According to Ztanzanite on the T-Nation forum, who is now almost 100% recovered from Permanent Deca Dick (PDD) after 6 years, Dr Romeo Mariano was very helpful in his recovery. I have also found other sources on the internet stating how knowledgeable and helpful Dr Mariano is for difficult-to-solve Neuro-Endocrinology problems. Dr Mariano also told me that he is currently helping a handful of guys recover. I don’t think that he or anyone else knows the exact mechanism in the brain that is causing Permanent Deca Dick but I think his opinion is the best we’ve got at the moment.

Here is a summary of my first call with Dr Mariano in Sep 2021 - bear in mind that some of this will be specific to me and the blood test I showed him:

He is helping a few guys with Permanent Deca Dick and one of his patients has recovered (he was probably referring to Ztanzanite). Recovery is a slow and gradual process, the younger you are, the faster you are likely to recover.

The focus of his treatment seems to be centered around healing adrenal dysregulation (Ztanzanite also says the adrenals need to be healed to recover from PDD) and any other endocrine issues if they are present. Mariano said that trying to be horny when you’re stressed/ have libido issues is like expecting to be horny when you’re about to be in a head on collision with a train - not going to happen.

Iron/ ferritin is the first thing to make sure is in check when trying to heal adrenals. Iron is pretty crucial for our bodies to create energy; when we have insufficient iron, our cells are unable to produce energy efficiently. This is also true for other micronutrients. When our bodies lack good nutrition, our metabolic processes which make energy are less efficient. Modern fruit and vegetables are lacking in micronutrients because genetic modification of our food supply has reduced its quality. We can test ferritin levels in our body - Dr Mariano said that he wants to see levels between 150 - 300 ug/L. Interestingly, my ferritin levels have been way beneath 150 for the entire time I’ve had PDD. It’s worth getting this checked. For micronutrients, Mariano suggests the following supplements each day: Vit D 5000 IU, Vit B12 4000 mcg sublingualy, Copper 2mg, Zinc 30mg, Vit A, Vit K MK-4 15mg.

So why is energy metabolism even important for healing adrenals? This bit was kind of an “Ah ha” moment. I don’t know exactly how, but apparently when our cellular metabolism is lacking, we use Norepinephrine (NE) to make up for the energy deficit. Most people think cortisol is the main stress chemical but it’s actually NE. Epinephrine (E) and NE are the fight or flight chemicals. NE and Corticotropin Releasing Hormone (CRH) are in a positive feedback loop, meaning that when one increases, the other increases, which then increases the other one etc etc. Cortisol disrupts this feedback loop unless cortisol is low like in my case.

Furthermore, Dr Mariano’s primary treatment for healing the adrenals is now improving sleep quality, especially by increasing deep sleep (I think it used to be hydrocortisone treatment but not any more). He told me “Improving the adrenals is sleeping well.” He made it clear that sleep is the most important thing. He also said that while NE is high, you won’t be sleeping well and that when iron is low “you are living on stress even when sleeping.”
As a side note, since PDD started and probably before too, I have noticed some sleep disturbances, but didn’t think much of them. I thought my sleep was generally okay but it wasn’t. I’d recommend getting a sleep tracker; the Oura ring and Fitbit Charge 5 are the best consumer sleep trackers I’ve come across. The Oura ring has given me a lot of insight into my sleep and has shown me that I’m really not sleeping well. I can also see the effects of different supplements and medications on my sleep and am now improving my sleep gradually.

Perhaps this is only relevant to me but my T3 and T4 levels were high during the first year of my PDD but I had symptoms of hypothyroidism. Taking T3 medication actually made me feel better even though my T3 was already high. This might have been related to rT3 but Mariano also said that if Iron/ nutrition is insufficient, T3 will just be spinning its wheels within cells which could explain the situation. Or it could have been Graves disease but my Thyroid Stimulating Antibodies are well within range so it’s not that.

I asked Dr Mariano whether he knew exactly what was going on in the brain of someone with Permanent Deca Dick. What is the mechanism that is causing feelings of sex drive, confidence, pleasure etc to be turned off? I got the impression that he doesn’t know exactly, but what he said is that in the brain we have 7 ancestral emotional systems/ circuits, located in the more ancient lower regions of the brain which are responsible for our visceral feeling experiences: seeking, fear, rage, lust, care, panic/grief and play. Each one is fairly self explanatory, apart from seeking. Seeking is the main emotional hub, the other 6 systems feed through the seeking system making it the most important in a way. Seeking is what makes us feel eager anticipation towards things. For example, when the play system is active, it runs through the seeking system; we have a strong emotional desire to play. When the lust system is active, we have strong urge to be sexual etc etc. Mariano also spoke about the lust system a little bit but I can't really remember too much. The seeking system is also known as the reward system but seeking is a more appropriate term. You can learn more by reading The Archaeology of Mind by Jaak Panksepp if you’re interested. I got the impression that Dr Mariano bases a lot of his work on this book and the work of Jaak Panksepp.

Here are some quotes from The Archaeology of Mind, describing the seeking system:

“Brain sources of eager anticipation, desire, euphoria and the quest for everything.”
“Humans report a sense of eager anticipation and an enhanced sense of themselves as effective agents who can make things happen in the world.”
“Our seeking systems keep us in a general state of engagement with the world.”
“It energises the eagerness for positive experiences, from tasty food to sexual posibilities, to political power.”
Dr Mariano also said the seeking system is responsible for our feelings of hunger.

Anyone else feel like that’s what they’re missing?

Dr Mariano said the seeking and lust systems have been affected in Permanent Deca Dick - the driver of the seeking system is dopamine. Dopamine activity in the seeking system has somehow been reduced or disrupted. Norepinephrine has an inverse relationship with dopamine and other neurotransmitters, so is it the NE that is suppressing the dopamine? Mariano suggested this but I'm not 100% convinced that this is all there is to it. Further evidence of low dopamine levels is that some PDD sufferers have high prolactin levels. Dopamine usually suppresses prolactin, so when dopamine is low, prolactin is high. It is worth checking your prolactin levels as it looks like some of us have high prolactin and some don’t.

It is supposedly possible to improve deep sleep quality by using the blood pressure medication Clonidine. Clonidine reduces norepinephrine levels and has been shown to increase deep sleep. I am currently about to start trialing Clonidine.

A caveat to all of the above is that I recently tested my norepinephrine/ epinephrine levels and they were within range. I will be testing them again soon and will have another call with Mariano to discuss.

In summary, I think the call has given us (or me at least) a sense of direction. I think there is a mechanism within the brain that we are unaware of which is causing dopamine signaling in the seeking system to be disrupted other than just high norepinephrine. I think this because people have PTSD and adrenal axis dysfunction but they don’t all report total loss of libido as far as I’m aware and because cabergoline, a dopamine agonist, doesn’t bring back what I lost. I think there’s something else going on but healing adrenal axis dysregulation seems to be the best course of action at the moment as it looks like adrenal issues are prevalent among most of us but we need more testing to be sure which is part of the reason that this forum has been set up.

Comments are encouraged

Cheers