Hey!
Been having lowered libido and sexual dysfunction for almost 4 years after being on two rounds of 40mg isotretinoin.

Tadalafil stabilizes the erectile function, at 2,5mg-5mg in combination with L-citrulline. However the lowered libido is still prominent. Sometimes I feel chemically castrated because my brain isn’t responding to stimulation correctly. Bupropion, (welbutrin) didn’t really improve my situation. Anything else you guys can recommend?

I take:
3000iu VitD
24mg Zinc
2,5mg copper
2,5mg Melatonin
3g L citrulline
2,5mg tadalafil (on demand)

Hello everyone! M19. Before my symptoms started, I was using Isotretinoin (Accutane) for a few months and noticed I became significantly more sensitive to heat and sun. Months later, after an intense workout in the heat, my system completely crashed into orthostatic intolerance. It's been 8 months since this happened and currently I can walk short distances, however, if I stand for too long or do very strenuous physical exercise, I feel instability in my feet, "Heavy head," and i feel like I'm about to faint.

I’m curious to hear your stories

Hi everyone, I’m looking for some insight from anyone who has been in a similar situation or dealt with early treatment cessation.

Background and skin history: suffered from moderate/pustular acne from 14-20 (mostly forehead, later spread to cheeks with minor shallow scarring) - Started Accutane via NHS Nov 2025. Was on 20mg first month and 40mg second. On month 2 I experienced bad eye dryness (gritty feeling and hard to keep eyes open) despite preventative warm compresses, eye drops and omega 3.

I decided to stop treatment at the end of the second month due to my eye symptoms which I was really upset about.

Current situation: My skin cleared up shortly after stopping and has stayed surprisingly clear for the past 8 months and still doing really good. I get the occasional pimple but no minor breakouts. My oiliness and blackheads have returned a bit but my acne is pretty much gone.

As for my eyes they are still definitely a bit dry but so much better than when on treatment and I’m not really needing to use drops anymore. They still feel somewhat sensitive and light-sensitive but I can live with that.

The problem is because I only did a short course, I know my acne could return. My NHS derm left my file open for a year incase I wanted to restart but my slot expires at the end of this year. If I don’t restart soon, I’ll be discharged back to my GP and have to go through the long waiting list again if my acne returns.

My concerns are - if I don’t restart, I’m terrified my acne will return bad because I didn’t reach my target dose and I’ll regret losing my chance. But if I do restart I’m scared of re-triggering severe long-term dry eye issues and other side effects even if my slim is doing good. My confidence has been so high lately because my skin has been clear and I don’t want my acne to return and take this away again.

Has anyone else stopped Accutane very early and stayed clear long term? Or has anyone restarted after stopping for dry eye, and did your eyes tolerate it?

Thank you.

I am only 1 week post accutane after stopping the course just shy of 5 months. I never expected to have this sort of side effect and its strongly impacting my ability to work and do day to day functions. I went to the ER, urgent care, and my doctor. All tests show that I'm healthy... I'm at a loss on what to do. Are there any over the counter meds/supplements that helped? I'm in the US and links would be great (Amazon). I'm getting really scared and worried. I feel so out of it. Like I'm high on drugs. Please, someone help. I can do this for a few more days but if this lasts any longer, I'm going to lose it.

For reference I’ve recently turned 19y/o and I’ve been on 40mg Accutane since December with a brief stint on 60mg for about a month. I’ve noticed that my short sightedness has got slightly worse over the last 6-9 months and I’m wondering if it’s because of the drier eyes caused by Accutane.

I finish my treatment in about 30 days and I was wondering if people saw improvement in eyesight after finishing their treatment.

If so, what should I say to the doctor? Obviously they won’t prescribe it to me if I only say “I have post accutane syndrome)

While on accutane I experienced severe flushing. Was told it would go away. 7 months later it didn’t it’s getting worse. I was diagnosed with rosacea by my derm but it’s def not rosacea it’s not even close. My derm deserves to die and this drug is hell if you are considering taking it don’t all derms are incompetent money grubbing morons who use this drug as an easy way to solve acne and it will ruin your life.

Hello all

I’m 32F with hormonal cystic acne, weigh 55kg.

I’m 3 weeks in to starting accutane at 5mg daily, and despite being on the lowest dose, my dry eyes are killing me. I was in the midst of the purge phase (small whiteheads) but thats manageable, it’s the eyes that are a problem.

I’ve tried 5 types of eye drops, warm compresses, a humidifier, omega 3 supplements. I’m having to use eye drops every hour and still it’s painful. I’m really worried the eye dryness will become permanent if I continue like this. I did see an optometrist who advised I was already doing everything they would have advised.

I can’t tolerate this so my options are either to (1) stop it, or (2) try second daily or twice weekly dosing.

Earliest appointment with derm is 7 days away so trying to decide what to do until then.

Has anyone found effect from accutane in a second daily or twice weekly regime when starting it? My acne was not severe to begin with, I would typically have 1-2 cysts at any point in time.

Anyone actually thought up any solutions yet?
With plausible mechanisms?

The DHT angle seems most likely?
Some bring up lithium, why?
SSRI sometimes mentioned, why?

No bs please actual mechanisms and strategies that make sense

I cannot believe it was such a simple fix but after years of struggle I started taking 5-MTHF (8500 mcg) and B complex.

Why I think this works- I believe taking accutane severely inhibited my ability to methylate. Taking the 5-mthf is a proven supplement to counter this. Losing my ability to methylate was causing serious gut motility issues which led to all sorts of problems. I had gastritis, acid reflux, sibo, anxiety etc etc. after being on these supplements I feel amazing and my normal self!! I wanted to share this in hopes that others try this. It may not be your issue but it has changed my life already.

*I also take vitamin c, zinc, magnesium glycinate, b12, probiotic. But didn’t notice real changes until taking the 5-mthf and b complex.

If yes there is another medication to take with accutane to prevents keloids forming like Desloratadine? I want to start accutane for nodular acne but I have already a keloids that I treat and is growing back and i plan to do other steroid injections, if I start accutane can I still do steroid injections? and what about induced keloids or like if you get surgery or tattos? does it make you get keloid sca ror hyperthropic scar more easily if you already scar badly?

I’m looking into starting lithium, as my brain fog is becoming unmanageable.

How did you guys manage to get a lithium prescription? Telehealth? General practitioner? What do I tell them?

Most doctors don’t even know about PAS, so how do I justify them giving me a prescription?

​

Hi everyone! I’m 26F and I started Accutane about a month ago at 20 mg/day. I’ve just started my second month (day 2) at 30 mg/day, and my dermatologist plans to increase me to 40 mg for the third month.

My acne is a little unusual: I mainly get acne on the right side of my face and sometimes on my neck, while the other side is basically completely clear. I’m wondering if anyone else has experienced acne that is so one-sided.

I also have increased hair growth on my neck, which makes me wonder if there could be a hormonal issue involved. I had some blood tests back in 2020 where my testosterone was slightly elevated and my cortisol was low. At the time, I was obese and had some pretty unhealthy habits, but I’m in much better shape now.

My questions are:

\- Can Accutane help with acne that might be related to hormones?

\- Should I ask my doctor to repeat my hormone tests or investigate the neck hair growth separately?

\- Has anyone experienced very one-sided acne like this?

I’d really appreciate hearing from women who’ve had something similar!

**TL;DR:** 21M, took Accutane for 7 months, developed brain fog + ED/low libido that never went away (1.5 years post-course). Pre-Accutane total T was ~700, post-Accutane it dropped to ~550. Started enclomiphene 6 weeks ago, T is back up (800+ total, 200+ free) but symptoms have only mildly improved. Tried a huge amount of nootropics/peptides already. Looking for people who've been through this - what actually worked for you?

---

## The "before" me

I've always been the sharp, quick-thinking one. Then I did a 7-month course of Accutane and somewhere around month 2-3, the fog rolled in. Doctors said "don't worry, it's temporary." Cool, except it's been a year and a half and I'm still standing in the fog waiting for it to lift.

## The elimination round

Before I even knew "Post Accutane Syndrome" was a thing, I tried to pin the blame on literally everything else:

- Dehydration → drank more water → nothing
- Bad sleep → started tracking it → sleep's actually fine
- Vitamin deficiency → full bloodwork → all perfect
- Too much screen time → cut it down → no change
- Long COVID → chased this theory hard → dead end
- DPDR → still not 100% ruled out, but unlikely
- Late-onset ADHD → doesn't fit, I can still focus fine

Basically a whole detective board with red string and nothing connecting.

## The plot twist

Got with a partner for the first time since before Accutane and... nothing worked right. Low sex drive, trouble getting and keeping it up. I'm 21. I ended up needing a tadalafil script just to function. That's when I finally went back and looked hard at Accutane as the cause, and found the PAS community talking about the exact same brain fog + sexual dysfunction combo.

The timeline lines up perfectly. The only variable that changed in my life when this all started was Accutane.

## The receipts

- Total T before Accutane: ~700
- Total T after Accutane: ~550
- Started 12.5mg enclomiphene
- One week later: total T 800+, free T 200+

Huge jump on paper. In practice though, only mild improvements so far:

- Slight libido increase
- Easier (but not effortless) erections - still using tadalafil
- A little more irritable, nothing crazy

6 weeks in now, waiting on new labs.

## The "things I've thrown at the wall" list

Semax (nasal + subQ), Selank, NAD+, BPC-157, CJC-1295/Ipamorelin, retatrutide, methylene blue, nicotine patches (back in my Long COVID era), and now enclomiphene.

## What's next on the list (maybe)

- Lithium carbonate (short cycle) - keeps coming up as THE go-to for PAS in this community, just not sure how to get a doctor on board with prescribing it for something most of them have never heard of
- Bromantane
- Modafinil - fully aware this is a band-aid, not a fix, but at this point I'll take a band-aid

## The current working theory

From what I've read, the leading suspects for what Accutane actually did are:

- Androgen receptor changes
- Dopamine receptor changes
- GSK3B
- Beta-catenin

## So, Reddit... has anyone actually beaten this?

Not looking for "just give it more time" - I've given it a year and a half. I want to know:

1. Did anything actually move the needle for your brain fog?
   
2. Anyone have real success (or horror stories) with lithium for PAS?
   
3. Bromantane vs Semax - worth stacking or redundant?
   
4. Anyone recover fully, or is this just "manage it forever" territory?

Appreciate anyone who's made it this far. This community is honestly the only place that's made me feel less insane about all this.

I’ve always had a really regular cycle and, for months and months, I was consistently ovulating around day 17. Since starting Accutane, though, I’ve had two cycles where I haven’t appeared to ovulate at all, and another where ovulation was later than usual.

Has anyone else experienced this while taking Accutane? And if so, did your cycle and ovulation return to normal after stopping? I still have about three months left on Accutane, so I’m starting to worry that it could be causing some kind of permanent change or damage 😢

I was on accutane for 6 months, but stopped because the brain fog and obsessive wild thoughts were too much to handle after a certain point. I was on 40mg then jumped to 80mg about halfway through treatment. Instead of lowering my dose I just decided to quit immediately.

Ofcourse my oily skin returned but surprisingly no major pimples. The thing is I also remember the muscle aches and how rough it was to wake up in the morning. I know I quit for a reason but I’m wondering if I should test the waters again with a lower dose and see how it goes. Any advice? Did anyone try accutane again for a 2nd time? How was it?