Would it be rare to have als with normal reflexes and normal clinical exam ? doctor said no need for emg as percieved weakness ie tripping at times / hand weakness when lifting things is not clinical and strength test was normal . chances of early al?

Rare rare unless u have family history. Ask for the genetic test if u can handle the results. Discuss with Drs first.

What causes you to focus on a disease of older people at age 32? Nothing in your post raises concerns of ALS. Do you possess anxiety and worry which needs to be addressed by counseling? Would cognitive-behavioral therapy by of assistance? Would discuss next steps with your doctor.