In a 33‑year‑old male with documented exposure to mercury and cadmium from a skin‑whitening cream (Forever Fairness), rising blood mercury (~4 µg/L) and cadmium near the safety limit, persistent 3‑year penile small‑fiber neuropathy, cognitive decline, secondary hypogonadism, chronic fatigue, depression, and no improvement after IV glutathione, should repeat metal levels be obtained before initiating oral dimercaptosuccinic acid (DMSA) chelation, is DMSA likely to reverse the neuropathy or is the nerve damage permanent, what long‑term monitoring and management is recommended for cadmium, and should gut restoration be started before or concurrently with chelation?

Chelation for Mercury/Cadmium Toxicity with Neuropathy

Obtain updated blood mercury and cadmium levels immediately before initiating DMSA chelation, as the rising mercury trend 15 months post-exposure and failure of IV glutathione strongly suggest ongoing internal redistribution or depot release that requires quantification before treatment decisions. 1, 2

Should You Start DMSA Now?

Do not initiate DMSA until you have current metal levels. Your last mercury level (4.38 µg/L at 88% of limit) is now outdated, and the critical question is whether mercury continues rising or has plateaued. 2

Why Retest First:

• Pre-challenge testing identifies current blood levels and ongoing exposures, which is essential for proper treatment planning 2
• The rising mercury pattern 15+ months after cessation is highly unusual and suggests either depot release from tissues (bone, CNS) or unrecognized ongoing exposure 1
• DMSA/DMPS efficacy declines dramatically as time from acute exposure increases—animal data show chelation works best within minutes to hours of exposure, with diminishing returns in chronic intoxication 1
• For chronic mercury exposure (which you have after 24 months of cream use), chelation may accelerate excretion but therapeutic efficacy for reducing morbidity/mortality is largely unestablished 1

The IV Glutathione Failure Is Telling:

• Your zero clinical improvement after 10 sessions of IV glutathione 1200mg suggests either: (1) the metal burden is not the primary driver of symptoms, (2) glutathione doesn't effectively mobilize mercury/cadmium, or (3) tissue damage is already irreversible 3
• One observational study showed 69% reduction in provoked urine mercury using oral DMPS/DMSA combined with IV glutathione and vitamin C, but this was measuring excretion, not clinical outcomes 3

Mercury and Penile Neuropathy: Reversibility Question

Mercury can cause peripheral neuropathy including small fiber involvement, but complete penile numbness persisting 3 years suggests permanent nerve damage that is unlikely to reverse with chelation at this stage. 4, 1

Evidence for Mercury-Induced Neuropathy:

• Mercury poisoning commonly causes paresthesia, weakness, muscle atrophy, and mixed polyneuropathy on EMG studies 4
• One pediatric case showed painful extremities, decreased motor strength, absent deep tendon reflexes, and mixed polyneuropathy from chronic elemental mercury exposure 4
• Neurologic manifestations are typically seen with chronic mercury intoxication and involve both central and peripheral nervous systems 4

Why Your Neuropathy Is Likely Permanent:

• Chelation efficacy for chronic mercury intoxication is unestablished—the evidence supports chelation only for acute poisoning initiated within hours 1
• You are 3 years into complete penile numbness with 15+ months since exposure cessation
• Small fiber neuropathy, once established, has limited regenerative capacity, especially after prolonged denervation
• The failure of IV glutathione to produce any improvement suggests the damage is fixed, not reversible

Critical Caveat:

• DMPS and DMSA do not redistribute mercury to the brain (unlike BAL), which is an advantage, but they also show negligible elimination of mercury from tissue deposits in organs 5
• One case of IV elemental mercury injection showed that despite enhanced urinary excretion during DMPS/DMSA treatment, mercury deposits in organs resulted in negligible elimination compared to exposed dose 5

Cadmium: The Bigger Long-Term Problem

For cadmium at 88% of limit with a 10-30 year biological half-life, chelation is NOT recommended—focus instead on preventing further exposure and monitoring renal function every 6 months. 6, 1

Why Chelation Won't Help Cadmium:

• Cadmium has a 10-30 year half-life in the body, meaning it will persist regardless of chelation attempts 6
• The evidence for chelation efficacy in chronic cadmium exposure is even weaker than for mercury 1
• Cadmium primarily causes renal tubular damage (elevated urinary NAG, β-2-microglobulin) and is associated with decreased creatinine clearance at low blood levels 6

What You Should Do Instead:

• Monitor renal function every 6 months: serum creatinine, creatinine clearance, urinary NAG, and urinary β-2-microglobulin 6
• Check for hypertension, as cadmium exposure increases risk of renal disease, especially in hypertensives 6
• Avoid NSAIDs, which can worsen cadmium-related renal dysfunction 6
• Accept that cadmium will slowly decline over decades—your goal is preventing additional kidney damage, not rapid elimination

Gut Restoration vs. Chelation Timing

Proceed with gut restoration first or in parallel—do not delay gut healing for chelation, as chelation efficacy in your chronic scenario is questionable while gut dysfunction will impair overall recovery. 7

Rationale:

• The American College of Cardiology warns that prolonged chelation can cause severe zinc and essential mineral depletion, which would worsen gut function 7
• Your chronic exposure scenario (not acute poisoning) means chelation urgency is low 1
• Gut restoration improves nutrient absorption, immune function, and may reduce systemic inflammation contributing to your symptoms
• Chelation agents can stress the GI tract, so starting with compromised gut function increases adverse effects 7

Monitoring During Any Chelation:

If you proceed with DMSA after retesting:

• Complete blood count with differential every 3 months to monitor bone marrow effects 7
• Comprehensive metabolic panel every 3 months including liver and kidney function 7
• Urinalysis every 3 months 7
• Serum zinc levels to prevent depletion—supplement with 50 mg elemental zinc daily if deficient 7

Bottom Line Algorithm

1. Retest blood mercury and cadmium NOW before any chelation decision 2
2. If mercury continues rising: Consider DMSA trial (succimer 10 mg/kg TID for 5 days, then BID for 14 days), but set realistic expectations—neuropathy reversal is unlikely 4, 1
3. If mercury has plateaed or declined: Chelation offers minimal benefit; focus on supportive care 1
4. For cadmium: No chelation—monitor renal function every 6 months indefinitely 6
5. Start gut restoration immediately regardless of chelation decision 7
6. Address secondary hypogonadism, depression, and fatigue with conventional therapies (testosterone replacement if indicated, psychiatric medication, etc.)—these may improve even if metal levels don't change

Harsh Reality:

Your 3-year penile numbness is almost certainly permanent nerve damage that will not reverse with chelation. The rising mercury 15 months post-exposure suggests tissue depot release, but by the time mercury redistributes from tissues, the neurologic damage is done. Chelation at this stage is closing the barn door after the horse has bolted. 1, 5