26 yr old male. perceived atrophy left quad, left hypothenar, left genioglossus. clean emg/ncs and clinical 1 month ago. nms thinks i'm okay. i think things have gotten worse. what steps should i take? no dysarthria, deviation, or weakness of tongue?

You used the word "perceived" which is a subjective feeling rather than a sure abnormality (atrophy) of the involved muscles which can be measured. To me, you are most likely not affected by the neurological disease which you are afraid off because you had gone through a thorough evaluation and you were given a clean bill of health. You can seek a second opinion for an absolutely peace of mind.