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I have a few questions. I have seen a urologist in the past (about 5 years ago) and my prostate was fine. Today my urine flow is strong, usually. I am 37 and very healthy and athletic (if it matters). I have taken testosterone in my early twenties, about 15 years ago (steroids). For the past few 10 years I have been urinating at night sometimes 3 times sometimes none. Recently when I urinate at night the flow is sometimes weak and sometimes strong. I drink alcohol rarely, but when I do my urine flow that night is always weak, and comes out in waves. There is never any pain in any urination though. When I jog sometimes it feels like I have to pee, so I do and very little pee comes out and the urge to pee is gone but when I start to run again the urge to pee comes back. My father and his father before him both had prostate cancer. Does it sound like I have an enlarged prostate or the beginning of Cancer in my prostate? Also, I think I may begin Hormone therapy Treatment for low testosterone levels, is this dangerous if I already have these symptoms?
Optional Information: Person's Gender: Male Person's Age: 37 Already Tried: I have not tried any drugs for any of my symptoms, I just follow a good diet and work out.
Thanks for your question. If I don't respond to you immediately, it is because I am either in the OR or traveling. I WILL get back to you ASAP.
You should not begin hormone therapy until your doctor figures out what is causing your urinary symptoms. Since you took testosterone when you were younger, this could have led to rapid prostate growth and may be leading to the symptoms you have. Prostate cancer is not very likely at all at your age, but since it runs in the family, your urologist should definitely examine the prostate and check your PSA. Also prostate cancer typically does not cause urinary trouble until it is in the late stages.
You need to get in to see a urologist for a prostate exam and possible cystoscopy to look in the urethra to rule out a stricture as the cause of the urinary troubles.
Hope this helps and let me know if you have questions
Is it possible to get a cystoscopy under anesthesia? I have a friend who said it hurt like hell. I have had catheters inserted after surgury, that is VERY painful and extremely uncomfortable. Is cytoscopy worse than a catheter? Also, can the hormone therapy increase the size of my prostate? There is conflicting opinions about it's effect on the prostate.
Cystoscopy is not more painful than a catheter insertion. It is the same size as a catheter.
Cysto can be done int he OR if you request that your doctor do so.
Hormone therapy is certainly though to cause the prostate to increase in size because the prostate is rich in testosterone receptors. When we put older patients on testosterone, they can develop obstructive urinary problems due to prostate enlargement in a few months.
Last question: So why does my urination at night become so weak after a night of drinking alcohol? Why does alcohol have this effect?
It's possible that the alcohol can be making your bladder muscle a bit "lazy" and have less of an ability to contract to get the urine out. The obvious way to prevent this is not drink too much (or any) alcohol.
Thank you. You are very helpful. It seems to contradict logic though that the prostate would get larger if testosterone increases. Because isn't it true that when we get older our testosterone levels decrease? If I assume that the prostate increases with more testosterone isn't it logical to assume that we have a lower chance of the prostate increasing in size as we get older, and a higher chance of the prostate increasing in size when we are young (as natural testosterone levels are higher)? This is not the case though (or is it); isn't it more likely for an older man to have an enlarged prostate than a young man? This is conflicting logic.
Because isn't it true that when we get older our testosterone levels decrease?- Yes, in most men, testosterone does decrease as you age.
If I assume that the prostate increases with more testosterone isn't it logical to assume that we have a lower chance of the prostate increasing in size as we get older, and a higher chance of the prostate increasing in size when we are young (as natural testosterone levels are higher)? - Prostate size is related to how much testosterone your prostate has been exposed to over your lifetime, not how much it sees at any given point in time. Therefore, if you pump more testosterone into your body when you are younger, this causes the prostate to grow more rapidly. In older men, even though testosterone levels may be lower, they are exposed to many more years of testosterone that allows the prostate to grow larger. Think of it like fertilizing a plant. Giving a plant tons of fertilizer at one point in time will make the plant grow quicker. But an older plant who has been exposed to years of fertilizer will be as large, if not larger than a young plant with lots of fertilizer.
This is not the case though (or is it); isn't it more likely for an older man to have an enlarged prostate than a young man?- See above explanation
This makes sense, thanks- sorry for all the questions. Does everyone have a certain "limit" (for lack of a better term) on the amount of testosterone their prostate can "handle" in a lifetime? I only took steroids for 6 months total (about(NNN) NNN-NNNNg per week during 3 different cycles). I know guys in the gym that have been taking testosterone "steroids" in these high doses for many years and don't complain about enlarged prostate or urination issues and they are my age or older. Do some men just have better tolerance or something? Also, if my natural testosterone levels were in the lower range of men my age, and I received "bio identical" testosterone cypionate from a doctor in a dosage that brought my testosterone levels closer to the upper range of the average man my age would that be dangerous and still enlarge my prostate faster (or does a small increase really not make a difference in prostate reaction)? Do these "bio-identical" hormones have a more negative effect on the prostate than our naturally occurring testosterone? Or should I try to lower my testosterone levels with the hormone therapy to stop the enlargement of a prostate (assuming that is my issue)? Can the size of the prostate be reduced or the process be reversed somehow?
This makes sense, thanks- sorry for all the questions. Does everyone have a certain "limit" (for lack of a better term) on the amount of testosterone their prostate can "handle" in a lifetime?- No, there is no limit.
Do some men just have better tolerance or something?- Some men's prostrate just do not grow that large regardless of how much testosterone they have.
Also, if my natural testosterone levels were in the lower range of men my age, and I received "bio identical" testosterone cypionate from a doctor in a dosage that brought my testosterone levels closer to the upper range of the average man my age would that be dangerous and still enlarge my prostate faster (or does a small increase really not make a difference in prostate reaction)?- A small increase is likely not going to make a difference, but I have some men who complain that they have worse urinary symptoms after starting testosterone.
Do these "bio-identical" hormones have a more negative effect on the prostate than our naturally occurring testosterone?- no
Or should I try to lower my testosterone levels with the hormone therapy to stop the enlargement of a prostate (assuming that is my issue)? This is not accomplished by lowering testosterone levels. It is done by blocking the conversion of testosterone to the active form that the prostate sees. This is done with medications like' Proscar or Avodart.
Can the size of the prostate be reduced or the process be reversed somehow? - Yes, Proscar and Avodart can shrink the prostate up to 50% in size.
Last questions, I promise! :-) Is it safe to take Proscar or Avodart while receiving testosterone therapy injections? Will it be counter-productive or will either one decrease the effectiveness of the other? Are these medications required to be taken for life? Would it make sense to take Proscar or Avodart BEFORE hormone therapy (again, assuming prostate is enlarged)? If the prostate shrank 50%, would it resume it's normal growth rate after that or would it grow back to it's large size faster than normal if you stop taking Avodart/Proscar? Thanks for all your patience, I will meet with my Urologist to get some tests before getting any testosterone therapy; I agree that is the right thing to do.
Is it safe to take Proscar or Avodart while receiving testosterone therapy injections?- Will it be counter-productive or will either one decrease the effectiveness of the other? That's a good question. There is no data out there that says this is a bad idea or is counter productive.
Are these medications required to be taken for life?- Yes
Would it make sense to take Proscar or Avodart BEFORE hormone therapy (again, assuming prostate is enlarged)? - Yes
If the prostate shrank 50%, would it resume it's normal growth rate after that or would it grow back to it's large size faster than normal if you stop taking Avodart/Proscar?- Yes, it would likely resume normal growth rate, but not any faster than normal.
Experience: Specializing in general urology and reconstructive urology