It is extremely important to establish what part of the body is responsible for the problem. This is how to distinguish Bromhidrosis from TMAU or other causes
The body has two main types of sweat glands. These are the apocrine and eccrine glands. The apocrine glands are normally the ones that create odors, and are normally the ones responsible for Bromhidrosis, which means someone has abnormally bad smelling sweat, that hygiene can't fix. These glands are primarily located in the underarms, genital area, anal area, and in the area of the breasts. It turns out they also exist in the scalp and certain areas of the face, but this is not usually mentioned in medical texts. If the odor is coming purely or mostly from the underarms that indicates Apocrine Bromhidrosis, which is by far the most common form of it. Axillary Bromhidrosis would be the fancy way of saying that you have abnormally bad smelling underarm sweat. The axilla refers to the underarm area.
The eccrine sweat glands are all over the body, and I confirmed this includes the underarms. It is possible to have Eccrine Bromhidrosis, but this is far less common than Apocrine Bromhidrosis, which usually is the result of the apocrine sweat glands in the underarm area.
If your underarm sweat is the problem, than there are medical procedures to deal with this including MiraDry and a whole range of different surgical techniques, if that fails to work. The basic idea is to start with the least invasive methods, and then move on more risky things that are more likely to work permanently.
Compensatory sweating is a real concern, and there is the potential for apocrine glands to either regrow, or for the ones not removed to take over and create the odor again. Apparently the apocrine glands restoring their function can take a number of years to happen. Ask a surgeon some hard questions about these topics before getting anything like this done. And please ask these questions of the actual surgeon who is going to be doing the operation, not just random people on reddit.
The main point of this post is that you really need to find out what parts of the body are responsible for the odor in order to figure out what to do about it. If you are noseblind to yourself, than it will extremely helpful if you can find someone who admits they can smell you, and is willing to sniff around to figure out where the smell is coming from. This would be a fully clothed thing, and nothing crazy. The main thing is to have them smell your underarm area to establish if that is the source of the problem or not. Getting sweaty is important for this to work properly. Perhaps do a little exercise to achieve this. You can put a paper towel in your sweat from different areas and have someone smell it if you want.
Everything I have read indicates that the true form TMAU (Trimethylaminuria) is an issue largely with the eccrine sweat. The late Dr. Preti was the worlds leading expert on TMAU, and he had patients come to his odor lab with actual odor judges who sniffed the people who came in. He reports that peoples underarms smelled basically fine, and everything else I have read indicates this an issue with the eccrine sweat, meaning its the sweat all over the body that's responsible. In addition to the sweat, any and all body fluids can be involved with creating the TMAU odor, and so females may report a vaginal discharge odor from TMAU. The breath can also be involved with the TMAU odor.
Some people here think that the sweat is not involved at all, and the things creating the odor are released like a vapor from the pores. By what mechanism could that happen? If there was some type of 'fan' in the body then perhaps that would make sense, but there is no such 'fan like' system in the body to do this. What makes sense is that the eccrine sweat is being used to release the thing the body needs to get rid of. Medical sources say that the eccrine sweat is what results in a odor if people consume too many spices for too long for example.
You only automatically notice you are sweating when lots of sweat is being released - otherwise you won't feel it coming out. The water can evaporate, leaving behind the solid parts that the bacteria can act on. This means your skin can feel dry, but you have actually sweated without realizing it.
If you can get somebody to sniff you and determine if the underarms are the source of the problem or not, you will have made a huge step towards understanding your problem, and in understanding the possible treatment options available. It also quite possible that the feet are the source of the odor, or the genital or anal area. You should not be noseblind to these areas, and so you should be able to smell them yourself. Smell the inside of your shoes when you get hot/sweaty, rather than trying to smell your feet directly.
If your underarms smell just fine, then you know not to pursue medical treatments like miradry or surgical options in that area. You probably don't have apocrine bromhidrosis either, and you may - or may not - indeed have TMAU. You might have an unusual cause that is neither TMAU or Bromhidrosis that involves the eccrine sweat - or perhaps does not involve the sweat at all.
The alternative to finding someone to sniff you would be to skip wearing deodorant for a week or so to see if peoples reactions to you change in a major way. If they do, this indicates the underarms are a major source, or the sole source, of your problem.
I was surprised to learn that the WebMD style sites out there that cover this topic are nowhere near as good as the sources actually meant to be accessed by medical doctors. I very strongly recommend making a free account at 'Medscape' and looking up 'Bromhidrosis'. They actually cover the different surgical options and things, whereas the mainstream medical sites basically just say to wear antipersperant and not eat too much garlic. Doing google searches for bromhidrosis surgical and microwave/laser treatments will also take you to medical sites that go far beyond things like WebMD in terms of what they cover.
