Gut Protocols

SIBO (small intestinal bacterial overgrowth) is an umbrella term for abnormal bacterial overgrowth in the small intestine, which can drive bloating, diarrhea/constipation, reflux, food intolerance, histamine-like reactions, and “brain fog” via inflammation, altered bile acid metabolism, endotoxin/LPS exposure, and disrupted nutrient handling. In a PFS/PSSD/PAS context, the reason gut issues get so much attention is that the gut isn’t just digestion—it’s an immune organ and a signaling organ. The microbiome can influence systemic inflammation and the stress response, and it has real interfaces with hormone and neurotransmitter biology. For example, most serotonin in the body is produced in the gut (primarily by enterochromaffin cells), and microbial metabolites can influence serotonin signaling, vagal/autonomic tone, and even blood–brain barrier and microglial activity. That means chronic gut dysbiosis can plausibly keep the nervous system in a “sensitized” state, where sleep, mood, libido, and cognition become more fragile.

Mechanistically, people often speculate about overlap with neurosteroids and androgen signaling as well. Neurosteroid balance (including allopregnanolone-related GABA-A modulation) is influenced by broader metabolic and inflammatory state, and the gut can affect that state through immune signaling and microbial metabolites (e.g., short-chain fatty acids, secondary bile acids). Separately, androgen receptors are expressed throughout the body, including in GI tissues, and androgens influence gut barrier integrity and immune function—so it’s plausible that disrupted androgen signaling could interact bidirectionally with gut health. None of this proves “SIBO causes PFS/PSSD,” but it supports a reasonable hypothesis: if the gut is chronically inflamed or dysbiotic, it can amplify the same symptom domains that define these syndromes (fatigue, anxiety, sleep disruption, emotional blunting, cognitive issues).

Community-wise, you do see a recurring pattern where some individuals report being cured or drastically improvedafter addressing gut problems—treating suspected SIBO, eradicating a persistent infection, improving motility, or removing dietary triggers that were continually inflaming their system. Just as often, others report partial improvement (especially in fatigue/brain fog/anxiety) without full sexual or emotional recovery, and many report minimal change. The most useful takeaway to communicate is: gut treatment may not be a universal “fix,” but in a subset it appears to be a major lever—especially when improvements follow a clear pattern (GI symptoms improve first, then sleep/stress tolerance, then cognition/mood). That makes gut/SIBO evaluation a sensible “foundational” area to explore with a clinician, while staying cautious about over-attributing every improvement to a single antibiotic or supplement when time, diet changes, and trigger avoidance may also be doing a lot of the work.

Anecdotes:

https://www.reddit.com/r/PSSD/comments/wmzuvd/gut_theory_how_im_fixed/

https://www.reddit.com/r/PSSD/comments/ywyql8/gut_theory_personal_recovery_update/

https://www.reddit.com/r/PSSD/comments/1252d8z/almost_cured_through_gut_treatment/

https://www.reddit.com/r/PSSD/comments/1kfk3co/evidence_that_pssd_is_gut_related_my_results/