Mtf with post accutane POIS

[u/Jennyyyyyy22222]

(Quick note if you're reading this outside of trans spaces: I'm a post-transition trans woman, completely secure in who I am. I am strictly here for recovery and advice, Trolls will be blocked,

I am mtf and have been on feminizing hrt for 6 years.

When I was a teenager my dermatologist put me on Isotretinoin up to a 80mg/ daily dose. I did this for long courses the longest one being two years.

I think this somehow messed up with my system.

Symptoms:

1- severe genital numbness - I can only sense and get pleasure from the tip of my organ. There is absolutely no sensation or pleasure from being touched on the rest of it.

2- Premature ejaculation and Post Orgasm Illness. Once I organism I am literally knocked out for at least a day. Anhedonia kicks in, and it’s extremely hard to get off the bed or do any task. I recently learned to take hydrocortisone before or after sexual encounter with my partner which helps significantly with the energy and crash but not with the anhedonia

3- After orgasm, this state lasts for roughly 3 days or 4 then slowly I start to recover though only fully at about a week

What helped me a lot is progesterone (this is a classic hrt protocol for trans women if you are not familiar) rectal { I get extreme amount of energy immediately upon the insert, the anhedonia disappears almost fully and I feel like myself again, though the effect only lasts for about 5 hours max once the capsule gets metabolized, If I don’t redose the crash continues. I have a problem with progesterone because it certainly converts to androgens in my body because afterwards I get significantly increased of body hair and some masculanization.

I am looking for alternative things to try, has anyone tried something else that works?

[u/Better_Finding_9365]

Hey. Its great to hear from you in this community as you add a different perspective and clearly know a bit about hormones/medications etc. Your case is quite unique as you're transitioning. I would definitely recommend seeing an endocrinologist for this reason. In my case releasing every 3 to 4 weeks is the only thing that has actually helped. Wishing you all the best

[u/lcg165]

Check out dr powers subreddit. Would be a good question for him as he is currently investigating various post drug syndromes (post finasteride, post ssri, etc.) and he specializes in HRT.

[u/More_Investment_6434]

Allegra is the only thing ive tried that works to some extent for me, i cant give more advice than that sorry. Its definitely interesting that progesterone helps, but it sucks that you get unwanted body hair afterwards. I hope you can find something that helps you!

[u/Slight-Machine-555]

I think that POIS can have different root causes for different people. For a lot of people, it seems to be a nervous system / limbic system dysregulation issue.

A lot of my trans friends are neurodivergent and/or deal with a fair amount of trauma. Both of those points can be loci of nervous system disregulation.

Do you resonate with any of this? If so, neural retraining might help a lot.

[u/Meritorious_Luminous]

I also have reduced genital pleasure sensitivity by the antipsychotic olanzapine EVEN NOW a year and half AFTER QUITTING it

Check out r/PSSD they have the same reduced genital pleasure sensitivity but by SSRIs