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Here is my assessment of the accuracy of the sensors, metrics, and algorithms of the Amazfit Balance. I really love my Balance and have been wearing and using it regularly since September 2023, shortly after it launched in the US. Where applicable, I share rationale and comparison with other baseline devices/data, as part of my assessment of its accuracy.
Accuracy estimate is on a scale of 1-10, with 10 being the highest and most accurate:
Vitals:
Heart Rate BPM - 9.5
I have compared the Amazfit heart rate bpm with an external chest strap ECG device and it is usually spot on or within 1-2 bpm of the external device.
Blood Oxygen - 9
IMPORTANT: The high accuracy for the primary blood oxygen as a standalone base metric, however, does not seem to be reflected in the aggregate sleep metric for breathing quality/apnea detection -- that is part of Zepp Sleep. My assumption is that blood oxygen is part of the aggregate for apnea detection/breathing quality, however it is not at all apparent that the algorithm uses this or uses it accurately.
Respiratory rate (BRPM) - 8.5
Steps - 9.
Generally very accurate, however there are two caveats to this high rating :

• When doing a stair climbing exercise, Amazfit Balance does not increment daily steps -- even with my arms at my side and not holding the stair climbing machine.
• When walking, be careful to ensure that your arm is at your side and not stationary holding a stroller or other object that you may be pushing -- as this stops the step increments.

Body Composition - 2.5
This sensor is unreliable and usually takes me 10-15 retries to even get it to work. It apparently is only measuring upper body composition. It is at least 50% off in accuracy compared with either the Amazfit Smart Scale and with a Dexa scan. I would be ok with that if I could use it to measure delta/differences in my baseline, however the metrics reported do not seem to vary over time -- when compared with the above 2 devices that do show incremental changes.
Heart Rate Variability (HRV) - 4
With the recent Balance firmware update, Zepp app now shows weekly and monthly historical charts for HRV, as well as showing the entire HRV chart range during sleep instead of just the average. I am not sure how accurate it is, however, as the daily trend compared to the baseline average does not match with what my Morpheus HRV/ECG chest strap device is reporting on a daily basis -- with respect to daily changes to the baseline average. I am only comparing the relative daily scores as compared to the baseline -- I am not comparing overall HRV metric across the 2 devices.
Also it only measures HRV during sleeping and displays that as a daily metric. It would be helpful for a firmware update that would allow HRV to be monitored duing a 2-3 minute period, on demand, as is done today with Blood Oxygen, Breathing and Stress.
It would also be great if other ECG metrics could be shared beyond HRV.
Sleep:
Sleep Detection (Assisted sleep monitoring) - 8.5
Overall Balance automatically detects sleep start and sleep stop times pretty accurately, including wake times. However it occasionally incorrectly detects naps during times of being sedentary.
Sleep Breathing Quality and Hypopnea Events detected - 1 I am confused with the data that Balance is reporting on the hourly Sleep Breathing quality / hypopnea events during sleep. Which metrics are included as part of this Sleep Breathing quality ? I would have thought that it is primarily measuring drops in Blood Oxygen, however the data from the watch in Zepp is not consistent. I have the auto blood oxygen monitoring enabled and I have never viewed or received anything below 95%. Usually it is at 98-99%. Similarly my respiratory rate (BRPM) is level. So this does not explain the events. The algorithm seems unreliable.
More importantly, Balance Sleep Breathing quality metrics do not correlate with breathing quality/apnea event data reported from other devices that I use.
Readiness -- 7
It would be very useful if Amazfit disclosed/published the equation/algorithmn that it uses to calculate the daily Readiness aggregate score -- using the 6 underlying base metrics. Overall though I like having this measure - it's somewhat accurate but not understanding the algorithm used and only seeing which primary metrics are part of it
Other:
PAI - 7
Seems to be accurate although it is strongly biased towards high intensity cardio, as opposed to Zone 2 or weights workouts.
Battery - 9.8
I love the battery on my Amazfit Balance! There was one trip that I was on where the battery on the Balance was depleted during the last 1-2 days of a 10 day trip - but I am accounting that that may have been due to some of the variability of my increased usage occurring during the trip. Typically I can last approximately 2 1/2 to 3 weeks before I have to recharge.
Zepp Flow / AI Gen -- 7.5
Overall nice feature but somewhat limited in the range of commands that can control different Balance functions.
VO2 Max - ?
Since Amazfit Balance only allows VO2 Max to be calculated during outside runs, I do not have many data points to evaluate accuracy. Also I have not yet compared Amazfit VO2 Max with VO2 Max from other devices. It would be helpful if Amazfit allowed additional workouts to be used to calculate VO2 Max -- to allow users more opportunities to utilize this metric.

Spot jogs 150 Skipping 200 Shoulder taps 200 Sit on the ground and get up 50 times Side to side jumps 100

Hi all,
Long time listener, first time caller. 33-year-old male. Workout 4-6 times per week and eat relatively well. Found my latest blood work (first time with this level of detail) interesting and was wondering if there was much to be concerned about. Specifically, my Lp(a) and ApoB aren't off the charts, but my LDL is quite high. Any thoughts would be appreciated!

Marker	Result
Lp(a)	18.3 mg/dl
ApoB	81 mg/dl
LDL	137
Total Chol	199
HDL	54
Triglycerides	43
Non-HDL Chol	140

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• Christopher Price’s Patriots mailbag: Some draft leftovers and the Brady roast are on the menu.
• Andrew Callahan’s Extra points: Patriots’ trade target revealed in failed first-round draft deal: South Carolina WR Xavier Legette; More.
• Ian Logue’s Patriots Notebook: Pats’ GM search underway; Clarity on Anderson; More.
• Doug Kyed reiterates the Patriots must comply with the Rooney Rule in their GM search.
• Michael Hurley reports that a number of candidates have turned down the Pats’ requests to interview for the GM position, adding that Eliot Wolf is widely expected to get the formal title.
• Nick O’Malley reports salary cap expert Samir Suleiman will interview for the Patriots top football executive job.
• Locked On Patriots podcast: Patriots Mailbag edition. Mike and Murph discuss Eliot Wolf’s chances at the GM job, potential Pats Stephon Gilmore or Justin Simmons, and their thoughts on “The Roast of Tom Brady.” (37 min.)

Good Morning Patriots
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2024 Opponents Set.

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New England Patriots News Catchup Links - Gonzalez, Douglas, Wallace, Maye’s footwork, and More!

• Paul Perillo’s Draft profiles: 3rd-round Caedan Wallace and 4th-round Layden Robinson.
• Paul Perillo’s NFL Notes: Two weeks later, Falcons move still makes little sense.
• Press Conferences: Demario Douglas (6.41 min. video) and Christian Gonzalez (10 min. video)
• Patriots Unfiltered: Tom Brady roast reaction, recent offseason workouts, Rookie Minicamp preview. (2 hours)
• Andy Hart says the local media will get a first look at the team’s draft picks this week at rookie mini-camp action. Here’s a rundown of the buzz heading into their first practice action.
• Bernd Buchmasser updates the post-draft depth chart.
• Mike D’Abate highlights Patriots star CB Christian Gonzalez with a shoulder injury update. New England has high hopes for the 2nd-year standout after a shoulder injury prematurely ended his promising rookie campaign.
• Mike Kadlick reports Christian Gonzalez says he’s healthy, “excited to go” ahead of the season.
• Ben Volin points out that Drake Maye has a clear objective: Improve his footwork. Even Bill Belichick pointed out the flaws in Maye’s technique, and the young QB is getting plenty of coaching to correct things for the NFL.
• Doug Kyed finds scouts and executives optimistic about QB Drake Maye’s ceiling as a Year 1 starter, set between Trevor Lawrence and Tua Tagovailoa in their rookie seasons.
• Alex Barth explains how Drake Maye’s college quarterback battle can help him early in New England.
• Zolak & Bertrand interview 98.5 Sports Hub guest Drake Maye, detailing what he needs to improve the most.
• Andrew Callahan relays Eliot Wolf with a scouting report on Joe Milton, the Pats’ 6th-round pick with a ‘rocket arm.’
• Nick O’Malley highlights Eliot Wolf on why 6th-round pick Joe Milton simply had “too much talent” to pass up.
• Mark Daniels notes DeMario Douglas plans to bring more ‘swagger’ to the offense.
• Matt Geagan finds DeMario Douglas hoping to score some touchdowns this season.
• Christopher Price’s Patriots mailbag: Some draft leftovers and the Brady roast are on the menu.
• Andrew Callahan’s Extra points: Patriots’ trade target revealed in failed first-round draft deal: South Carolina WR Xavier Legette; More.
• Ian Logue’s Patriots Notebook: Pats’ GM search underway; Clarity on Anderson; More.
• Doug Kyed reiterates the Patriots must comply with the Rooney Rule in their GM search.
• Michael Hurley reports that a number of candidates have turned down the Pats’ requests to interview for the GM position, adding that Eliot Wolf is widely expected to get the formal title.
• Nick O’Malley reports salary cap expert Samir Suleiman will interview for the Patriots top football executive job.
• Locked On Patriots podcast: Patriots Mailbag edition. Mike and Murph discuss Eliot Wolf’s chances at the GM job, potential Pats Stephon Gilmore or Justin Simmons, and their thoughts on “The Roast of Tom Brady.” (37 min.)

Good Morning Patriots
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Free place to chat and a good place to discuss whatever you like with other sub users
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2024 Opponents Set.

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Patriots Coaching Staff Tracker.

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New England Patriots News Catchup Links - Gonzalez, Douglas, Wallace, Maye’s footwork, and More!

• Paul Perillo’s Draft profiles: 3rd-round Caedan Wallace and 4th-round Layden Robinson.
• Paul Perillo’s NFL Notes: Two weeks later, Falcons move still makes little sense.
• Press Conferences: Demario Douglas (6.41 min. video) and Christian Gonzalez (10 min. video)
• Patriots Unfiltered: Tom Brady roast reaction, recent offseason workouts, Rookie Minicamp preview. (2 hours)
• Andy Hart says the local media will get a first look at the team’s draft picks this week at rookie mini-camp action. Here’s a rundown of the buzz heading into their first practice action.
• Bernd Buchmasser updates the post-draft depth chart.
• Mike D’Abate highlights Patriots star CB Christian Gonzalez with a shoulder injury update. New England has high hopes for the 2nd-year standout after a shoulder injury prematurely ended his promising rookie campaign.
• Mike Kadlick reports Christian Gonzalez says he’s healthy, “excited to go” ahead of the season.
• Ben Volin points out that Drake Maye has a clear objective: Improve his footwork. Even Bill Belichick pointed out the flaws in Maye’s technique, and the young QB is getting plenty of coaching to correct things for the NFL.
• Doug Kyed finds scouts and executives optimistic about QB Drake Maye’s ceiling as a Year 1 starter, set between Trevor Lawrence and Tua Tagovailoa in their rookie seasons.
• Alex Barth explains how Drake Maye’s college quarterback battle can help him early in New England.
• Zolak & Bertrand interview 98.5 Sports Hub guest Drake Maye, detailing what he needs to improve the most.
• Andrew Callahan relays Eliot Wolf with a scouting report on Joe Milton, the Pats’ 6th-round pick with a ‘rocket arm.’
• Nick O’Malley highlights Eliot Wolf on why 6th-round pick Joe Milton simply had “too much talent” to pass up.
• Mark Daniels notes DeMario Douglas plans to bring more ‘swagger’ to the offense.
• Matt Geagan finds DeMario Douglas hoping to score some touchdowns this season.
• Christopher Price’s Patriots mailbag: Some draft leftovers and the Brady roast are on the menu.
• Andrew Callahan’s Extra points: Patriots’ trade target revealed in failed first-round draft deal: South Carolina WR Xavier Legette; More.
• Ian Logue’s Patriots Notebook: Pats’ GM search underway; Clarity on Anderson; More.
• Doug Kyed reiterates the Patriots must comply with the Rooney Rule in their GM search.
• Michael Hurley reports that a number of candidates have turned down the Pats’ requests to interview for the GM position, adding that Eliot Wolf is widely expected to get the formal title.
• Nick O’Malley reports salary cap expert Samir Suleiman will interview for the Patriots top football executive job.
• Locked On Patriots podcast: Patriots Mailbag edition. Mike and Murph discuss Eliot Wolf’s chances at the GM job, potential Pats Stephon Gilmore or Justin Simmons, and their thoughts on “The Roast of Tom Brady.” (37 min.)

Good Morning Patriots
__
Free place to chat and a good place to discuss whatever you like with other sub users
__

2024 Opponents Set.

__

Patriots Coaching Staff Tracker.

__

New England Patriots News Catchup Links - Gonzalez, Douglas, Wallace, Maye’s footwork, and More!

• Paul Perillo’s Draft profiles: 3rd-round Caedan Wallace and 4th-round Layden Robinson.
• Paul Perillo’s NFL Notes: Two weeks later, Falcons move still makes little sense.
• Press Conferences: Demario Douglas (6.41 min. video) and Christian Gonzalez (10 min. video)
• Patriots Unfiltered: Tom Brady roast reaction, recent offseason workouts, Rookie Minicamp preview. (2 hours)
• Andy Hart says the local media will get a first look at the team’s draft picks this week at rookie mini-camp action. Here’s a rundown of the buzz heading into their first practice action.
• Bernd Buchmasser updates the post-draft depth chart.
• Mike D’Abate highlights Patriots star CB Christian Gonzalez with a shoulder injury update. New England has high hopes for the 2nd-year standout after a shoulder injury prematurely ended his promising rookie campaign.
• Mike Kadlick reports Christian Gonzalez says he’s healthy, “excited to go” ahead of the season.
• Ben Volin points out that Drake Maye has a clear objective: Improve his footwork. Even Bill Belichick pointed out the flaws in Maye’s technique, and the young QB is getting plenty of coaching to correct things for the NFL.
• Doug Kyed finds scouts and executives optimistic about QB Drake Maye’s ceiling as a Year 1 starter, set between Trevor Lawrence and Tua Tagovailoa in their rookie seasons.
• Alex Barth explains how Drake Maye’s college quarterback battle can help him early in New England.
• Zolak & Bertrand interview 98.5 Sports Hub guest Drake Maye, detailing what he needs to improve the most.
• Andrew Callahan relays Eliot Wolf with a scouting report on Joe Milton, the Pats’ 6th-round pick with a ‘rocket arm.’
• Nick O’Malley highlights Eliot Wolf on why 6th-round pick Joe Milton simply had “too much talent” to pass up.
• Mark Daniels notes DeMario Douglas plans to bring more ‘swagger’ to the offense.
• Matt Geagan finds DeMario Douglas hoping to score some touchdowns this season.
• Christopher Price’s Patriots mailbag: Some draft leftovers and the Brady roast are on the menu.
• Andrew Callahan’s Extra points: Patriots’ trade target revealed in failed first-round draft deal: South Carolina WR Xavier Legette; More.
• Ian Logue’s Patriots Notebook: Pats’ GM search underway; Clarity on Anderson; More.
• Doug Kyed reiterates the Patriots must comply with the Rooney Rule in their GM search.
• Michael Hurley reports that a number of candidates have turned down the Pats’ requests to interview for the GM position, adding that Eliot Wolf is widely expected to get the formal title.
• Nick O’Malley reports salary cap expert Samir Suleiman will interview for the Patriots top football executive job.
• Locked On Patriots podcast: Patriots Mailbag edition. Mike and Murph discuss Eliot Wolf’s chances at the GM job, potential Pats Stephon Gilmore or Justin Simmons, and their thoughts on “The Roast of Tom Brady.” (37 min.)

Just an annual reminder that 12th board marks/results, though very important - is not something that will forever hold the key to your success and future happiness. Only you hold this key.
My experiences with Class 12th science CBSE exams were pretty traumatising though I was a pretty good student till 10th. Failed in 12th due to many issues then opted out of an irrelevant bachelor’s degree one year in. Before I went on to finally graduate/post graduate.
Fast forward a decade and half to today. Currently working in an MNC organization in my mid 30s in a senior post with a team of about 15 people reporting to me and earning about 70LPA cash component here in India. Even in my 20s when I worked I was doing pretty well too.
And significant amounts were also made in ESOPs and I do own a nice car, bike and stay in my house while we take international vacations pretty often. And a happy family too. I also take care of my old parents. 🧿
With just some due diligence, I knew that I earned/am earning more than about 90% of my classmates who had passed that dreadful year. I used to have dreams/nightmares about board exams etc well into my 20s and a little bit even today. Though initially traumatic, through my efforts at work and the changes it brought in my life, eventually those dreams and nightmares made absolutely no sense and I got the power to shut them off and change the narrative of the dreams mid sleep. Slaying my demons in my sleep now. Hehe. Also do note bad dreams related to exams is one of the most common dreams in adults all over the world. So not a big deal really.
Anyway.
Though not a part of this sub, I am visiting this sub after knowing about the result announcements, to help students as I know the fear, the anxiety and the uncertainty all too well.
Can share some advice for you kids to navigate these times-

1. Comparison is the thief of joy. Don’t compare yourself with him or her or the neighbour or its dog. You are unique and you are gifted. You just need to find what you are good at. You just need to chart your own path and grab your opportunities.
   
2. Work on your communication skills. This will take you places. No matter what field you are in.
   
3. Prepare to be mentally very tough. As a famous movie quote goes- “The world is not all rainbows and butterflies. It will beat you to your knees and you will fall. But it’s not about how hard you get hit but how many times you can keep getting hit but still keep going.” Also to build mental toughness read/research about phenomena and biases like the Spotlight effect or the Dunning Kruger effect etc. You’ll see how most of the psychological problems we have are all already pretty common and there’s already solutions for it.
   
4. Be curious. Curious how things work. Curious how companies work. Gain knowledge. Knowledge in this day and age is not limited to CBSE books. Go after knowledge.
   
5. Workout. Do weights. Male or female. Doesn’t matter. Do some workout and teach yourself to win and take care of yourself.
   
6. Know that a good life- a happy, prosperous life is your right. It is damn well your birth right. Go get it. Don’t let an education board or parents or relatives or teachers or friends make you think you are not cut out for success. Sadda haq aithe rakh. And also be happy. Don’t let these things dictate how happy you should be in life. YOLO.
   
7. Work on continuously improving yourself. You are still very very young at 17-18. There is a very long way to go. Improve your focus, your efforts, your understanding of things etc. Don’t for one minute think that you are a finished product- even if you got great grades. You are a Work in Progress and you will continue to be that till your old age. Keep learning.
   
8. Know that value creation and value addition is what equates to career success. Consistently if you deliver value to this world you will be guaranteed to be a success.
   
9. Embrace failure as a stepping stone to success. Might be clichéd but it still holds strong. You will fail again and again. The most successful people have failed again and again. Think of any famous successful athlete or celebrity. They will tell you the same. Learn from your failures and keep walking.
   
10. Be brave. The biggest point I wanted to make. It’s ok to be scared. It’s ok to be fearful. But develop the mindset to face that fear each time and every time. Despite all my experience and accomplishments, I am still scared about work, meetings, etc. Lol. But now I’m used to it. Just like thirst, hunger and other things. Grab opportunities. Make opportunities.
    
11. Beyond a certain point in your career no one will care about your class 10/12 marks and you will eventually remove it from your resume/CV. So don’t overthink it too much also like I did. Lol. I wish I hadn’t and I wish I allowed myself to be happier during those times.
    
12. Have sincerity in your attitude when you go for that job or even when you’re taking steps to launch your business. Be warm, well mannered and sincere in your approach. And also demonstrate how you are special. Soft skills like work ethic, leadership, communication, hard work, speed, sincerity, emotional intelligence etc are eventually way more valued in real life than certificates and mark sheets.
    
13. Your life is 100% your responsibility from here on. No one is coming to save you. Yes your parents, family, friends may or may not be there to support you. And that is a great bonus. But the truth is that you will have to take responsibility for your future from here on. Don’t blame him or her or the neighbours or their dogs. It won’t make sense and you’ll realise it soon enough.
    
14. Be an optimist. This is probably what really kept me going. And still does. In a world full of pessimists and pessimism be that optimist. Believe in yourself and be a problem solver. It’s easy to spread darkness. Be a light instead.
    
15. It’s totally ok and normal to be confused at this age. Heck most people in their 20s, 30s, 40s and more haven’t figured it all out.
    

Breathe. Don’t worry, you’ll be fine. :)
P.S. 1. I’m not advocating that academic results are not at all important. In fact I might’ve done even better had I excelled there. It definitely gives you a good headstart and will always be a good point. However all I am saying is don’t be limited by it.

1. I might not be able to reveal exactly what I do due to privacy reasons. But yes I am in the non-tech field.
   
2. It has been well over a decade since I had been in school/college and hence not well placed to help on questions about academics.
   
3. Please don’t get oversmart and question the legitimacy of what I’ve mentioned wrt my life. This is an anonymous platform and I gain absolutely nothing by making things up. I haven’t made ‘millions and billions’ like those influencers so I ain’t a public figure but yes do get a decent private salary and a good lifestyle.
   

——————————
Even if one of you benefits in the long run from this post, makes it totally worth it.
God bless you all! Shine and do well.

In 2014 I weighed 140 pounds measuring above six feet. Naturally, I was teased by my friends for my lankiness / "feminine body". I always laughed it off, but deep inside it bugged me, and I knew I wanted to change.
So the following year, I started my lifting journey. As a beginner, I turned to and other Reddit wikis with free workout plans. Sometimes I would follow them and I started seeing great results. Lifting did wonders for my confidence.
But tracking everything was tedious, to say the least. Most of the plans are on spreadsheets or PDFs which is incredibly hard to use. I also tried several workout apps but found several of them too complicated.
I decided to tackle this problem head-on and decided to build a simple fitness app with the mission of making amazing workout programs easier to use because reaching your fitness goals is much easier when you develop good habits.
I started with a simple one-tap set counter. From there, I just continued building it out slowly with more and more features like splits, videos, charts, and my favorite feature which is the muscle visualizer (I painstakingly mapped over 500+ exercises to which muscle it targets so that when you're done with your workout, the muscles are shaded from most exertion to least). I also like to draw, so I added 500+ hand-drawn images to go with workout plans and exercises.
(by the way the app is 100% free and free from ads, I don't make a cent) After years of work (100% by myself), earlier this month I'm thrilled to say that I managed to publish to both app stores (iOS & Android). For anyone who wants to start building a good fitness habit, give FitnessWolf a try and shoot me a message if you have any questions or feedback.
App interface: https://imgur.com/gallery/5TRSXLF
My mission is to improve people's lives like resistance training & fitness did for me. Enjoy the app!
https://fitnesswolf.app
Free on iOS and Android

I am a 32yr male 5’9” 180-185lbs. My goal is around 165-175 according to the BMI chart. As a kid I was always active but never really worked out. I was about 140 until I was 21 then progressively got to we I am at now.
I am having trouble finding time to actually work out. It might just be an excuse but that’s what I going with. A glimpse of my schedule. I wake up at 430am get ready for work and home by 500pm ish. Dinner with family kids asleep by 8ish and then from 9-10 spend time with my wife before sleep. I walks around 10k steps daily and eat pretty healthy. I don’t count calories but I know I’m around 2000 calories daily.
With this information, where would you fit in a workout if you were in my shoes. Wake up at 4 get a half hour sesh in or after the kids are asleep and miss time with the wife? Or somewhere else entirely.
Also. What motivates you?! That’s probably my biggest struggle lol

The link between Post-SSRI Sexual Dysfunction, Hard Flaccid Syndrome, Post Finasteride Syndrome, Pelvic Floor Dysfunction, Chronic Pelvic Pain Syndrome and advice on how to start your healing journey based on 8 years of research and personal experiences : pssdhealing (reddit.com)
Here are all my thoughts and advice based on my personal experiences, other people’s insight and helpful experiences, and research I have done on and off about pelvic floor issues from the past eight years or so. I am not claiming that any of this is revolutionary, but I hope it can help some of you out there to give you a head start on healing and advance our understanding of these conditions. As I am a 27 year old male with previous major problems with pelvic floor issues and hard flaccid, some of my advice may be biased towards my condition. However, I believe everyone can benefit from a lot of this because I really do think that all of these conditions that I mentioned are linked in at least some way, especially by pelvic floor dysfunction and sex hormone desensitization. I try not to come to these forums because it increases anxiety and negative emotions which leads to worse pelvic floor symptoms, so my apologies if I do not respond to your questions. For hard flaccid and pelvic floor affected people, follow my advice and I am confident you can heal and reach a place where your symptoms barely affect your life, if at all, which is where I am at now. The mentality of trying to find a 100% “magic cure” solution just leads to anxiety and catastrophic thinking if you have a set back which will only worsen your symptoms. You can and will heal. I know this is a lot of information, but try to implement just one or two things at a time. Focus on the present, and take it one day at a time. Don’t get overwhelmed. All of this is my opinion and not professional medical advice. Talk with your doctor before starting anything.
Post Finasteride Syndrome (PFS), Post-SSRI Sexual Dysfunction (PSSD), Hard Flaccid Syndrome (HFS), Pelvic Floor Dysfunction, and Chronic Pelvic Pain Syndrome all can have some similar symptoms. I believe that they are all either caused or can be exacerbated by androgen and estrogen receptor insensitivity and are triggered by medication, genital injury, and pelvic floor inflammation and dysfunction. The pelvic floor is rich in androgen receptors and estrogen receptors. However, without proper androgen receptor activation and sensitivity, the pelvic floor muscles don’t have enough DHT which line the tissues of the pelvic floor, genitalia, and lower urinary tract. DHT is vital for healthy sexual functioning in both sexes - it provides an anabolic effect to tissues to provide strength, stability, healing, and relaxation to tissues. As a result of androgen receptor insensitivity and lack of DHT, the pelvic floor can become chronically weakened, tight, and inflamed which reduces blood flow to the region leading to even more androgen receptor insensitivity and thus less DHT. These symptoms can cause psychological stress to the individual which tightens the pelvic floor further leading to more symptoms and less blood flow. One study found that androgen sensitivity has raised the possibility that androgens can be used to rebuild the weakened and/or damaged muscles comprising the pelvic floor - source. Some people may also have normal hormone levels in the blood when tested, but these hormones cannot reach or be effective in the pelvic floor tissues or brain due to sex hormone insensitivity and the lack of the blood flow in the region caused by pelvic floor tightness and dysfunction. It is also likely that there is a problem with desensitized estrogen receptors causing a similar mechanism of dysfunction because they are also found in the pelvic floor, genitals, and brain and are important for pelvic floor health, sexual functioning, cognition, and emotions in both sexes. The most important element to remember to help start the healing process for these disorders is to boost blood flow through supplements, stretches, and exercises which will increase both androgen and estrogen receptor sensitivity over time.
Many males with PFS, PSSD, and Pelvic Floor dysfunction are affected by the hard flaccid condition.
Post Finasteride Syndrome (PFS) caused by Finasteride, a 5-alpha-reductase inhibitor (5-ARI), plummets DHT levels in the body to try to help hair loss causing sexual dysfunction and pelvic floor issues. Androgen receptors that surround the pelvic floor, genitals, and brain become desensitized due to the Finasteride leading to less DHT binding to these receptors causing dysfunction and a tight, weak pelvic floor. The tight, dysfunctional pelvic floor now restricts blood flow which impacts healing and the delivery of testosterone to this area that further exacerbates androgen insensitivity leading to less DHT in these tissues. Since androgen receptors are found in the brain and androgens have neuroprotective effects, this could be one reason why some PFS and PSSD sufferers are also impacted cognitively. An herbal supplement called Saw Palmetto has also been reported to cause a disorder similar to PFS because it is also a 5-ARI that blocks the conversion of testosterone into DHT. Another disorder called Post Accutane Syndrome (PAS) is also similar to PFS and it reduces DHT as well through being a 5-ARI: “Isotretinoin, used to treat severe acne, has been shown to induce hormonal changes, especially to reduce 5 alpha-reductase in the production of the tissue-derived dihydrotestosterone (DHT) metabolite 3 alpha-Adiol G.”. PFS, PAS, and PSSD are thought to cause not only androgen receptor desensitization, but likely estrogen receptor desensitization as well.
For Post-SSRI Sexual Dysfunction (PSSD), SSRIs are also known to decrease androgens and down regulate androgen receptors. This study shows that SSRIs can have an anti-estrogenic effect as well and can even reduce the expression of estrogen receptors (ER), including in the hypothalamus.. As sex hormones get desensitized in the pelvic floor, genital region, and brain, it causes localized DHT and estrogen levels in these tissues to decrease causing emotional blunting, sexual dysfunction, pelvic floor issues, hard flaccid syndrome, and more. The pelvic floor dysfunction can then prevent the sex hormone receptors from being reactivated and sensitized due to restricting oxygen and sex hormone rich blood flow to the tissues. SSRIs can cause androgen receptor insensitivity and estrogen receptor insensitivity by severely inhibiting the serotonin transporter (SERT) leading to increased serotonin levels which desensitizes those receptors throughout the body. One key to help heal from PSSD is increasing androgen production, androgen receptor sensitivity, and blood flow to boost BDNF, SERT, and DHT levels to hopefully allow any estrogen receptor desensitization recover on its own over time after everything else is normalized. Once androgen levels in local tissues (pelvic floor, brain, genitals) are normalized again through androgen receptor activation and sensitivity, it will encourage the conversion of androgens into estrogens in these tissues via aromatase. It is also worth to mention that some community members are trying to restore estrogen receptor sensitivity via boosting estrogen in various ways including by taking hops extract which is a potent phytoestrogen. This is also interesting: Estradiol represents another important natural ligand for androgen receptors that may play an essential role for the androgen receptor function and the development of the male reproductive system.
As mentioned earlier, people with PSSD and other disorders might have normal looking hormone blood tests (testosterone, DHT, estrogen, etc), but the issue is that these hormones are not functioning in the brain, pelvic floor, and genitals properly due to androgen and estrogen receptor insensitivity. An important thing to also recognize is that the medical community still has no official explanation how exactly SSRIs cause all of these debilitating side effects, but they are still being readily prescribed without informed consent about the risks of PSSD. It is unfortunate that it is people like us on the internet leading the charge to investigate and inform. We all need to continue to do our part to spread awareness of these iatrogenic disorders to warn people about the risks of taking these medications because their medical providers aren’t likely going to. Thank you to the PSSD Network for helping to give a voice to the unheard.
Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors
Androgen receptor (AR) inactivation in mice led to reduction in hypothalamic neural nitric oxide synthase (nNOS), indicating the regulatory sexual function of this neurotransmitter. Furthermore, activation of the pre and post-synaptic 5HT1A receptors was found to be correlated with inhibitory effect on erectile function. All of these factors are speculated to be involved in this symptom and might be related to epigenetic alteration of androgen receptor (AR) and estrogen receptor (ER) densities due to influence of SSRIs on the epigenome.
In male PSSD sufferers, the penile shaft can be rigid during erection, yet the glans of the penis remains flaccid.This symptom may arise from hypo-activation of the dopaminergic and oxytocinergic pathways. The glans of the penis, in particular, receives its blood supply from the deep dorsal artery. Perhaps this points to a selective arterial malfunction relative to pelvic floor dysfunction which usually accompanies PSSD.
Here is another interesting study that gives support to the importance of increasing blood flow to help heal:
If SSRIs produce sexual side effects by impairing vasocongestion to the genital region, it would be expected that pharmacologic agents that increase blood flow to the genital region would improve sexual functioning. Indeed, several anecdotal reports and studies have found that sildenafil (a drug designed to treat erectile failure by increasing blood flow into the penile tissue) was successful in reversing SSRI-induced sexual dysfunction in both men and women [8,9,87,88,109]. Sildenafil acts to increase blood flow into the genital tissue by facilitating c-GMP activity that is initiated by nitric oxide [19] and preliminary evidence suggests that the SSRIs may cause sexual difficulties by inhibiting nitric oxide synthase [39,118].
Here is a paper from a community member that hypothesizes that the main issue is lasting estrogen receptor insensitivity just to give another interesting perspective on Post-SSRI Sexual Dysfunction, Post-Finasteride Syndrome, and Post-Retinoid Sexual Dysfunction
As the body is starved of DHT, ARs upregulate in response. At the same time, ER activation is significantly increased as a result of the increased production of Estradiol during treatment (due to higher Testosterone availability by reduced 5a reduction to DHT) - eventually leading to ER downregulation.
Hard Flaccid Syndrome (HFS) - There are many men suffering from HFS and pelvic floor issues due to PSSD, PFS, heavy weight lifting, excess kegeling, or in the case I’m presenting here, physical damage to the genitals from excessive, vigorous sexual activity (my case) or penis enlargement exercises. When the genitals get damaged, an inflammatory process starts and the pelvic floor contracts to protect itself. Since the pelvic floor is now in a chronic, contracted state, it limits oxygen and sex hormone rich blood flow to the genitals and pelvic floor which leads to sex hormone insensitivity and negatively impacts healing, muscle relaxation, and DHT production in these tissues. Finasteride, Accutane, and SSRIs also desensitize sex hormone receptors in the genitals and pelvic floor tissues leading to hard flaccid and pelvic floor dysfunction. Since the pelvic floor tightness restricts blood flow, it is difficult for hard flaccid sufferers to reactivate and sensitize their pelvic floor muscle androgen receptors again to regain relaxation and strength in their pelvic floor muscles, including the ischiocavernosus (IC), bulbocavernosus (BC), and pubococcygeus (PC) which are in a contracted state; the IC muscle in particular is thought to be the most implicated in the cause of hard flaccid. We first need to promote relaxation in the pelvic floor by boosting blood flow through supplements and stretches because tight muscles are weak muscles. Once the pelvic floor is in a chronic state of tension, it is hard to heal from pelvic floor issues because you likely already had bad habits such as poor posture, unhealthy sexual practices, stiff muscles, sedentary lifestyle, unchecked anxiety, and other negative lifestyle factors. Along with supplements, exercises, and stretches, correcting these bad habits is necessary to heal to have an even healthier pelvic floor than you ever had before because it likely was already tight and dysfunctional to begin with before developing obvious issues, but it was more subtle and you had no awareness of your pelvic floor muscles until now. You have the potential to now become a much healthier person overall than you ever would have been without being affected by pelvic floor dysfunction and hard flaccid.
32% of women will develop a pelvic floor disorder in their lifetime which is double that of men. While childbirth and pregnancy plays a role in this discrepancy, women also have far less testosterone and DHT levels than men which I believe plays a major factor. Since women have less testosterone, their androgen receptors that line the pelvic floor don’t make enough DHT to adequately support these tissues compared to men. This makes them more prone to pelvic floor dysfunction that causes them a disparate amount of pain, tightness, and inflammation. Androgen receptors and their ability to convert testosterone into DHT play such a vital role in pelvic floor health and sexual functioning. This is mentioned in a research study: Prevailing scientific literature has indicated the presence of androgen receptors in the levator ani muscle and pelvic fascia. The existence of androgen receptors in the vaginal wall can play an essential role in the development of pelvic floor disorders in women.Thus, androgen-related disorders may interfere with the function of pelvic floor muscles. [Many people mistakenly believe that androgens are only important for male sexual health:](https://www.bumc.bu.edu/sexualmedicine/patientinformation-physicians/androgen-insuffiency-in-women/#:~:text=Androgen%20insufficiency%20syndrome%2C%20characterized%20by,of%20sexual%20dysfunction%20in%20women.] Androgens have a three-fold action on female sexual function. They (1) increase libido by providing the fuel for a woman’s psychosexual stimulation, (2) increase sensitivity and blood flow to the external genitalia, and (3) increase the intensity of sexual gratification.
What I see in all these conditions is that sex hormone receptors become desensitized in the pelvic floor and genital tissues either from a drug, pelvic tightness, or inflammation from injury leading to less hormones being produced causing sexual and pelvic floor dysfunction. The pelvic floor now goes into a chronic tightened state as a response, leading to less oxygen and testosterone rich blood flow to the genital and pelvic region which leads to more androgen insensitivity and subsequently less DHT. This all explains why many people who have these conditions are helped by supplements that improve androgen receptor sensitivity and blood flow, and why pelvic floor therapy and exercises are so helpful to many of them. Estrogen receptor insensitivity in the pelvic floor also appears to have a similar mechanical negative effect by leading to less estrogen levels in the pelvic floor and genital tissues. It is also possible that some people with PSSD/PFS may have subtle or no pelvic floor symptoms, but the medication still desensitizes sex hormone sensitivity in their genitals and pelvic floor tissues that is leading to sexual dysfunction.
Another study linking androgens and the pelvic floor: Levator ani and other muscles of the pelvic floor and lower urinary tract are sensitive to the anabolic effects of testosterone. Androgen receptors are also expressed in the pelvic floor and lower urinary tract of both animals and humans. Anabolic effects of androgens may play an important role in the female pelvic-floor and lower-urinary-tract disorders. Furthermore, the interactions between androgen and nitric oxide synthase and arginase have been demonstrated, suggesting that androgens may also participate in modulating the physiological functions of the lower urinary tract through nitric oxide. The action of androgens in the lower urinary tract and pelvic floor is complex and may depend on their anabolic effects, hormonal modulation, receptor expression, interaction with nitric oxide synthase, or a combination of these effects.
My solution to help heal and improve the well-being of people with these issues is to try to improve sex hormone receptor sensitivity and pelvic floor function through supplements, stretches, exercises, and boosting blood flow which will hopefully restore normal levels of estrogens and androgens in pelvic, genital, and brain tissues. The body has a tremendous capability of self-healing, but we need to support it through active recovery methods.
We will first start with supplements (this is not professional medical advice - talk with your doctor before taking):
L-citrulline - This is the precursor to l-arginine, and it will improve blood flow and levels of nitric oxide to help get oxygen and testosterone rich blood to the pelvic floor and genital tissues to increase androgen sensitivity. Nitric oxide can also induce smooth muscle relaxation which is important for relaxing the pelvic floor. Herein we report on a young man affected by PSSD who regained sexual functioning after 3-month treatment with EDOVIS, a dietary supplement containing L-citrulline and other commonly used aphrodisiacs.. I recommend taking at least 6000 mg daily by taking 2000mg three times throughout the day. The max dose is 10,000mg. Even potentially better, people report great results using Cialis to improve blood flow and healing rather than L-citrulline and some doctors will even prescribe it to women if you show them the evidence - talk with your doctor. “Tadalafil (Cialis) reversal of sexual dysfunction caused by serotonin enhancing medications in women”. L-Citrulline and Cialis are not recommended to be taken together.
L-Carnitine - This will improve the number of androgen receptors and their sensitivity to testosterone to increase levels of DHT in the pelvic floor, genital tissues, and brain. I recommend taking 2000mg daily. Acetyl-L-Carnitine can pass through the blood-brain barrier, while Propionyl-L-carnitine has a high degree of interaction with testosterone. Propionyl may be better for sexual and pelvic floor dysfunction, while Acetyl might help people suffering from the mental effects of PSSD. This study used each at 2000mg daily to improve erectile dysfunction along with Viagra.. I would work up to 2000mg each of Acetyl and Propionyl L-Carnitine along with Cialis instead of Viagra as it lasts in the body for much longer (36 hours) for increased blood flow healing purposes. You can also use L-Citrulline instead of Cialis as mentioned earlier. Discuss with your doctor before taking them.
Vitamin D - This vitamin, which acts more like a hormone, works directly with the endocrine system. It has its own receptors throughout the body and they are often in close proximity to androgen receptors. Deficiency in vitamin D is associated with a stunting of testosterone's effects on androgen receptors and a decline in testosterone levels. Vitamin D will encourage androgen receptor resensitization. One study found that higher vitamin D levels are associated with a decreased risk of pelvic floor disorders in women, and The levator ani and coccygeus muscles are skeletal muscles that are critical components of the pelvic floor and may be affected by vitamin D nutritional status. I recommend 4000IU of vitamin D daily or whatever gets your levels to 60 - 80 ng/ml.
If you have inflammatory issues or pain due to pelvic floor dysfunction, I recommend a fish oil supplement daily. I take fish oil, and I find that it helps limit pelvic inflammation. I also take Magnesium Glycinate to relax the smooth muscle that lines the pelvic floor and genital tissue. I recommend it for people with clear pelvic floor dysfunction, but others should be careful as research says magnesium is a 5-alpha-reductase inhibitor. Take quercetin and bromelain as needed if you experience pelvic inflammatory flare ups and pain, but just be careful as quercetin can also inhibit the production of DHT from testosterone as well. Some say fish oil blocks DHT too, but experiencing chronic pelvic floor pain and inflammation will do more harm to you than minimal DHT blocking. I recommend staying away from all DHT inhibiting foods and supplements for people with PSSD, PFS, and PAS unless you are experiencing pelvic pain and inflammation.
As always, discuss these supplements with your doctor to see if they are okay for you. Lower your supplement intake based on side effects. These aren’t a magic cure, but a tool to help you on your journey to recovery. Don’t do anything without doctor supervision, but this thread gives more evidence for the “cure” for PSSD/PFS being resensitizing androgen receptors and estrogen receptors along with enhancing blood flow as it details how some men recovered through taking high doses of androgens, post cycle therapy, and Cialis. This at least gives hope that a hormonal cure can be created one day by medical professionals. I would of course recommend trying to heal yourself naturally for a long time before doing any hormone treatments under the supervision of a doctor.
I also recommend doing some form of yoga or pelvic floor stretches daily to improve blood flow for pelvic floor relaxation and sex hormone receptor sensitivity. You also need to request to see a pelvic floor therapist for an evaluation and treatment. Learn how to do reverse kegels. Doing reverse kegels will be difficult at first because your pelvic floor is tight and you have little to no awareness of these muscles, so just focus on lengthening and relaxing the pelvic floor through stretches for now. Do not do regular kegels for pelvic floor issues. Learn how to diaphragmatically breathe in 360 degrees to create expansion in your rib cage and abdomen to encourage pelvic floor relaxation. Do not breathe through your chest, and “belly breathing” isn’t the right term because the ribs need to expand as well. You can learn how to diaphragmatically breathe through an exercise such as 4-7-8 breathing. Here is a great video on diaphragmatic breathing and another video. I cannot overstate it enough: retraining yourself to properly breathe diaphragmatically is the single most important thing that you can do to heal from pelvic floor issues. Be a student of breathing: study and take notes on how to breathe better.
Stretches/Yoga poses I recommend:
Hold the Malasana/hindi/yoga squat pose for at least 5-10 minutes at least twice a day, but doing it morning, mid-day, and at night would be the best. Some get great results holding it for 15-20 minutes.This is one of the most important things for your pelvic floor because it will help lengthen and release it. Doing them barefoot is also very beneficial to strengthen your ankles and feet which are connected to your pelvic floor. Again, remember to breathe deeply down into your belly and pelvic floor for all these stretches.
Begin your stretching routine with an Exercise ball ab stretch and Upward-facing dog/cobra pose. This will help stretch your lower abs and psoas muscles so that you can get more breath deeper down into your pelvic floor for the rest of your stretches. Some people say that these types of stretches aren’t great for people who have Anterior Pelvic Tilt, which we should fix, but I still do them as it is important to stretch the lower abs that are hard to get to. You can experiment with doing them sporadically instead of every time you stretch.
This is my current personal complete stretch routine I do in order 3+ days a week:
Myofascial release on my glutes with an orb massage ball but you can use any small hard ball (don’t do this if glutes are currently sore) > Calf stretch against a wall or a yoga block which is what I use > exercise ball ab stretch > upward facing dog > (optional) Do a handful of cat cows > Supine hamstring stretch with yoga strap or an IdealStretch tool which is what I use > Kneeling hip flexor stretch > flat on back supine single knee to chest stretch > then bring knee to opposite shoulder stretch > supine figure four > I do this stretch next right after figure four > Reclined bound angle pose > (optional) butterfly stretch > (optional) A little bit of downward facing dog to stretch the calves > (optional) Lizard Pose) > (optional) Half split stretch/Half monkey pose with yoga blocks > Half-pigeon pose > Child’s pose > Wall quad hip flexor stretch > Wall figure four stretch > Wall straddle pose > Wall happy baby pose > Flat on back while pulling knees apart > kneeling with one leg, other leg out to side for adductors > (optional) Frog pose with feet together > regular Frog pose with feet separated in line with the knees > Yoga squat/malasana > Corpse pose
All these stretches are the ones I found most useful in a routine. See what works for you and develop your own routine. Consistency is the most important. This long stretching routine may not be possible for you to complete regularly so make adjustments, but doing this routine at least 3 days a week is ideal. Stretches such as the yoga squat, supine hamstring stretch, hip flexor stretches, and wall stretches are vital and should be done most days to help relax the pelvic floor. For how long you should hold each stretch, just go by how you and your body feels. Really let go, breathe, and sink into every stretch. On rest days, doing some deep breathing in child’s pose, reclined bound angle pose, flat on back while pulling knees apart, and the happy baby wall pose is really great while trying to do gentle reverse kegels.
You can also work on more individualized stretches for posture to correct anterior pelvic tilt, muscle imbalances, and to release other tight muscles, such as the upper body. Listen to your body if you need to give yourself a rest day from stretching. Adding in a 30-60 minute walk/swim on rest days is incredibly beneficial as well. Eventually, you can also try to learn isometric PNF stretching to incorporate it into some of the stretches such as the kneeling hip flexor stretch and hamstring stretch.
After working to relax and lengthen your pelvic floor through yoga and stretches, I would begin gentle body strengthening exercises that are pelvic floor safe. The pelvic floor is a master compensator. So, if the glutes, adductors, deep hip rotators, transversus abdominis, and other supportive muscles are weak, then the pelvic floor is in the prime position to pick up the slack which leads to a lot of strain on the pelvic floor which results in tightness and dysfunction. You need to strengthen the surrounding muscles to relieve tightness in the pelvic floor. This is where working with a pelvic floor therapist would be helpful to point out safe individualized exercises for you. Yoga will help strengthen your muscles in a safe way too.
The glutes and transversus abdominis in particular are very important to strengthen. Glute bridge, single glute bridge, side lying leg raises, lateral band walks can help build up glute strength. Deadbugs, Bird Dog, 8- point planks, or planks with pelvic floor-friendly modifications, can help to strengthen the transversus abdominis (TVA). Abdominal work may be triggering to your pelvic floor symptoms, especially the 8 point plank, so you can instead look into hypopressive exercises to work the TVA without overworking the pelvic floor. These exercises will help you bring more awareness to your breathing, diaphragm, TVA, and pelvic floor which are all important for recovery. Here is how to find and become aware of the TVA. Do side planks for your oblique ab muscles.
For hip/abductors do the side lying hip abduction exercise, fire hydrants, and the shinbox lunge. For the adductors, do Copenhagen adductor exercise, cossack squats, and an exercise where you squeeze a soft ball between the knees just don’t do any crunch movements with pelvic floor issues. For hamstrings, Nordic hamstring curl/glute ham raises, and single leg bridge. For the back, do supine pelvic tilt. One person even reported that dorsiflexion exercises and stretches were one important element to solve his pelvic floor issues; this is most likely because the ankle bone, like everything else including even our jaw, is connected to the pelvic floor.
Like with anything, do all these exercises in moderation and stop if you sense your pelvic floor is not responding well to them - do them one at a time to see which ones your pelvic floor can handle for now. Here is an exercise routine from another poster that has helped many people. Just be careful of the ab exercises such as the ab wheel and 5 minute planks with your pelvic floor issues - don’t over do it or avoid it if they cause too many symptoms.
Myofascial release and foam rolling to release trigger points also helps a lot of people to relax their pelvic floor muscles and improve blood flow. The glutes are the most important area to target for pelvic floor issues when foam rolling in my experience if you only had limited time. Using a soft ball to lay on and breathe deeply can help release trigger points in the abdominal muscles and psoas which can help you breathe better and relax the pelvic floor. I haven’t done it, but you can also try out a massage gun for myofascial release; just be careful and don’t use it in sensitive pelvic areas. Some men and women also report success using a therawand to release internal trigger points that are causing them pelvic floor dysfunction symptoms.
Walking and swimming for 30-60 minutes are some of the best exercises to lengthen, relax, stretch, and release your pelvic floor, boost blood flow, and help to retain and build strength in muscles that give support to the pelvic floor. Walk or swim for 5+ days a week for the best results. The breaststroke and freestyle are very helpful for pelvic floor sufferers. Along with swimming, people also use an elliptical at a low resistance to help provide a cardio workout that is safer for your pelvic floor.
Fix your posture. Pelvic floor issues and hard flaccid syndrome are closely associated with Anterior Pelvic Tilt and other postural issues. Get evaluated by a physical therapist so that they can give you exercises and stretches to fix it. You could also look into the Postural Restoration institute and see one of their providers and try to implement some of their exercises. In the meantime, here is one video playlist on how to fix APT. Another video to fix APT says to stretch the hip flexors, lower back, while focusing on strengthening the abs, glutes, and hamstrings. Make sure that you sit and walk with good posture - watch this to learn how to walk correctly - activate your glutes during each step and push off with your back foot!. I also recommend getting a standing desk to try to avoid sitting for long periods of time.
Weight training can be effective for boosting active androgen receptors in the body to increase testosterone and DHT levels. However, you need to make sure that it isn’t making your pelvic floor symptoms worse which defeats the purpose. If you are going to lift weights with pelvic floor issues, don’t lift heavy, do any intensive ab workouts, or any other exercises that can put extra strain on your pelvic floor. Do lifts where you can sit down instead of standing up. Start with yoga, stretching, and gentle body exercises to relax your pelvic floor and strengthen surrounding muscles before incorporating consistent weight training. I highly recommend, however, just sticking with yoga and pelvic floor safe body weight exercises to build strength instead. Those with PSSD without pelvic floor dysfunction may benefit a lot from lifting weights, high-intensity interval training, and doing bodyweight exercises such as squats regularly to boost androgen receptors and DHT. Remember to see a pelvic floor therapist to get evaluated first before starting any weight lifting because many people have pelvic floor issues without even realizing it.
Work on your mental health. Anxiety can worsen pelvic floor issues. Just as dogs tuck and tense their tails when stressed, we tense our pelvic floors which are directly connected to our tailbone where we used to have tails ourselves in our evolutionary history. As we are impacted by sexual dysfunction and pelvic floor dysfunction symptoms, we become anxious along with other negative emotions which leads to more pelvic floor tension symptoms due to the fight or flight mode response causing even more anxiety leading to more symptoms. It is a vicious cycle that needs to break by not becoming anxious and negative when we experience pelvic floor symptoms or hard flaccid and instead let go, accept, and realize that it is a normal process when trying to heal because sometimes our muscles that are used to that tightness don't want to let go of the tension we hold in our pelvic floors. Daily yoga, meditation, stretching, and walking will help with anxiety. I would also see a mental health therapist because all of these issues are deeply traumatic and we cannot go through this alone. We often hold tension in the form of emotions and trauma in our bodies, especially our pelvic floor and genital areas. By openly talking about these issues with a therapist, it will help us process and release our emotions and trauma that we are holding inside our bodies to improve our anxiety, relax our pelvic floor, and to let go of all of our tension. Many people who healed their hard flaccid and pelvic floor issues said that solving their anxiety and negative thoughts by talking to a mental health counselor was vital in recovery. The mind-body connection is so powerful, and it directly impacts our pelvic floor. Those who are stuck in the cycle of experiencing pelvic floor symptoms leading to anxiety and negative thoughts will also benefit from Cognitive Behavioral Therapy you can do by yourself like in this video or preferably with a trained therapist. Here is an informative mini lecture on how stress impacts the pelvic floor.
I would also definitely go on a healthy anti-inflammatory diet. Avoid caffeine, alcohol, marijuana, and other substances. Avoid foods and liquids that can trigger pelvic floor inflammation such as highly acidic fruits and veggies, carbonated beverages, very spicy foods, and artificial sugars. To maintain a healthy gut to reduce inflammation in your body I recommend trying a low-histamine probiotic supplement along with eating healthy. You should also work on preventing or fixing constipation; eat a lot of soluble fiber to not get constipated - take a supplement such as metamucil if you have to. Check the Bristol stool shape chart to identify if you are constipated because even mild constipation can contribute to pelvic floor tension. This is because the constipation leads to a lot of pressure being put on your rectum and pelvic floor leading to the muscles becoming weak and dysfunctional. I am willing to bet many of you are constipated and don’t know it because it isn’t just whether you go regularly, it is also how your stool is shaped. People with pelvic floor disorders are at a high risk of constipation which makes their tension and dysfunction worse which then worsens the constipation, another cycle to fix. I recommend getting a Squatty Potty to reduce strain on the pelvic floor during elimination.
To help heal hard flaccid and pelvic floor issues, never watch pornography again (this is vital). Go on NoFap for 90+ days to help heal your brain and body from any unhealthy pornography and sexual habits you have partaken in. Pornography leads to involuntary kegels, a tight pelvic floor, desensitizes you, and messes up the dopamine and arousal circuitry in your brain. Don’t climax too often. Learn how to reverse kegel by yourself and during sexual activities. Never edge or regular kegel - it leads to pelvic floor tightness and dysfunction - just relax your arousal through a reverse kegel. Keep your pelvic floor relaxed during sexual activities.
Stay strong and never give up. You will heal. Thank you for reading.

I got my results for a metabolic panel today and I am concerned because according to this my liver enzymes are off the charts. These three results were flagged:
AST: 192 U/L, reference range 10-40 ALT: 99 U/L, reference range 9-46 Globulin: 1.9 g/dL, reference range 1.9-3.7 Glucose: 52 mg/L, reference range 65-99
About me: 29 yo male, 120 lbs, just started exercising regularly last week after being pretty sedentary for a long time. Currently taking:
Nattokinase-serrapaptese (blood thinning supplement) Magnesium B Complex L-Tyrosine Bacillus Subtilis probiotic
I did not take Tylenol or drink alcohol the day before my test, or fast (said no fasting). My last workout was 48 hours before the blood draw.

As a diabetic, I realized I had to reverse my insulin resistance and fix my mitochondrial dysfunction. That led me down a deep rabbit hole of research, a lot of which is embodied in Max Workout.
While listening to this talk, it was like reliving my path of discovery. Of course, I'm not a doctor, and I'm not able to communicate these ideas as well as I'd like, but if you are interested, this interview with Dr. Humberman and Dr. Casey Means will explain it all in a way I can't.
Dr. Casey Means: Transform Your Health by Improving Metabolism, Hormone & Blood Sugar Regulation
The short of it is less profound than the effects. Unfortunately, we must exercise, eat right, walk a lot more, and reduce stress—all the usual. But I hope that the why all that actually works at a deep fundamental level in our bodies will make a difference.
A summary:
Core Discussions:

• Metabolic Health Importance: Dr. Casey Means emphasizes that metabolism is foundational to overall health, detailing how metabolic dysfunction influences various health issues. She highlights that most American adults exhibit signs of suboptimal metabolism, contributing to prevalent health problems.
• Role of Food: Food is discussed as a critical factor in metabolic health. Dr. Means urges awareness of the profound impact food has on our bodies, building on the concept that food acts not just as a caloric substance but as a modifier of cellular function and health.
• Empowerment through Understanding: The episode promotes empowering individuals through knowledge and actionable advice, such as understanding biomarkers and adjusting health strategies based on them. The discussion points out that this empowerment can help navigate the noise of various health and dietary recommendations.

Key Messages:

• Addressing Metabolic Dysfunction: Dr. Means calls for a shift from medication to lifestyle adjustments like proper diet and exercise to combat metabolic issues.
• Personalized Health Approaches: She advocates for personalized health strategies informed by regular checkups and biomarker analysis to tailor individual approaches to diet and exercise, reinforcing the message that understanding and action can coexist to foster better health outcomes .

This episode provides a broad yet profound look at how modifying basic lifestyle elements like diet and exercise can fundamentally alter our metabolic health, which is crucial for overall well-being.

1. Empowerment through Lab Testing:

• Dr. Means stresses the importance of regular lab testing to navigate the plethora of health and dietary advice. Understanding one's biomarkers allows for tailored strategies, enabling individuals to see if their health interventions are effective. This encourages a proactive approach to health, moving away from dependency on conventional health providers toward self-reliance and informed decision-making .

1. Role of Food in Metabolic Health:

• Food is fundamentally linked to metabolic health. Dr. Means explains how our bodies are literally built from the food we consume, which impacts every cellular process. She advocates for addressing key lifestyle factors like diet to enhance metabolic function, underscoring the necessity of choosing the right foods to maintain or improve health .

1. Understanding and Addressing Metabolic Dysfunction:

• Metabolic dysfunction is alarmingly common and forms the foundation of various health issues. Dr. Means highlights significant statistics indicating that a vast majority of American adults experience suboptimal metabolism, which is at the core of many chronic diseases. She emphasizes that improving metabolic health can fundamentally alter our overall health state

Here's her book:
Good Energy: The Surprising Connection Between Metabolism and Limitless Health
I have not read it yet; it's on pre-order, so I can't vouch for the book, but after listening to her interview, I bet it will be good. It's kind of a bummer that it's on pre-order. Either they made a mistake on the interview timing, or they are trying to bump up pre-order sales to make a splash on the charts. In either case, it's unfortunate.