BPH - Enlarged Prostate After being on TRT

[Nashtide]

I have no explanation for the sudden, dramatic rise in my PSA. The dre was normal and my symptoms were mild. The urologist suggested it was probably acute prostatitis. He did not think it was a lab error. The cialis is the only thing I changed. I stayed on my TRT protocol. I didn’t think to ask why cialis worked, I just assumed it did. A biopsy was discussed but only if the PSA remained elevated. It was a slightly anxious time.

 

[Derrick]

So I have been on trt for over 2 years now and everything is going well except about 8 months after starting it till now I have had an enlarged prostate. i constantly have to urinate , I get up 3 plus times a night , i have a weak stream and I cant seem to hold it very long at all. My doctor has tried flomax and terazosin so far with no luck. I am going to go see a urologist but it is going to take 6-8 weeks to get in..... ALso I am only 31 years old...

HAs anyone else had this issue ? I had no issues with this before. All my have come back normal in the past , I am getting bloodwork done next week again.

I’m 47yrs old and have been on TRT since 2013 with no prostate issues at all. Every time I have my labs drawn my PSA is always within normal range even more so on the low side. I’m thinking that this could be due to the nettle root, saw palmetto, Pygeum Africanum and zinc concoction that I take regularly everyday or it could just be my diet.

 

[Jim98122x]

Called the doctor he is willing to prescribe it. Insurance does require a damn form as stated earlier by Orrin. So that will be filled out and sent it, could take 2 weeks for that to come back. Hopefully if approved i can get my script and start taking it. I am over having to get up 3 times a night and pissing constantly during the day. Since on TRT and getting my dose finally figured out everything is good except this issue and low libido.. But one issue at a time I guess.

i am hoping that this takes care of my issue though. Thanks for the input gentleman.

Go to PharmacyChecker.com and find a reputable Canada-based internet pharmacy and forget the stupid insurance company. You’ll get it cheaper paying out of pocket than your copay would be. You can buy Indian generics which work perfectly well (they’re not fakes) or you can buy made-in-Canada generics now too. I wasted months on my f***ing insurance company too before I started buying them through Canada. Always been 100% satisfied and never bought anything crap.

 

[chevrolet572]

Go to PharmacyChecker.com and find a reputable Canada-based internet pharmacy and forget the stupid insurance company. You’ll get it cheaper paying out of pocket than your copay would be. You can buy Indian generics which work perfectly well (they’re not fakes) or you can buy made-in-Canada generics now too. I wasted months on my f***ing insurance company too before I started buying them through Canada. Always been 100% satisfied and never bought anything crap.

Ill wait the two weeks. My copay is 15 bucks for 3 months. We will see if they approve or deny it. That may be the route for Arimidex though

 

[DragonBits]

I’m 47yrs old and have been on TRT since 2013 with no prostate issues at all. Every time I have my labs drawn my PSA is always within normal range even more so on the low side. I’m thinking that this could be due to the nettle root, saw palmetto, Pygeum Africanum and zinc concoction that I take regularly everyday or it could just be my diet.

Your concoction is on a lot of lists, I see most of those ingredients in lifeExtension's prostate formula and other NIH citations.

Though age is a huge factor in increasing PSA levels, I am nearly 20 years older than you.

Three other supplements that have merit.

Lycopene
Turmeric / Curcumin
Low dose aspirin

I have often seen the first two listed as good for inflammationm I was surprise to see aspirin listed as also good for prostate health.

 

[Starplex]

Fsa plan? Why do I need a compounding pharmacy for it also?

Flexible spending account. You pay $$ in before taxes off your paycheck and then you receive a reimbursement for elgible expenses. Beneficial for lowering your year end taxes if your plan offers it.

I don't trust buying from the overseas pharmacy's thus I use a local pharmacy. Because it is compounded locally it is cheaper than name brand Cialas. And it it is elgible for FSA.

However, if your insurance plan covers it this will likely be your best option.

 

[Butchmo]

The symptoms you describe could also be due to prostatitis (swelling and inflammation of the prostate) which is actually much more common in younger than older men (unlike BPH, which is more common in older men). It can be caused by a bacterial infection but sometimes the cause is never clear. There are long discussion boards at various forums about men who have had to deal with this. I had acute bacterial prostatitis. It came on fairly suddenly and involved generalized aches, low grade fever, and sudden onset of urinary tract symptoms (like the ones you described), but you can have the infection without fever or the other symptoms (the second time I had it I didn't have a fever or the aches and chills I had the first time). If due to an underlying bacterial infection, it requires extended treatment with antibiotics such as Bactrim. In my first experience with it, the urinary symptoms improved within 4 days but I had to stay on Bactrim for six weeks. The reason is that the prostate has tissues which are difficult for antibiotics to penetrate. It can become recurrent and even chronic, so a good diagnosis is needed. Sometimes antibiotics are given "empirically" which simply means "let's try it and see if they work". One good resource is an article at the American Association of Family Physicians - google "prostatitis American Association Family Physicians" and it should come up. Hope you find answers!

 

[chevrolet572]

Ok so my testosterone levels came back good but my estradiol is 50pg/ml on a scale of 20-47. Insurance company denied cialis, doing an appeal but they probably aren't going to care and approve im assuming.

Who is on an AI? What is your dose? Did you have issues like I'm having? Did it help relieve them? My doctor has not wanted to prescribe one in the past. Any suggestions on how to convince him? I have had no luck with 4 doctors he's been pretty good except this issue and it takes forever to get into any doctor.

Any suggestions or help. I'm all ears.

 

[cmg123]

Ok so my testosterone levels came back good but my estradiol is 50pg/ml on a scale of 20-47. Insurance company denied cialis, doing an appeal but they probably aren't going to care and approve im assuming.

Who is on an AI? What is your dose? Did you have issues like I'm having? Did it help relieve them? My doctor has not wanted to prescribe one in the past. Any suggestions on how to convince him? I have had no luck with 4 doctors he's been pretty good except this issue and it takes forever to get into any doctor.

Any suggestions or help. I'm all ears.

Get a prescription from your doctor. Use pricepropharmacy.com. It is a Canadian site that will ship you generic Cialis (Tadalifil) from India. You need a prescription or the pharmacy will not fill it for you. For your first order, they will call you to get a simple medical profile by asking you a few questions (current meds, allergies, etc). They will then have their pharmacists check the prescription before they fill it. After your first order you can then just have them fax a prescription refill to your doctor to be filled out. It takes about 3 weeks to get your meds in the mail. The meds are legit and work great. I take Adderall and a side effect was weak erections. The meds worked exactly as they stated. I take 10mg daily. My doc advised me that even if I stop taking Adderall he will continue to prescribe me Tadalifil to help with BPH even though I dont have it. I pay around $83 with shipping for a 90 day supply. I get 88 pills because for some reason that is the quantity they come in. They will send you a reminder when it is time to refill about 4 weeks out because it takes 3 weeks to get to you. When it is time to refill I just have them fax a prescription refill form to my doc and my doctor's office just fills it out and faxes it back. They have a chat option on their site that you can use to get updates on where your refill is at in the process. You also get a tracking number from USPS. I can tell you now that I am extremely happy with this Canadian pharmacy and their customer service is top notch. The drugs are legit and safe too. Just my suggestion to help you get your meds. I will eventually purchase Cialis in the US when it becomes generic. Good luck.

 

[Butchmo]

My suggestion is to get a good differential diagnosis for your condition from a competent doctor (rather than simply trying to diagnose yourself and treat yourself - see my previous post regarding possibility that your urinary symptoms could be due to something unrelated to homone issues - such as prostatitis). Having said that, your TRT concerns are certainly valid, and since you have a test result showing elevated estradiol, one approach to dealing with your current doctor is to ask them why they think this abnormal result should not be addressed. Your doctor may want to do a follow up test to confirm you actually have an abnormal result, which is not unreasonable since testing for blood levels of some hormones is not as accurate as some might imagine (do a search for "accuracy of estradio testing"). If you don't feel your doctor's answer is satisfactory, ask for a referral to an endocrinologist experienced in hormone replacement therapy.

 

[Butchmo]

I meant to add that my own experience with an estradiol level of 46 (in my case the lab's reference range for men was "less than 30") is that my GP prescribed anastrozole 1/4mg three times a week. I recently saw an endocrinologist who has experience in hormone replacement therapy, and he said to continue on that regimen, even though my estradiol is now a bit low on it. He said some of the concerns about low estrogen is men are, in his opinion, not well supported by evidence, while the concerns about the effects of elevated estrogen in men are well supported.

 

[Nashtide]

I meant to add that my own experience with an estradiol level of 46 (in my case the lab's reference range for men was "less than 30") is that my GP prescribed anastrozole 1/4mg three times a week. I recently saw an endocrinologist who has experience in hormone replacement therapy, and he said to continue on that regimen, even though my estradiol is now a bit low on it. He said some of the concerns about low estrogen is men are, in his opinion, not well supported by evidence, while the concerns about the effects of elevated estrogen in men are well supported.

Now you’ve gone and done it! The forum is going to be very unhappy with you. You might want to hurry and get into your flame suit.

 

[DragonBits]

Metformin Restricts Spread Of Benign Prostatic Epithelial Cells- Dr. David Samadi
March 8, 2017
NEW YORK, NEW YORK (PRWEB) MARCH 08, 2017

A recent study published in the online publication of PLoS One found that the diabetes drug metformin controls the spread of benign prostatic epithelial cells by suppressing the expression of IGF-1R and IGF-1 secretion. This finding could have significant clinical implications in managing patients with benign prostatic hyperplasia (BPH) with the drug metformin.

Metformin is an oral diabetes medication that helps control blood sugar levels in people with type 2 diabetes. BPH is the most common condition affecting the prostate gland and is common in older men. About half of all men between the ages of 51 and 60 have BPH with up to 90% of all men over the age of 80 having it. BPH is a non-cancerous enlargement of the prostate gland that can press down on the urethra and is associated with issues such as inability to completely empty the bladder, dribbling, or frequent nighttime urination. Even though BPH is not cancer, BPH and prostate cancer can occur at the same time.

“It has been known for a while that there is a link between men with elevated insulin levels and having a greater likelihood of BPH,” said Dr. David Samadi. “We know that insulin resistance can affect the growth and regulation of gene expression and BPH. The reason for the association between hyperinsulinemia and BPH involves two insulin-like growth factors, IGF-1 and IGF-2.”

In this current study, it has been shown through previous studies that diabetes significantly increases a man’s risk of developing BPH. But it was not known whether anti-diabetic medications were useful in preventing this development. From past studies, it had been found that stromally expressed IGF-1 promoted benign prostatic epithelial cells to proliferate.

...“This study found that when metformin was used for 24 hours it lowered the G2/M cell population by 43.24% in P69 and 24.22% in BPH-1 cells. What was also interesting that was found was that IGF-1 increased the number of G2/M cells in P69 cells and in BPH-1 cells thus enhancing IGF-1 in benign prostatic epithelial cells,” explained Dr. Samadi. “But the important thing is that metformin stopped the spread of the cells by inhibiting IGF-1.” ...

Metformin Restricts Spread Of Benign Prostatic Epithelial Cells- Dr. David Samadi

I have read that metformin can reduce PSA levels by 8-35% or an average of 34% in diabetic men, and metformin reduced PSA independently of being a diabetic.

(I don't believe metformin is well studied in men without diabetes. )

 

[Butchmo]

Now you’ve gone and done it! The forum is going to be very unhappy with you. You might want to hurry and get into your flame suit.

Nobody was flamed, so I don't need a flame suit.

 

[Nelson Vergel]

Now you’ve gone and done it! The forum is going to be very unhappy with you. You might want to hurry and get into your flame suit.

Sometimes I wonder what purpose it serves for you to always be cynical about this forum and estradiol comments.

 

[Pauly_P]

My suggestion is to get a good differential diagnosis for your condition from a competent doctor (rather than simply trying to diagnose yourself and treat yourself - see my previous post regarding possibility that your urinary symptoms could be due to something unrelated to homone issues - such as prostatitis). Having said that, your TRT concerns are certainly valid, and since you have a test result showing elevated estradiol, one approach to dealing with your current doctor is to ask them why they think this abnormal result should not be addressed. Your doctor may want to do a follow up test to confirm you actually have an abnormal result, which is not unreasonable since testing for blood 'levels of some hormones is not as accurate as some might imagine (do a search for "accuracy of estradio testing"). If you don't feel your doctor's answer is satisfactory, ask for a referral to an endocrinologist experienced in hormone replacement therapy.

My first thought was mild prostatitis as well. Glad you brought it up. I've had both mild and severe versions of this issue. I'm now off everything except Cialis and Metformin. My urine flow still stinks, but I never liked the side effects of Flomax. Good luck solving your issue! I'm going to look into focal laser ablation at some point.

 

[Nashtide]

Sometimes I wonder what purpose it serves for you to always be cynical about this forum and estradiol comments.

I think this forum is terrific. The overwhelming negative feelings towards the use of an AI is not based in science and may turn out to be terrible advice. Only time will tell. We now live in a culture where any form of disagreement is taken personally. I say this every time someone jumps on me for suggesting that anastrazole was not created by the devil to kill men that not even the experts know the consequences of either long term AI use or long term elevated estrogen.

 

[DragonBits]

I think this forum is terrific. The overwhelming negative feelings towards the use of an AI is not based in science and may turn out to be terrible advice. Only time will tell. We now live in a culture where any form of disagreement is taken personally. I say this every time someone jumps on me for suggesting that cwas not created by the devil to kill men that not even the experts know the consequences of either long term AI use or long term elevated estrogen.

I agree with you that any disagreement in our culture is taken personally. It's not popular to be neutral about any subject, it's seen as being wishy washy and doesn't provoke a response.

I am not sure you are being neutral either with your assumption the forum is going to be very unhappy with anyone that uses anastrazole.

But I object to the cookie cutter approach that I have seen from every doctor / clinic I have ever visited. As in, take x amount off testosterone, 0.125 X anastrazole three times a week, Vitamin D, DHEA, Fish oil.

Who is to say in advance I need an AI? IMO there is an over prescription of AI's based on assumptions. That is not to say that an AI isn't a useful tool when E2 is too high. But I know I really have to get my Total T way above range before my E2 is above range. So I wouldn't take an AI unless I planned to have TT at least 1200-1300 ng/dl.

Different doctors will give different advice, but it all tends to be cookie cutter type of recommendations, mostly based on what sort of hammer they are involved with or their personal "individual" experience with a problem then assuming most people must be the same as their personal experience. They seldom ask their patients or explain the various other options.

For instance, for the same condition, an urologist would most likely suggest not getting on TRT, and it could affect the prostate, they are more concerned with that than other aspects of health. A psychiatrist will tend to promote SSRI, while a T clinic will promote Testosterone + an AI, while a few T clinics / doctors will say high E2 levels don't matter. All for the same condition. They can't all be right.

 

[Nashtide]

I agree with you that any disagreement in our culture is taken personally. It's not popular to be neutral about any subject, it's seen as being wishy washy and doesn't provoke a response.

I am not sure you are being neutral either with your assumption the forum is going to be very unhappy with anyone that uses anastrazole.

But I object to the cookie cutter approach that I have seen from every doctor / clinic I have ever visited. As in, take x amount off testosterone, 0.125 X anastrazole three times a week, Vitamin D, DHEA, Fish oil.

Who is to say in advance I need an AI? IMO there is an over prescription of AI's based on assumptions. That is not to say that an AI isn't a useful tool when E2 is too high. But I know I really have to get my Total T way above range before my E2 is above range. So I wouldn't take an AI unless I planned to have TT at least 1200-1300 ng/dl.

Different doctors will give different advice, but it all tends to be cookie cutter type of recommendations, mostly based on what sort of hammer they are involved with or their personal "individual" experience with a problem then assuming most people must be the same as their personal experience. They seldom ask their patients or explain the various other options.

For instance, for the same condition, an urologist would most likely suggest not getting on TRT, and it could affect the prostate, they are more concerned with that than other aspects of health. A psychiatrist will tend to promote SSRI, while a T clinic will promote Testosterone + an AI, while a few T clinics / doctors will say high E2 levels don't matter. All for the same condition. They can't all be right.

Dragon, my point of view regarding the use of an AI is neutral. My entire beef with 90% of guys on here is that they demonize anastrazole because they had a bad experience based on a terrible protocol or they believe you only need an AI if you are having symptoms. I say again, neither of those reasons are scientific or proven. So, I’m not sure someone with such bias should hand out advice like it’s gospel. I don’t care if a new member takes an AI or not, I just want them to know it’s a good option if necessary. A crap ton of guys on TRT use anastrazole every week and aren’t on this forum because guys doing great don’t seek out forums. My doc has a large number of guys on TRT. He is on TRT himself and most of his patients are taking anastrazole. This doesn’t prove anything, but the reality is there’s lots of guys on TRT and an AI so the combination can’t be as bad as it’s portrayed on this site.

 

[DragonBits]

Dragon, my point of view regarding the use of an AI is neutral. My entire beef with 90% of guys on here is that they demonize anastrazole because they had a bad experience based on a terrible protocol or they believe you only need an AI if you are having symptoms. I say again, neither of those reasons are scientific or proven. So, I’m not sure someone with such bias should hand out advice like it’s gospel. I don’t care if a new member takes an AI or not, I just want them to know it’s a good option if necessary. A crap ton of guys on TRT use anastrazole every week and aren’t on this forum because guys doing great don’t seek out forums. My doc has a large number of guys on TRT. He is on TRT himself and most of his patients are taking anastrazole. This doesn’t prove anything, but the reality is there’s lots of guys on TRT and an AI so the combination can’t be as bad as it’s portrayed on this site.

I have wondered about the fact that I had very low E2 (unmeasurable) when I was low on TT.

I didn't feel anything outside of the effects of low testosterone.

Maybe the low E affected my bone density, maybe it affected tendon health, but hard to prove. I have had some minor tendon sensitivity / tendinopathy, but hard to say it's related to low E or just age/overuse/overstain. No doubt repetitive strain on knee, groin, elbow, shoulder, foot tendons caused the problems, but was I more prone to this because of my low E2?

I say minor tendinosis because I can work around the problem and usually in 6 months or so it goes away.