r/DrWillPowers

So In confused and curious what I might be missing in here. Im 30's and on monotherapy 0.1 mg estradiol patches bi weekly for almost two years. My estradiol level is 115 pg/ml and my testosterone is 20 ng/dl.

The problem is whenever I'm on patches, I feel like my sleep is never restful, always wake up at 4 and when I wake up, I didnt feel fully rested. When I took my patches off then that day I usually will have a good sleep like I used to before hrt. I was injection before which give higher level of estradiol but my mood and sleep quality is way worse.

So I wonder what is my body missing or what is missing from my regimen. I takes melatonin, still doesnt help and my doctor doesn't want to prescribe me progesterone because he thinks Im sensitive with hormones and progesterone might worsen it. Because of sleep deprivation, it wrecks my metabolism, my lipid profile is off chart, even when Im not overweight, I eat healthy and exercise.

So help me I feel lost.

I am a 30 (AFAB) looking for help from anyone who has successfully navigated complex hormone crashes.

I have PCOS, POTS, Fibromyalgia, and Hypermobility diagnosis. For almost two years, I have been living with severe, weekly flares of vaginal burning and irritation that feel completely untreatable. I am also waking up with drenching night sweats Bi weekly.

My doctors have run common pathogen, fungal, and bacterial panel (all negative), but they keep dismissing my blood work and won’t order any more hormone labs for me.

I have recently went out of my way and did direct to consumer testing thanks to this community for helping me learn that was something I could do. I’m currently waiting on fresh Day 3 labs, but here is my baseline from my last draw that that has me confused.

Baseline Labs (Day 3 of Cycle - October 2024)

• Estradiol: 32.8 pg/mL

• Free Testosterone: 2.0 pg/mL

• Total Testosterone: 23 ng/dL

• SHBG: 81.9 nmol/L

• LH: 21.1 mIU/mL

The Symptoms

Constant off and on burning/pain and irritation for 2 years. They told me it was yeast at first, but when it would return to burning and pain after a few days after fluconazole and tests show no positive result for yeast, they told me to just use boric acid indefinitely. That seems to help sometimes. They just have me using lidocaine for the pain and corticosteroid cream every other day..

Menopause has been ruled out. My ovarian reserve is “normal”

After some time I felt like the issue was I didn’t have enough T or E maybe?

I was told by a clinic (Circle Medical) that using compounded testosterone cream on my vagina would cause it to "shrivel up and waste away." This sounds like total nonsense given that the vestibule is packed with androgen receptors.i am even seeing specialists at OHSU and being dismissed and told to just keep taking boric acid..

• Systemic: Severe night sweats, joint instability (hypermobility flares), and POTS crashes.

• I’m currently on GLP-1 medication.

What I need from you:

1. Lab Insight: Do these numbers look as "Menopausal" to you as they do to me? (Especially for a 29-year-old at the time of the labs?

2. WA Telehealth Recs: I need a doctor licensed in Washington State (or Oregon) who understands Optimal vs. Normal.

I will update with my most recent labs once they are in.

Recently I was given compounded T cream from a friend about two weeks ago that I’m applying to the genitals daily as well as E cream and for the first time since all of this has started i have been able to find some relief that I never expected. This is why im really taking steps to look at my hormone labs again because this level of relief is something I have never had in the past year.

Dear all,

In November/December 2024 I took Finasteride for a short period. I noticed changes after the very first dose and stopped quickly. Since then I've been dealing with classic PFS symptoms: penile numbness, difficulty getting and maintaining an erection, and near-complete loss of libido.

This week I got blood work done. Unfortunately I couldn't test everything due to cost.

My urologist says this looks like primary hypogonadism and wants to treat me with testosterone. I'm not sure that's the right call given the context.

---

Lab results:

Marker	Result	Reference range
Testosterone	3.65 µg/l	3.50–12.00
SHBG	56 nmol/l	18–54
Free Androgen Index (FAI)	22.74	35.00–92.60
LH	12.8 U/l	1.7–8.6
FSH	4.9 U/l	1.5–12.4
Progesterone	0.21 µg/l	< 0.15
DHT	70 ng/dl	30–85

---

Why I'm struggling to interpret these:

Based on Dr. Powers' theory (as I understand it so far), PFS involves a blockade of the 5α-reductase enzyme, which prevents the conversion of progesterone → 5α-DHP → allopregnanolone. The resulting neurosteroid deficiency (particularly allopregnanolone) is thought to drive many PFS symptoms via disruption of GABA-A receptor signaling.

However, my DHT is in the normal-high range (70 ng/dl), which suggests 5α-reductase is actually functioning? Yet progesterone is elevated, LH is significantly high, and free androgens are low.

I haven't been able to test allopregnanolone, pregnenolone, or free testosterone directly.

Has anyone seen a similar pattern? Does the elevated progesterone with normal DHT fit anything described here? And is testosterone treatment the right move, or could it suppress LH and mask what's actually going on?

Any input appreciated.

I’ve always wondered what is considered a good value for the SHBG? I’ve tried reading up on it and understand basically what it means but the literature still seems vague on what the goal would be for someone like me on HRT. Is a higher value better or is a lower value better? Is there a sweet spot to target/hope for?

Hi everyone, posting on behalf of a friend (trans woman) who had vaginoplasty about 10 years ago. She doesn’t know how to speak English and doesn’t have Reddit so that’s why I’m helping her :(

She’s been experiencing recurring symptoms and we’re trying to understand what might be going on:

Main symptom is a burning sensation at the entrance of the vagina (neovaginal opening), especially at the beginning of the canal. The skin doesn’t seem very painful to touch directly (with fingers, lubricant, or dilator), but the burning sensation is still there.

The area looks generally pink/normal, but sometimes (slightly redder in certain spots near the entrance). The burning can sometimes extend to the perineum and occasionally the anus

She feels like the pain is more external than internal, but she’s not 100% sure

Other details that might help:

- She has tried a healing cream (Blastoestimulina), which seems to improve elasticity but does not reduce the burning. Painkillers like ibuprofen or dexketoprofen sometimes help, but not consistently.

- Symptoms improve or disappear when lying down, especially in a fetal position. Sitting tends to trigger or worsen the symptoms, and they come and go throughout the day. Some days she has no symptoms at all, other days it’s quite uncomfortable. This started again recently after a symptom-free weekend :/

She’s wondering if this could be something like nerve-related pain, pelvic floor issues, irritation/inflammation or even something like hemorrhoids or vascular pressure (since it changes with position)

Has anyone experienced something similar this long after surgery? Any ideas what this could be or what kind of specialist she should see?

She lives in Spain and she has a long history of problems with her vaginoplasty. She had urethral stenosis that developed two years after her surgery, and was corrected through a second surgery; after that she feels like the nevers in her pelvic floor have been damaged. On and off she gets symptoms like discomfort in her bladder (that started after the second surgery) or pain in the muscles of her pelvic floor, etc. She saw a new surgeon who recommended a medication for her and apparently it’s been helping her, but now she has this new problem where she has a burning sensation in the entrance of her vaginal cavity, and sometimes even the peritoneum and anus like I said.

I would greatly appreciate it if someone could help us figure out what’s happening to her, or maybe somebody went through the same thing and knows how to handle it. If that’s so, please help us! She’s very scared and feels really bad :(

I come to Dr Will Power’s page too since he mentioned he uses a testosterone cream in some of her trans women patients with SRS that have pain when dilating because of tissue shrinkage, could that be what’s happening to her?

Thank you 🙏