u/RevolutionarySecret7

If so, what should I say to the doctor? Obviously they won’t prescribe it to me if I only say “I have post accutane syndrome)

I’m looking into starting lithium, as my brain fog is becoming unmanageable.

How did you guys manage to get a lithium prescription? Telehealth? General practitioner? What do I tell them?

Most doctors don’t even know about PAS, so how do I justify them giving me a prescription?

**TL;DR:** 21M, took Accutane for 7 months, developed brain fog + ED/low libido that never went away (1.5 years post-course). Pre-Accutane total T was ~700, post-Accutane it dropped to ~550. Started enclomiphene 6 weeks ago, T is back up (800+ total, 200+ free) but symptoms have only mildly improved. Tried a huge amount of nootropics/peptides already. Looking for people who've been through this - what actually worked for you?

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## The "before" me

I've always been the sharp, quick-thinking one. Then I did a 7-month course of Accutane and somewhere around month 2-3, the fog rolled in. Doctors said "don't worry, it's temporary." Cool, except it's been a year and a half and I'm still standing in the fog waiting for it to lift.

## The elimination round

Before I even knew "Post Accutane Syndrome" was a thing, I tried to pin the blame on literally everything else:

- Dehydration → drank more water → nothing
- Bad sleep → started tracking it → sleep's actually fine
- Vitamin deficiency → full bloodwork → all perfect
- Too much screen time → cut it down → no change
- Long COVID → chased this theory hard → dead end
- DPDR → still not 100% ruled out, but unlikely
- Late-onset ADHD → doesn't fit, I can still focus fine

Basically a whole detective board with red string and nothing connecting.

## The plot twist

Got with a partner for the first time since before Accutane and... nothing worked right. Low sex drive, trouble getting and keeping it up. I'm 21. I ended up needing a tadalafil script just to function. That's when I finally went back and looked hard at Accutane as the cause, and found the PAS community talking about the exact same brain fog + sexual dysfunction combo.

The timeline lines up perfectly. The only variable that changed in my life when this all started was Accutane.

## The receipts

- Total T before Accutane: ~700
- Total T after Accutane: ~550
- Started 12.5mg enclomiphene
- One week later: total T 800+, free T 200+

Huge jump on paper. In practice though, only mild improvements so far:

- Slight libido increase
- Easier (but not effortless) erections - still using tadalafil
- A little more irritable, nothing crazy

6 weeks in now, waiting on new labs.

## The "things I've thrown at the wall" list

Semax (nasal + subQ), Selank, NAD+, BPC-157, CJC-1295/Ipamorelin, retatrutide, methylene blue, nicotine patches (back in my Long COVID era), and now enclomiphene.

## What's next on the list (maybe)

- Lithium carbonate (short cycle) - keeps coming up as THE go-to for PAS in this community, just not sure how to get a doctor on board with prescribing it for something most of them have never heard of
- Bromantane
- Modafinil - fully aware this is a band-aid, not a fix, but at this point I'll take a band-aid

## The current working theory

From what I've read, the leading suspects for what Accutane actually did are:

- Androgen receptor changes
- Dopamine receptor changes
- GSK3B
- Beta-catenin

## So, Reddit... has anyone actually beaten this?

Not looking for "just give it more time" - I've given it a year and a half. I want to know:

1. Did anything actually move the needle for your brain fog?
2. Anyone have real success (or horror stories) with lithium for PAS?
3. Bromantane vs Semax - worth stacking or redundant?
4. Anyone recover fully, or is this just "manage it forever" territory?

Appreciate anyone who's made it this far. This community is honestly the only place that's made me feel less insane about all this.

21N Finished course of accutane a little over a year ago. Main side effects that I STILL have are extreme brain fog and sexual dysfunction. What can I try next?

Ive tried enclomiphene, semax, CJC-1295, GLP-1s, and I’m really grasping at ANYTHING to try and help. Thinking about Lithium next.

Please give me suggestions.

I have a pending transaction that won’t show up in my copilot transactions. However, the same transaction DOES show up in my Monarch app… how do I fix this? (Discover card)

I’m 21 and have been having lower libido, drive, and a slightly harder time maintaining a full erection. A couple years ago I was around 700-800 total test, now I hover between 500-600.

What’s the best route to go for enclomiphene, how much should I take, and how expensive is it? Been looking into telehealth platforms.

I’m 21 and have been having lower libido, drive, and a slightly harder time maintaining a full erection. A couple years ago I was around 700-800 total test, now I hover between 500-600.

What’s the best route to go for enclomiphene, how much should I take, and how expensive is it? Been looking into telehealth platforms.

I’m on 1.5mg on Reta for maintenance, and was thinking about switching over to tirz (lower hr, better sleep, better cardio endurance), but was worried about the “fatigue” that some say comes along with tirz. Thoughts?

I’m on 1.5mg on Reta for maintenance, and was thinking about switching over to tirz (lower hr, better sleep, better cardio endurance), but was worried about the “fatigue” that some say comes along with tirz. Thoughts?

I’m 6’1 185 male and maintaining at 1.5mg dose. I’ve noticed a 5-7bpm increase in heart rate, and was curious if this would be bad for endurance?

I was considering switching to tirz (to keep the inflammation benefits), but I’m worried that it will make me feel “sluggish”. Thoughts?

Currently on 1.75mg of Reta, and wanting to switch to tirz cause I already hit goal weight. What would be the tirz dose equivalence, and what’s the best want going about switching?

Currently on 1.75mg of Reta, and wanting to switch to tirz cause I already hit goal weight. What would be the tirz dose equivalence, and what’s the best want going about switching?

Currently on 1.75mg of Reta, and wanting to switch to tirz cause I already hit goal weight. What would be the tirz dose equivalence, and what’s the best want going about switching?

I hit my goal weight a couple months ago using Reta. I’m still using it mainly for the insulin and inflammation benefits.

Should I switch to Tirzepatide if I’ve already hit my goal weight just to get the inflammation benefits? Or, is Reta superior for insulin sensitivity and inflammation?

Slightly elevated HR on Reta is another question mark for long-term use.