Ask The Urologist Anything (Dr Michael Rotman)

[Nelson Vergel]

I will find out more from a urology work up. I learned a lot by watching this video:

 

[DrRotman]

They help somewhat when a diagnosis of I.C. has been made. IC is not that common in men and your symptoms aren’t the typical IC presentation.

 

[Paulyhotsauce]

Hi! New member to the forum, long time reader. I have been on my trt journey since April. Had lots of ups and downs, mainly downs.
I'm at the point where I feel I am almost dialed in.
Question is: my ball sack usually is very high and tight except the first 1-2 days after my weekly injection of 200mg. After that it's right and doesn't hang.

Is it mainly due to estrogen or testosterone levels?

Thanks!

 

[JT]

Hello Dr Rotman

I seem to have all the symptoms of Interstitial CystitisLower abdominal pain and referred pain down to my lower back and anus. Third occurrence. Previous two seemed to have responded to minocycline bid for 14 days.

I have retrograde ejaculation caused by a green laser procedure to remove calcium deposits from my urethra over 10 years ago. Can that be causing this issue?

I do not have urgency to urinate but I am now getting up once per night to pee. I void reasonably well. No pain while urinating or having an orgasm. No fever.

The main complaint is the abdominal (and lower back) pain that feels like my IBS has flared up (or at least what I used to think was IBS).

I am going for an urology work-up but wanted to pick your brain first. Thank you.

Nelson and Dr. Rotman, sorry I am a little late to this conversation about the prostate and ICS along with urinary frequency, but I am curious, is it abnormal to need to urinate once a night? From what I have read this is fairly common, but maybe that is incorrect? If your sleep is disrupted just once a night with the need to urinate is that a sign to have something checked out, or would that have to be occurring more often to be a concern?

 

[CoastWatcher]

Nelson and Dr. Rotman, sorry I am a little late to this conversation about the prostate and ICS along with urinary frequency, but I am curious, is it abnormal to need to urinate once a night? From what I have read this is fairly common, but maybe that is incorrect? If your sleep is disrupted just once a night with the need to urinate is that a sign to have something checked out, or would that have to be occurring more often to be a concern?

It would be of help if you mentioned your age.

 

[DrRotman]

That’s interesting , as it should be tighter after a high dose injection of testosterone in the first few days not looser. It could be the way your body metabolizes the testosterone. Try injecting half the dose every 3.5 days and see if that improves your situation.

Hi! New member to the forum, long time reader. I have been on my trt journey since April. Had lots of ups and downs, mainly downs.
I'm at the point where I feel I am almost dialed in.
Question is: my ball sack usually is very high and tight except the first 1-2 days after my weekly injection of 200mg. After that it's right and doesn't hang.

Is it mainly due to estrogen or testosterone levels?

Thanks!

 

[Tom Larabee]

Hi Dr Rotman,

I have a left testicle Variocele that I have had most of my adult life. After recent Emergency Gall Bladder removal surgery (3 weeks ago,) it now is painful during ejaculation. I have had it looked at before and all of the urologists say since it doesn't hurt leave it alone. So I guess I am wondering your thoughts on why now it hurts when it didn't before and whether you think I should get it looked at again.

Tom

 

[DrRotman]

I would definitely have your scrotum examined again and see if it is related your ejaculatory dysfunction. It may not be related to the varicocele. Good luck!

Hi Dr Rotman,

I have a left testicle Variocele that I have had most of my adult life. After recent Emergency Gall Bladder removal surgery (3 weeks ago,) it now is painful during ejaculation. I have had it looked at before and all of the urologists say since it doesn't hurt leave it alone. So I guess I am wondering your thoughts on why now it hurts when it didn't before and whether you think I should get it looked at again.

Tom

 

[Tom Larabee]

I would definitely have your scrotum examined again and see if it is related your ejaculatory dysfunction. It may not be related to the varicocele. Good luck!

Thanks Doc, I have an appointment with Urology in early October to review.

 

[KennyT]

My question is kind of long and drawn out but ill be brief as I can. I have low T. I was tested September ish of last year and total T was 184. I was put on Clomid to start with. Total T went up to 216 after 1 month This was October. I then was told Clomid was not the answer and was switched to testosterone cypionate 200 Mg / ML . I use 75 ML .75 ML=150 MG one time per week. I also take Anastrozole 1 MG tablets. 5 MG/ ½ tablet 3 times aweek, Mon/ Wed/ Fri My total T went up to 731 by December. ( I was feeling great). He also has me on HCG at 500IU 3 times a week to keep my buddies happy, But whey where way smaller and like mush. At witch he upped my HCG to 750IU 3 times a week. Last blood test was in February for my march appointment. Total T was 580 and feeling a bit down.
Ok. My question is. I'm having blood drawn for my 6 month checkup. If it is 580 or lower, Am I justified in asking for the T dosage to be increased? I always have more in the vial than I use each month and I'm just using it when my next batch arrives in the mail instead of opening a new vial. I have a full shot and some of the next left. I just run out of syringes and needles. I think it would pretty much add up to 1 ml per injection without having to ask for more vials per month. Side question is why would total T go down over time anyway? Nothing has changed with injections.
Long question. Thanks in advance
Kenny_T

 

[DrRotman]

Hi Kenny,

Those HCG doses are very high and those anastrozole levels are very high as well. Something is not making sense honestly, posting all your labs in some form with your identity hidden may help.

My question is kind of long and drawn out but ill be brief as I can. I have low T. I was tested September ish of last year and total T was 184. I was put on Clomid to start with. Total T went up to 216 after 1 month This was October. I then was told Clomid was not the answer and was switched to testosterone cypionate 200 Mg / ML . I use 75 ML .75 ML=150 MG one time per week. I also take Anastrozole 1 MG tablets. 5 MG/ ½ tablet 3 times aweek, Mon/ Wed/ Fri My total T went up to 731 by December. ( I was feeling great). He also has me on HCG at 500IU 3 times a week to keep my buddies happy, But whey where way smaller and like mush. At witch he upped my HCG to 750IU 3 times a week. Last blood test was in February for my march appointment. Total T was 580 and feeling a bit down.
Ok. My question is. I'm having blood drawn for my 6 month checkup. If it is 580 or lower, Am I justified in asking for the T dosage to be increased? I always have more in the vial than I use each month and I'm just using it when my next batch arrives in the mail instead of opening a new vial. I have a full shot and some of the next left. I just run out of syringes and needles. I think it would pretty much add up to 1 ml per injection without having to ask for more vials per month. Side question is why would total T go down over time anyway? Nothing has changed with injections.
Long question. Thanks in advance
Kenny_T

 

[KennyT]

Just had blood work done on friday. I will post it as soon as I get it back.

Thanks

 

[Checkdis]

Hello Dr. Rotman,

I am currently a patient of yours, funny to find you on the forums. I just wanted to let you know I am still taking Clomid as directed. I have blood work coming up soon, hopefully shows signs of my hormones stabilizing. I do experience frequent urination still, but it seems to be slowing down. Although yesterday I had a episode and the urination increased. The urination is the only thing I really want to fix. Everything else like libido, ed, energy is not really an issue for me.

I have been hearing my crashed estrogen is the culprit of my symptoms. If my estradiol doesn't increase next time I see you should we try HCG instead? I wouldn't mind the injections, just hope my insurance covers the cost, which it did surprisingly for the Clomid.

https://www.excelmale.com/forum/showthread.php?11965-Question-Frequent-Urination-Hypogonadism-%28crashed-E2%29

 

[Nelson Vergel]

In my case, increased urination (or at least feeling like you have to pee more frequently) happens when my bladder gets irritated or inflamed after eating spicy foods or alcohol. It is something I learned just recently after going to a local urologist (Dr Khera).

 

[Checkdis]

Yeah I agree, unfortunately since this has happened I cut out all caffeine, alcohol, spicy food, certain fruits religiously.

I have been battling this since April.

 

[Nelson Vergel]

I was given Meloxicam (an anti-inflammatory) and about to start pelvic floor therapy.

If you are getting up only one time per night to pee, you do not have an issue.

Some patients are prescribed Vesicare for overactive bladder.

 

[Checkdis]

I was given Meloxicam (an anti-inflammatory) and about to start pelvic floor therapy.

If you are getting up only one time per night to pee, you do not have an issue.

Some patients are prescribed Vesicare for overactive bladder.

Yes that is what I was diagnosed with, OAB. Luckily it is one time at night. The worst is when I wake up everyday at 5:30am to 3pm. I seems to go every 30min-1 hour. And after 3pm I am fine? Also I wake up with chills sometimes it is crazy.

I am just worried with Vesicare. 5mg is manageable and expensive, but 10mg I have heard bad things. Also I have hemerroids which hurt sometimes. If Vesicare backs me up I will be in a world of hurt.

 

[sportsfan8724]

Hi Dr. Rotman what ferritin levels do you think are ideal. Hearing this can be big for cancer prevention if they are optimized.

 

[pm3405]

First time to ask a question, long time reader. Thanks for educating me and all others in this group Dr. Rotman. Since having a prostatectomy back in 2013, I've been using penile injections for ED successfully. I've tried various Trimix formulas and Bimix and Super Bimix. Regular strength Trimix, (PG 20 or even 10mcg would cause pain). I tried Super Bimix, (from another compounder, (Papav/Phento/Forskolin-150mg/10mg/500mcg), and it was pretty good although not as consistent as Trimix. Lastly I Tried a "Trimix #1" formula from Imprimis, another compounder, (Papav/Phento/PG-10mg/0.5mg/5mcg), prepared in 0.5ml vials. This formula causes me hardly any pain and is practical because I mixed the small vials myself and I could travel w/o having to worry about refrigeration. Unfortunately, they can no longer ship to Texas. Do you or anyone in the group know of any compounder making the same product?

 

[ajamesmiller35]

Dr. Rotman:

Have you (or anyone else on this forum) heard of Clomid causing prostate problems? I am 27 years old and am taking 25 mg every day for infertility. It has drastically raised my testosterone (from 107 to about 670 last time we checked) and has drastically improved my fertility.

However, a few months after beginning the Clomid, I began having pain in one of my testicles. I went to a local PA, and was diagnosed with epididymitis. No labs of any kind were done, only a physical exam, but I was prescribed Levaquin 500 mg once daily for 10 days. The pain got worse for several days, and then I noticed my prostate began hurting. At this time I also felt a constant need to urinate, and pain in my urethra. I called the PA and said I wasn't feeling better and she extended the course of Levaquin to 14 days. After finishing my course of antibiotics, I still didn't feel better. I went back to the PA, and a PSA, Chlamydia and Gonorrhea test, UA, and scrotal ultrasound were done. They all came back normal. The PA suggested she thought it might be from the Clomid, because she couldn't find any sign of infection. I was then referred to my urologist.

I started feeling slowly better however and my urologist is a 3 hour drive away, so I didn't go see him right away. However, I have continued to have symptoms on and off for the last 4 months including testicle pain, prostate pain, and urethra pain. About 3 weeks ago, the pain in my prostate got significantly worse so I scheduled an appointment with my urologist. I have also been having a very weak stream of urine, and it is hard to finish urinating. I have never had any discharge, visible signs of inflammation, or pain with sex or ejaculation.

After going to see the urologist, the only test they did was a simple UA. He took a quick look at my testicles, but did not do a prostate exam. He said he thought it was prostatitis that wasn't properly treated by the first round of antibiotics, because prostate infections take longer to treat, and put me on Bactrim DS twice daily for 30 days. He said he had never heard of Clomid causing prostatitis. Its been about a week and a half on Bactrim so far, and I feel just as bad as when it started. I have been avoiding drinking water lately, because I feel like I have to go to the bathroom almost constantly. It seems like the more I have to urinate the more irritated everything gets.

I talked to my wife's doctor (not in the scope of an appointment) and she also thought it could be from Clomid. She said she couldn't find any mention of this in the literature, but theoretically anything that increases your testosterone too much could cause your prostate to swell. I haven't had a testosterone test done since before this began. Is there any possible link, or does this just sound like an infection? I have felt like I have had an overactive bladder and difficulty finishing urinating my whole life, but it is a lot worse now. Could this be related?

Please help!