Ask The Urologist Anything (Dr Michael Rotman)

[DrRotman]

Similar to other reflex tests. Like 4K

I don’t know personally if anyone uses this test.

Honestly, total, free and PSA density + MRI are pretty useful and helpful!

 

[Vince]

Dr. R, are there any labs that you run to measure a person's nitric oxide levels.

 

[DrRotman]

Honestly I’m not familiar of any validated labs. What specific test are you speaking of?

 

[Vince]

Honestly I'm not familiar of any validated labs. What specific test are you speaking of?

ADMA blood test, I was just wondering if doctor's use this test for checking nitric oxide levels.

 

[Vince]

ADMA blood test, I was just wondering if doctor's use this test for checking nitric oxide levels.

Last year when I stop my NO stack for 3 months , my ADMA levels we're too high out of range. It was recommended that I should start my stack again and my levels went back into a good range.

 

[Nashtide]

Hey Doc. thanks for doing this. I'm 56. On TRT 2+ years. Recent PSA was 4.4. All previous levels were less than 1. I am having symptoms of bph but family doctor didn't find enlarged prostate on dre. Referred to a urologist. Any help on questions I should ask. I'd love to avoid a biopsy if it's at all possible.

 

[looyvillelarry]

Dr Rotman,

This post is concerning the use of Phenyleferine .1% injections, to counter priaprism from use of penile injections of trimix/bimix. I've suffered 3 this year, so have a prescription for it, however, I think the directions may be wrong.

Several members have discussed in this thread

Many times, including my script, call for "inject 1ml every 3-5 min, until detumescence, or 1 hour max" . The amount seems like a LOT. I can't imagine injecting up to 12ml into a priaprism, I believe, these are the instructions for flushing AFTER an aspiration.

Can you provide clarification on what amounts would be used prior to an aspiration at an ER ?

Note: I would think of this as last step before going to an ER.

 

[DrRotman]

Yes you have the incorrect doses. You need to speak your local urologist to further clarify as I don’t send patients with prescriptions for this medication.

 

[Pauly_P]

Hi Dr. Rotman, what are your thoughts, and how do you council your patients who are on TRT and are diagnosed with low grade PCa, and would be eligible for active surveillance. Dr. Morgentaler stated in his book that he does allow some patients to continue TRT, and presents some studies that he says basically debunks the entire argument that testosterone is like throwing gas on the fire of PCa.
Thanks in advance!

 

[DrRotman]

This is a rare situation. I would likely recommend patient receive treatment first prior to resuming TRT. That being said, if a patient insists on staying on TRT while on active surveillance, I may consider it if patient is aware of the risks. Each situation needs to be considered individually.

 

[atlien2488]

Dr. Rotman,

What is your opinion on HCG protocol? My doctor is going to have me cycling a month on a month off and I'm not sure whether I should try to stay on it indefinitely or do the cycling. I heard you can desensitize leydig cells by always staying on...

 

[DrRotman]

I have not seen any signs of densensitization. I don't thing cycling is necessary

 

[steve-wv]

Dr. Rotman, I was on SSRI for 16 yrs. due to about 5 anxiety attacks,I would go to Dr, PCP, he would ask me how I felt and they would renew my prescription.I regret not asking to discontinue, but I was unaware of the side effects.It was before Google. I slowly weaned and discontinued them. About 3 months post SSRI i started experiencing weak erection,numbness, db premature Ejaculation, none of which I had while taking the medication or before. I have since read that it is called PSSD, or Post SSRI Sexual Dysfunction. It has been 4 yrs since I discontinued and I still suffer from this. It has been very hard to deal with to say the least. I have tried to reinstate the medicine for 3 months but no luck. I now take 5 mg Cialis daily, and Trimix at times to combat the situation. I've been to several docs and they discount my claims that it is from the medicine. None of them believe that the SSRI's can do this. I have read that this can be permanent. Have you ever has a patient with this same situation? Is there any thing I could do to help change the situation? Just getting rid of the PE would be a win at this point, Thanks..

 

[atlien2488]

Ssris contributed to messing me up too man.....i think it just takes a massive amount of time unless you go the hormonal route

 

[Ritchie225]

hi I am a 38 year old male who has recently been learning a lot about trt
over the last few years I have been experiencing symptoms of low t.
just a about every one in fact
10 years ago I used to lift heavy and was 17 stone
as years gone one my muscle has decreased
my weifgt dropped and fat built up I know when you're apprcohing 40 it harder but lately even getting out of bed has been a struggle
I've no energy my knees and back ache
I see hair in bottom of bath I'm moody with the wife and and no energy or drive
I got tested at docs vit d thyroid bloo sugar
everything was fine but no test for T
I know in uk it's very hard to get diagnosed
fast forward 3 weeks I'm on test e around 0.75mg p/w 140mg ish
I feel like a new man
I'm full of energy no joint aches I can go bk yo gym all the symptoms gone evey one of em
I know I'm gonna go catabolic if and when i decide to come off. I thought long and hard
I've got 2 kids so fertlilty ain't a problem
it's made such a differnce to me that I forgot what's it's like to feel normal
I just want to know without seeing a urologist if I decide to come off after a few months on s low dose am I better using hcg and or clomid as I do not want my body to crash as I went though that 20 years ago after a steroid cycle (which I haven't done since) I don't understand why I would need serm with no side effects
I know hcg is controversial I just want to know what's best to take pct or should I just say hell and stay on trt. many advice would be great thanks

 

[DrRotman]

Hi, ill be honest, the pictured above does not tell the whole story. You need your levels evaluated, possibly semen analysis if future fertility is at all a concern, and a visit to your local hormone specialist. Using unverified products from a gym setting makes it difficult to figure out what you actually received and how toxic it may have been.

 

[phxdiver]

Dr Rotman,

Thanks for taking the time to answer our questions. I was a 2 year TRT patient (stopped 1 year ago). The last 3 labs I had drawn prior to stopping treatment (the final 6mths or so) showed a significant increase in total T even with reduced dosages, as follows:

150ml 1x/wk - 850 Total Testosterone Serum
120ml 1x/wk - 900 Total T
100ml 1x/wk - 1182 Total T

During this timeframe I was also receiving 250ml HCG 1x/wk and taking an AI (Anastrozole) of 0.25mg anywhere from 1-3x/wk.

My provider didn't/couldn't explain this paradox of rising T and jokingly suggested maybe I didn't need TRT (hence my decision to stop treatments due to partly agreeing with them as well as my perceived poor standard of care from them in only being concerned with the #'s).

Having been off TRT for a year now (cold turkey) and reconsidering TRT again, could you please provide any thoughts/insights into what perhaps was happening with me during my last treatment? My hopes are to be better informed if/when I re-start therapy, as the provider I had seen was seemingly not well informed on TRT therapies.

Thanks in advance for your help!
CM

 

[DrRotman]

Dr Rotman,

Thanks for taking the time to answer our questions. I was a 2 year TRT patient (stopped 1 year ago). The last 3 labs I had drawn prior to stopping treatment (the final 6mths or so) showed a significant increase in total T even with reduced dosages, as follows:

150ml 1x/wk - 850 Total Testosterone Serum
120ml 1x/wk - 900 Total T
100ml 1x/wk - 1182 Total T

During this timeframe I was also receiving 250ml HCG 1x/wk and taking an AI (Anastrozole) of 0.25mg anywhere from 1-3x/wk.

My provider didn't/couldn't explain this paradox of rising T and jokingly suggested maybe I didn't need TRT (hence my decision to stop treatments due to partly agreeing with them as well as my perceived poor standard of care from them in only being concerned with the #'s).

Having been off TRT for a year now (cold turkey) and reconsidering TRT again, could you please provide any thoughts/insights into what perhaps was happening with me during my last treatment? My hopes are to be better informed if/when I re-start therapy, as the provider I had seen was seemingly not well informed on TRT therapies.

Thanks in advance for your help!
CM

Honestly, testosterone values vary so much depending on time of day, stress levels, levels of absorption, that nobody could answer this question properly. It certainly isnt the norm but not unheard of.

 

[phxdiver]

Thanks Dr.

 

[Alex78]

Dr Rotman,

I recently discontinued my testosterone to focus on fertility and possibly having another child, but I have experienced terrible allergies since coming off which is consistent with how I felt the last time I stopped using testosterone. I did get Prednisone script from my Dr. which helped while I was taking it, but it wore off and now I back to feeling miserable.

Do you think there is any correlation between no/low testosterone and the terrible allergies I am experiencing?