into a bingo square on EF bingo at the brainery last year which was cool. Also, shit has admittedly kinda sucked for a while. I'm a physician, HIV specialist, and I care for a ton of transgender people, and admittedly that specific job has become particularly high stress since approximately November of 2024. Getting antagonized by your government simply for trying to help people really blows. But whenever stuff has sucked for me in life, I've tried to turn that misery into something good instead. Forest is a place where I can just sort of forget about those problems for a few days and just be free, and it gives me great joy to enrich the experience of EF for literally anyone I can as its so important to me. So, I do my best to do that, and this year will be no different.

That being said, alongside the hidden bitcoin, I decided to craft a lot of fun trinkets to give away. Some of these will be concealed inside containers. Some are just meant to be found randomly aside from the BTC hunt. I went with more of a Zelda this year and a little less Mario, but it's a pretty solid mix of stuff related to fun things I like. You can find Rainbow cats, electric forest fidget spinner keychains, EF fidget spinner rings, spinning EF bracelets which are made with planetary gears and spin around your wrist and more! I'm pretty geeked to play the Ocarina of Time remake this year, so I decided to make some "Spiritual Stones", particularly the stone of the forest people, a tiny Kokiri Emerald as well tucked into every little container. There's also some hidden Koroks to find! Yahaha!

I generally start hiding wallets on main street on wednesday night, and I typically hide the top prize wallets on saturday and sunday. But some years I found such a perfect spot I couldn't help but drop one early.

There is one GUARANTEED location BTC canister, which is one of the $250 canisters which will be at the trading post. I drop it off on the first day, and it will contain one of all the trinkets as well. (The giant dragon egg). Can you find something worthy to trade for it?

Because people recognize me now, I tend to have my friends hide canisters for me once I find a good spot, but occasionally I can tell someone is following me, so there's a lot of 5th prize tier decoy canisters that only contain a small trinket and mini cash prize. There's about 160 mushrooms and 40 or so "other containers" but only 43 of the total containers contain actual bitcoin paper wallets. Don't be sad if you find a decoy container with no bitcoin, they still have a little surprise in them!

As always, I keep the private key of all the paper wallets. I do this because people sometimes don't claim the money (I know right?). You have until August 1st to sweep the funds to your own bitcoin wallet once you find a canister. (Instructions of how to do this are inside the canisters with bitcoin). If you fail to do this by then, I will consider the canister "lost" and reclaim the funds. Do not message me afterwards begging me to put them back. You have more than a month to claim the funds, so if you find a canister with hundreds of dollars in bitcoin, CLAIM IT. Last year I swept back approximately 15% of all the canisters which went unclaimed by August 1st. I WANT you to claim the funds, so do so! I just don't want to throw money in the trash, so if you don't, I will sweep them back come August!

If you have any questions, hit me up in the comments. If you just wanna say hi in person, I am usually wearing something absurd and ridiculous fit inside forest, such as my peacock costume, my cyberpunk outfits (It has a glowing sandevistan spine) or some other incredibly extra sort of thing.

Don't ask me for hints! I wont give any! But I am happy to share in the spirit of the forest, and hugs are always free.

See you soon Forest Fam!

- Will

Guinness World Record holder and PFM Office Therapy Cat Fenrir Antares Powers defends the pile of Electric Forest Loot alongside his melanistic brother Dustin Krobus Powers. They keep the prizes safe until game day as is tradition!

Bitcoin Public Addresses for funds verification:

(you can look any of these up on https://www.blockchain.com/explorer to verify the funds are really there)

BTC public addresses EF 2026

$50

1J6YFFtqikfSC3USCXKKPin5YyAEzitDjs

1JSAwvM1ejqPKCqYgdLBYBumQk8K5Lmdjd

1HMwAS63KTdgCbQVD7JR4kWLXqpPPJeLbJ

169QMFkoLMrDiEMpNkcRFNdiZfjhvqJqom

1EDRsh5nYM4T2YxNRnjbFLwHgy8jkhdN3G

1Nj8QZrNpCQnZPGee7WzfZTYHdBchCm3GS

1NQeWj7RRwoUkUQTMnztycw7ee6yeL78gT

1Pf5wzRzFHSL3Jcmcrwk2U9ashW1FkgPSo

1KLY46SCsZL97QiqAXqgfMfGgz5Wuw5yrX

1MH2A2DDsQuyeNKaLFiyLXvvnUYPZzoTrp

17rUJSuSt5XURGETbsAFZrQoxJWjYgqEz8

15VQKJAwCGufmCNEyrvQbRGRnimp3RpgFG

1DpUQqfPscw4vXeti8d7kMXLncte9u1gUn

1Fn9iLLKepC5xNJ3kQRHFVFkVnP9JnC5yL

18jo2ffPWWo7wSm7yoUfJWng7fVqRLd8Eu

1MMswJZDrHLWnru4ZwTb9gnUb5yojahdfV

1NrjGZn63h2eyDtmyKCjEZ3RfmT1YpwVYz

14unX4q7KJnaf826SWGTpqpiGzH49HGwTK

1NXQwqZCe1htEwDsvvy7KQMxEmsiBmTGjN

177mqjuAYAX5nT5kni35TU9HAyGLp3FTKT

1M9tWV6e1Y7Y47cXudrqMphuMVs3VNhqFw

17VXcDCkVNXXpBBegQ2aiPuX9wwVJQ1e8T

16wc9E5cztKuQ6sjWzgn3ojSnsomhJE1CL

19HJhUqrEmYL4af4rsrmbJEDCRaKz5gyJs

1BBQUAjLBFpVjau3Qb1QUaFYmEvBJix8cq

1Mdu2mS4wT3iZ2JZnWrzawXTc9TP6pTGNM

1DUpY2Dptx9vGUD8wpcSyUuYJG5hGikTha

18P1evmi9KKKufZnE1ovHVd9x6FFE27q2H

19YmQEAPCEXkZ2EqXyzVfCkRLaVTmcgtrK

1AcBaF1wa5f9ZvyxbYK2ADEHeuRiCqLCf6

$100

1MQTXic8iNEdARbbjXSD9rcMwpLyNE3PVk

1C9JgFb1dEb879vQM88uA4GHHzDy6gcpBC

183zypXA6qurWbzefYqWJcbu2NnKDdCvRa

17R85cNCvLnNbxAXCKem9U5WY5F2LdscYo

15fZMU1Q8LorUmxemoNLkjtyGBhmtRNaob

17D3DZ2WwKqQH2HuF8NTRhEVHrTsBYf23E

1MrnSRLTPbDF24TBunPRHSVCgEvvXpS7iY

1E4aBPdfA3SEMMfM4m3bPnbgwSWnkFt92u

1MhS9futM93nSpRe4soZP5yrYyTX4DcpQQ

1t1Fi6ak33vGZ2ikPaZrV29dv1jhcWwN9K

$250

19GaDHrpDvHT7T8Dqkc8TrY4BBf7GbHEsj

1URwPGJXZhZqLJQJxMgJeCfWva6MTGGScK

$500

1GCWwC4EYDiFpXUL2w8MF2Wd2j5Yv1Uv99

Basically I've got a lot of PSSD dutch tests now. The one factor that seems to be common among them is a low dopamine metabolite, Homovanillate.

​

This is a breakdown product of dopamine. The general consensus of course among everyone is that this means that the dopamine levels are too low. Low HVA must mean low dopamine right?

​

I've been suspicious of this narrative for a while as PSSD behaves a lot like PFS, and it is my suspicion in one of my many theories that could potentially explain the mechanistic behavior of PSSD that there is a buildup of an intracellular transmitter, or the erasure of a concentration gradient.

​

For signaling to occur, there has to be a difference. If there is no difference, there is no signal. Biological systems are tuned to operate within a particular parameter of concentrations of things, and if that were deranged too much, I could imagine erasure of signaling occurring. This is what happens with PFS with intracellular metabolite accumulation.

​

I suspect that the reason that this value is often low is not because dopamine levels are low but rather dopamine metabolism is poor. Dopamine levels might actually be astronomical.

​

Slow COMT seems to be relatively common among PSSD patients, but there's a mutation now that I've seen show up in genomes too much.

​

Basically, I keep finding rare, high revel score glitches in Dopamine Beta Hydroxylase.

​

https://en.wikipedia.org/wiki/Dopamine\_beta-hydroxylase

​

I do not think that this is the magic gene for PSSD, but it has now shown up a statistically anomalous amount to the point where I'm suspicious that it is at least one of the possible glitches that form the family of things that make someone susceptible to PSSD.

​

For PFS I've isolated these two things like glucuronidation or transport or so on. ABCCs, UGTs, SLCOs etc.

​

I'm still working on that for PSSD, but if you have a genome and you are a PSSD patient, take a look at this specific gene. I'm curious to see if this is a statistical glitch or a real signal.

​

I plan on probing this in my own patients by utilizing high dose apomorphine as it is a dopamine receptor agonist without actually being dopamine. Adding more dopamine to the situation likely would make things worse if this theory is the correct one. Apomorphine may "window" someone with this problem. It in no way would be a cure, but simply a probe to give information. But if it does temporarily restore some functionality that would be intriguing. If it does absolutely nothing, that would be useful information as well.

​

Again I have many mechanistic theories that make sense on paper, but only one of them (maybe) is correct at this time. This was the same for PFS, and it took me quite a while to narrow down which was the mechanistically sound and genetically coherent one. But I do plan on attacking this problem systematically the same way.

​

Thank you if you are willing to offer this personal information here anonymously.

​

-Dr. Powers

​

​

I keep being asked this all over reddit so I'm making a brief update.

On the GNRH drugs, it took this patient approximately 2 weeks to reach a level of T and DHT that could be considered "chemically castrated". Effectively, what could be considered an adrenal level of production.

Patient zero's weirdest baseline metabolite value was a 3A-ADG that was astronomical. So high it could not be measured. Just, something over 5000ng/dl could have been 5001, could have been 100,000ng/dl. no idea. Assay got maxed out.

Despite T and DHT being wiped, that value hung out in the average male range for weeks after that point.

Its now been almost 6 weeks since we started this journey, and his 3A-ADG has finally dropped below 100ng/dl, which means as far as I know, he's clean of androgenic metabolite build up.

During this time, we also did a brief course of daily hydrocortisone replacement at slightly supraphysiological dosing in order to wipe out a potential middle glucocorticoid metabolite build up. In most "melty" patients, this is 11DOC, but it can vary in my experience. Disable ACTH and CRH, and the body stops making these precursors to cortisol, and they can wash out. This was done just to make sure there was no occult metabolite pile up there.

At this point, we're just waiting for his system to wash out the GNRH drug and reboot. I expect he will start to come online by the end of June and produce his own natural hormones again. I imagine it will take him a few weeks from that point to decide if he feels normal and cured or partially so or not at all, and based on that, there are plans of what to do next. But I do hope this is all that's required for most patients of the "androgenic signal loss" Post Finasteride Syndrome phenotype due to metabolite buildup.

non-seq, I did meet with people from corewell about them funding and starting a research study, and we have more meetings to do about this as well, but it does seem like the plan is to put my theory of exactly how PFS works and what genetic mutations cause someone to be vulnerable to it to the test with formal and funded academic research.

This is a glacially slow process sort of thing, as academia always is, so I will continue to do my own thing with my own patients while that process is underway, but I figured I should mention that it will be happening.

That's all for now, please stop asking on unrelated threads every time I comment on literally anything. PFS cure project test #1, "have you tried unplugging it and plugging it back in again?" is still underway. This is all the information I have until he reboots naturally, and even then, I expect a few weeks of time from that point for him to really know if he feels right or not. If you ask in a comment thread, I will be linking this post until I have more information to offer.

-Dr. P

For literally decades, internet pretend-doctors (and some real ones) have thrown out all kinds of wild and crazy theories on the nature of PFS, as well as potential treatment options.

I know this, because I was one of them. Guilty as charged.

Yes, I am also excited. I am not stupid, the community is filled with people who desperately want to get better, and they can see the writing on the wall same as the researchers did. They are exceedingly well educated on molecular biochemistry, and as a result, it's rather obvious to pretty much anyone who understands said molecular biochemistry of sex hormone signaling, my theory is probably the most comprehensive and predictive model of PFS that has ever existed. It explains all known phenomenons, all subtypes, and it predicts experimental research findings that match known research findings, as well as ones that you guys don't know about yet (but I do) because they are super top secret (TM) research studies from the various teams that are not yet published, and their findings match what my theory would predict them to find, even though they haven't released them yet.

Great. Go me. Well done. Pat on the back. 5 good boy points to Dr. Powers.

It however, does not, in any way whatsoever, guarantee or imply a particular cure or treatment or anything that might improve anything. The only true "boon" I can say this gives to the community at this time is that it will help prevent it from growing. We now know the likely majority (but certainly not all) inborn genetic glitches that predispose someone to getting PFS. We don't know every variable though, or even what behaviors/foods/etc could contribute to the problem. But I can with a reasonable degree of accuracy (I think) tell someone before they take the drug "yeah, you're likely to get PFS if you do, you have X Y and Z enzyme deficiencies at baseline, this is a catastrophe waiting to happen if you block 5AR".

Despite me repeatedly saying I don't yet have a cure (I have ideas, but they remain as unproven as my whole theory), people are throwing all kinds of insanity into their system, bragging about it on the internet, and flying a flag with Fenrir's head on it claiming my theory as justification for why they're snorting lines of Bicalutamide. Fenrir howls at you disapprovingly. He says if he finds out you did self experimentation based on my theory, that he won't let you pet him or give him treats when you visit the practice.

Fenrir protests your self experimentation!

Please, I BEG OF YOU. STOP.

STOP DOING THINGS TO FIX YOUR PFS

Let me and the researchers figure out the best way to go about this, and when I have some real, concrete data or even just some positive anecdotal outcomes with matching labs and genomes to report on, I will tell you. You risk making your situation vastly worse by messing around. I don't even think the same treatment that might work on androgenic signal loss people will be the treatment that works on the neurosteroid phenotype nor the same as the "melty" collagen damage phenotype.

NON EXHAUSTIVE DO NOT DO LIST:

• Experimenting with anti-androgenic substances (bicalutamide etc..)
• Purchasing Lupron and other GnRH agonists (agonists in some cases could make it WORSE)
• Making said purchases from black / grey marketplaces where purity, dosage and labelling are wildly inconsistent 
• Taking these substances in the absence of oversight from any well trained clinician who knows the molecular biochemistry of sex hormones almost as well as I know world record feline biochemistry.

Please, let me work, and don't make more work for me when it's your turn off the list. (Or when you see another clinician participating in what we're trying to potentially do in the next year, which may involve some formal research studies).

55 People will be pulled off the waitlist over the next week or two. There are exactly 55 patients currently enrolled in my DPC program who have quarterly instead of an annual membership fee. This fee is due "quarterly" on the first of the quarter, and has a 30 day payment grace period. We extended this another 30 days trying to be kind.

These 55 people either declined to renew, or failed to respond to multiple attempts to reach them, and are now 65 days overdue, so I welcome the next 55 in the line to the practice.

This will occur quarterly, and so you can expect the next major influx of patients if you don't make this round to happen around the end of July. With people waiting to see me, we're going to likely be a lot less merciful next time with people being late on their membership dues.

I know that the DPC cost is expensive. I know this. I am sorry about that. As a reminder, I have previously published my W2 on this subreddit, and I have yet in 6 years of owning my practice yet to make even 50% of what I"d be paid per year working a 9-5 at an urgent care as I have the pleasure of caring for multiple disadvantaged patient populations, as well as being the target of government harassment because of them. We also now incur astronomical malpractice costs to be able to provide care to these specific populations. My clinic is quite literally the last standing clinic for hundreds of miles that still cares for one specific population and has not bent the knee despite the misery the government has heaped on us for not doing so. So when you support the DPC, you support that vulnerable population, as without the DPC, I'd have thrown in the towel years ago. I'm not going to mention them by name, but I think you know who I mean. They really appreciate my clinic still existing, as there is literally nowhere else for them to go anymore.

I look forward to seeing your fresh faces soon. Please stop self experimentation, the wait list is moving.

- Dr Powers

I am 41 now. I find this surreal, as feel literally no different than I did at 22 mentally. I'm sure I'm more mentally mature, but the change is so subtle you hardly notice it. If you've been to my practice, you'd think it was designed by a 12 year old boy who loves video games and minerals/crystals and RGB lighting.

As a child, I looked up to adults and saw them as the "authority" on things, and I thought someday, I would grow up too, and become an adult and be an "authority". At this point, i've come to realize that adults are simply large children. Many "experts" stick to their guns despite being demonstrably wrong, but because of systems of power, it doesn't matter, even if you can prove they are wrong, because once a belief system is entrenched, it is exceedingly difficult to stamp out. Even more so if it is endorsed by a government.

Every few years I make the following post. I was having some drinks with friends last night, and we were talking about the absurdity of the American medical system and how bad things have gotten. The vast majority of my friends are exceedingly liberal, and so conversation drifted over government healthcare. One person brought up the UK's NHS as a "great example" of nationalized healthcare, and I had to show them this old post:

https://www.reddit.com/r/DrWillPowers/comments/xuobd0/this_is_my_annual_reminder_that_the_nhs_website/

Many years ago I was told the doctors who authored that document called me a quack. I don't know if that's true or not, but pretty much all the top WPATH endocrinologists have called me a quack for a decade so this would be in character for sure. This particularly infuriated me, as I was being called a quack by people who endorsed:

https://preview.redd.it/px5gg6vciyyg1.png?width=1787&format=png&auto=webp&s=115e16a0340c3bfeb78565848c7e35cbf6d07f37

This is about as false as something can be false. Not only do humans lack a "de-aromatase" enzyme, there is no animal on earth, no insect, nothing that produces such an enzyme. There is no known dearomatase enzyme in all known life.

This is not just some random document from decades ago, This is current as of 2025.

https://preview.redd.it/9i2jzpv4jyyg1.png?width=520&format=png&auto=webp&s=006c740c799eda8f36f7a3e5b38bc047d289abf5

Who's document is this? Well, the Tavistock is a mental health organization publicly funded by UK taxpayers.

Before the recent Cass review changes, the Tavistock ran the UK's main pediatric gender clinic, and was essentially a complete monopoly on gender care for minors in the UK.

Because of the Cass review, the NHS shut down GIDS (tavistock's gender clinic) and now regional NHS centers integrate gender care into their overall pediatric care.

Tavistock still exists as a mental health trust, but they no longer have a monopoly on gender care for minors.

It remains to be seen if this will be better for minors in the UK with gender dysphoria. I don't know enough about the politics nor have boots on the ground there to speak on that, but my point here is this:

For decades, this organization had a stranglehold on pediatric gender care. They had an effective monopoly, and their word was law. Doctors followed their methods, and those that didn't were shamed and ostracized. Their "top docs" following their methods literally did not understand the most basic tenets of the molecular biochemistry of transfeminine HRT (as is demonstrated in this document, along with MANY other glaring errors), but for 13 years, have been calling me a quack.

I have mostly just kept my head down, ignored my detractors, and continued my work privately while they shouted "He never publishes!" as I put out three publications, inventing a new use for a drug, and publishing the first ever method on how to restore the fertility of trans people.

Did anyone care? No, because I'm not "head of X at Y". Therefore I must be stupid. Same as when I tried to publish my Crofelemer paper. My idea was rejected not on the grounds that it was a bad idea, but because I wasn't a Gastroenterologist (I made a post about this last fall if you search for it). As if somehow, not being a GI doc made me incapable of inventing a short bowel syndrome use for a drug intended for HIV patients.

For decades, people have hung their hopes on "the experts" while the experts wrote documents like this one, pooh-poohing their real concerns because "we know more than you, we're the experts".

I don't know everything. I don't have all the answers. I am a very good pattern recognition machine, I build models around what patterns I observe, and I refine them over time. All of them are wrong, they just become less wrong as I gather more data. But what I do not do is say "This is how it is, and the reason I am correct is because I"m the X of Y".

Whether you hate my guts and think I'm an asshole, or you think I'm brilliant, my ideas are just my ideas. Their validity should be judged on their merits and arguments, not because of my "titles" (not that I have many).

I've been feeling frustrated lately, seeing discourse online basically revolve around "Where is the double blind placebo controlled study" because society has been indoctrinated to believe, that's where discoveries come from. This is patently false. Before an idea is stress tested to that degree of extreme testing, it is first bouncing around in the head of a random family doctor. Then he starts constructing a model about it. Then he collects data privately, and he takes that data and refines the model and takes more data and refines the model and this process continues for many years. Eventually, he has collected so much data, he's quite certain his model works in "most" cases, but now it's time to involve "hard" science. This kind of "research" is not admissible in "academic court". IRB's are required, and various other rules are followed. But if you think someone just says "I think peanut butter will improve people's vision, we should do a study on that" and someone just throws 10 million dollars at that to find out, that's not how it happens.

But if some guy who is an expert in peanut butter works in his basement for a decade and has a ton of anecdotal evidence that he can present to the top peanut butter executives, he might be able to secure some funding and support if his idea looks, sounds, and appears to be reasonable and correct.

That's what's happened with my PFS model, and we're in talks now to figure out the best way to legitimize it for real. Or, disprove it entirely and show that all my data was an absurd statistical anomaly.

So....why should you trust my idea before its been peer reviewed?

You shouldn't. You can think it's a good model, you can realize it matches your own experiences, but you should remain skeptical. You should think through it yourself until you fully understand it, and see if it matches with your own observations/experiences, and if it does, you still should remain skeptical.

The greeks believed that we had seasons because persephone ate 6 pomegranate seeds in the underworld when she was kidnapped as she was starving. Hades said this bound her to the underworld, but Demeter was freezing the earth, killing all the humans pissed that her daughter was kidnapped. Zeus brokered a deal where she'd spend half the year in the underworld and half above it with her mother Demeter.

As a result, our world gets cold half the year and warm half the year. This is what was observed, and it happened every single year for as long as anyone could remember, so this model was "correct" to the greeks as it was reliable and accurately predicted when the cold would come. My model might be like this. It may be "predictive" but "wrong".

If patient zero recovers from his temporary chemical castration and returns to his pre-PFS baseline in a few weeks like some miracle, this is not grounds for all the world's PFS patients to do this. I would NOT encourage such a thing. His case is unique, he has a homozygous UGT2B17 deletion among a few other genetic glitches. Not all PFS is the same.

The purpose of this post is to show you the arrogance of physicians, including myself when we are confidently incorrect. I believe in my own idea. I've spent 6-7 years slowly refining it over time. You can find posts on this subreddit where I'm discussing what is effectively a planarized Dr. Melcangi model as far back as 2019, and I based my treatments around that for a long time. Treatments I confidently prescribed (and which often worked but sometimes didn't. Looking back on it now, my high dose oral/rectal neurosteroid precursor therapy did work for most people, but in my current model, it likely worked due to anti-gonadotrophin effects, meaning my model was wrong, but the treatment was still successful. Summer still came, but it didn't fix EVERYBODY.

We are not gods. We are not "experts" in the sense that we always know what to do. We are middle school teenagers in a class of kindergarteners. We know more than most of you lay people do, but we don't know everything. Most of us know one thing really really well, and it's hard to see where the intersectionality lies with other specialties, often leaving us with glaring knowledge holes we don't know we have. I managed to treat MTF gender dysphoria with estrogen treatment for over a decade before fully understanding exactly how estrogen is metabolized and excreted from the body.

That is my full honesty. I literally didn't know the full complexity of this image below halfway down, not the relative potency of the estrogen molecules nor their exact excretory mechanisms. What's even wilder is this is a gross oversimplification compared to what really happens:

https://preview.redd.it/6dhdq2semyyg1.png?width=3574&format=png&auto=webp&s=1a988f9c4a5bc25aa4d5c622f4c5e2eee90efaef

That's terrifying! But in reality, the model I had in my head, even if it wasn't perfect, worked well enough that I was usually successful, even if my model was partly wrong or missing large amounts of data. This is the reality of medicine at the moment. The sheer complexity of trying to fix the most complex object in the known universe results in the development of "guidelines" and "diagnostic flow paths" which work well MOST of the time but not always. But when you've got some young man in front of you saying his dick is limp for 2 weeks since taking only a single pill of finasteride, and you lack a mental model for how that's even possible, your flowpath goes "That's not possible, therefore this must be psychiatric". Occams razor offers the choice of "Is it more likely that I lack the knowledge of this thing i've never heard of before, or is it more likely this kid is crazy and suffering from An Induced Delusional Disorder with the Potential of a Mass Psychogenic Illness?

"I know everything, so he's definitely crazy".

Doctors don't know everything. In fact, we know about 10% of what the public "thinks" we really know. We are always making risk/benefit decisions, and the ever increasing demand on the medical system and falling reimbursement means those treatment decisions must be made far more rapidly than they used to be, and as a result of that, you get slapped with a "most likely" answer on your symptom list rather than a "I have fully thought this through, and asked follow up questions to hunt for zebras". This is the best "game theory" choice, as it results in the best outcomes for the most people. but if you have something rare? a "zebra"? You're screwed. You will be referred around from place to place, eventually finishing your referral journey at Psychiatry.

I am making this post for a number of reasons, but if you take nothing from it, read this below and I'll be happy if you can integrate what's in bold, I'm good with that.

We are not wizards, we are just human beings doing our best in a broken system. It is shameful when for almost a decade now, I have pointed out that this previously "highly respected" organization in the UK claimed something so biochemically false that a high school science student should know better, and claimed it like it was absolute fact, and used it to deny proper HRT care to MTF people in the UK.

So what does an average lay person do about this nightmare?

Find yourself a doctor who will tell you, "I was wrong" or "I didn't know that, thank you for teaching me". Quacks are people who are confidently incorrect. When someone is provably wrong, but continues to insist on their methodology (even if it sometimes works), that is what a quack is. It's not an iconoclast. Barry Marshall was not a quack (but was called that plenty).

If someone can break my model, the fault lies not in finding "what's wrong with this person" but "what's wrong with my model, why does this exception exist?"

A doctor who can admit, "I was wrong" and update their mental model to be less wrong is worth 1000x than an "expert" who is confidently incorrect. Both doctors were incorrect, but only one ever stops being so.

My model of PFS is at least partially wrong, and if you can break it and prove it's partially wrong, please show me how, so that I might improve it.

- Dr Powers