Ask The Urologist Anything (Dr Michael Rotman)

[Nelson Vergel]

Dr Michael Rotman is kindly offering to answer questions here on ExcelMale.com

I would like to open this thread to invite you guys to ask any urology related questions (prostatitis, prostate cancer, bladder issues, ED, TRT, etc).

So, ask away!

Rules for New Folder: Ask Doctors and Experts

 

[DrRotman]

Urological Issues involved in Hypogonadism and its treatment

Hi Guys,

I am always willing to answer any questions involved with TRT and it's urological implications. Will check back frequently answer all your questions. Thanks !

 

[sportsfan8724]

Hey doc was wondering if you feel there is a estradiol level that men shouldn't go over as far as prostate cancer goes?

 

[DrRotman]

Hey doc was wondering if you feel there is a estradiol level that men shouldn't go over as far as prostate cancer goes?

Please clarify. Are you saying if someone has prostate cancer and is on TRT , what level should they be below? Or are you asking if estradiol causes prostate cancer ?

 

[JakeH]

Dr. Rotman,

The general mood on most forums is that treating low T does not improve erections, while some doctors claim otherwise. What is your experience?

Also, have you seen a clinical significant resistance to PDE5 inhibitors occur that is not tied to the further decline of the underlying disease (e.g., endothelial disfunction from lipiids or diabetes)?

Jake

 

[sportsfan8724]

I'm saying a healthy male on trt? Where do you like to see their estradiol levels at? And do you use the sensitive estradiol test or standard?

 

[DrRotman]

Dear Jake,

Testosterone is one component of erectile function. There are many other factors some of which you touched upon. However , I have certainly seen improvement in erectile function in patient with low testosterone whom I have returned to a normal level.

Regarding your second question, I have not seen resistance to PDE-5 inhibitors when used properly and while one maintains good health and hormonal levels .

 

[DrRotman]

I try to use ultrasensitive estradiol and try to maintain a level within range. I rarely encounter very high levels when someone is using TRT appropriately. Likewise, low levels are not commonly seen in my practice with appropriate treatment. I do believe, as recent studies have shown, that a slightly high level is much more desired than a low level.

 

[sportsfan8724]

Thanks so I'm normally right at the top on the range on sensitive test now a then a few points over but not by much so I should be good. Do you like to see men on zinc and vitamin d while on trt? I've read articles saying zinc is both good and bad. I currently take life extension multi vitamin and it contains 30 mg zinc. Taking 5000 ius daily d3 with a fatty meal too. Just wanna make sure I'm on the right path with both those?

 

[DrRotman]

There is no consensus on zinc, like you said, I have seen views positive and negative. I am a big believer in vitamin D especially if you are subnormal. Sounds like you are doing things right and feeling well.

 

[sportsfan8724]

Greatly appreciate your answers! One last question. Any other supplements besides d3 that you recommend with trt to keep the body and prostate healthy? Or any health tips in general for a healthy prostate. Thanks again!

 

[DrRotman]

Lycopene has been shown to contribute to prostate health and is found in tomatoes. Certainly we know low fat diets, and avoiding bad habits such as smoking do lead to better prostate health. As a urologist, I do recommend PSA screening as well beginning at age 50 or earlier if you have family history of prostate cancer.

 

[brownwilliam1]

Hello Dr.Rotman.I have been on clomid (25mg/ED) for last 5 weeks and haven't noticed any difference.My level was 200.
I have been reading so many mixed reviews about the effectiveness of clomid.What do you think about the clomid for the treatment of low T?How long do you should i have to wait before i explore other options?

 

[sportsfan8724]

Thanks ! I'm definitely doing all of those👍🏻

 

[DrRotman]

Hi,

i would certainly have levels checked for T and Estradiol to see what the levels are now. If they are normal, you are one of those patients that has the paradoxical effect of Clomid; you obtain normal numbers and still do not feel better. I would speak to your prescribing physician and see what his plans are regarding your follow up. Take care.

 

[DrRotman]

You are very welcome.

 

[Leesto]

Welcome DrRotman.

I have seen speculation that trimix usage a few times a week for 3 to 6 months can be rehabilitative after a person has experienced many years of ED and no nocturnal or morning erections. I'm wondering if there is evidence of this or if it is just wishful thinking. My doctor (GP not a Urologist) also told me this but was not forthcoming about details.

 

[DrRotman]

I am not aware of any evidence based medicine to support that notion. We do know injections can cause scarring and lead to fibrosis in some patients makin the ED non responsive to any local therapy aside from surgical pump placement. There is some data on PRP injection and stem cell therapy injections for improving ED but those are still experimental treatments and are quite costly.

 

[Leesto]

I am not aware of any evidence based medicine to support that notion. We do know injections can cause scarring and lead to fibrosis in some patients makin the ED non responsive to any local therapy aside from surgical pump placement. There is some data on PRP injection and stem cell therapy injections for improving ED but those are still experimental treatments and are quite costly.

Thank you very much for taking the time to reply!

 

[MikeXL]

Dr Rotman
1- do you think DHT is a protagonist in PCa?
2- do you think estrogen is a protagonist in PCa?
3- what do you think is the reason as to why finasteride and dustasteride were associated with higher rates of Aggressive PCa in the trials ?