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Urology (Expert Forum)
Severe/Chronic Prostatitis and Testosterone
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Severe/Chronic Prostatitis and Testosterone
by LRS337, Jul 26, 2004 12:00AM
I have a couple problems. Also related to male hormones so has already created anxiety problems which creates more anxiety. I am 53 & have had a "sensitive" prostate for years. Numerous things would cause it to flare up - spicy foods, too much drinking (quit a couple years ago), OTC sinus meds. Usually the symptoms faded in a few days to 2 weeks. One other time antibiotic treatment had become necessary several years ago (only about 2 weeks).
Therefore wasn't overly concerned when some minimal symptoms developed several months ago. Around mid June symptoms escalated. I saw regular Dr 6/23/04 & symptoms were very strong / full-time. No blood work done at that time, only a urine sample given. Scheduled for blood work the next week. Plus he felt that there were indicators of low testosterone (moody, anxiety, low self-esteem, fatigue, bodyfat gain, no libido, etc).
On the afternoon of 7/1/ ended up in ER as my symptoms had increased to the point where I was agony & having recurring hot flushes & chills. At the ER they did blood work, x-rays, etc., and diagnosed as "severe prostatitis". The ER doctor prescribed Bactrim. The ER doctor said not to worry about the erectile dysfunction and loss of libido, that it would "correct itself" when the prostatitis cleared up. Been on the Bactrim 7/1/04. My Dr on 7/13/04 renewed the prescription for Bactrim, and concurred with being "severe prostatitis" and that it "might take six weeks to clear up". My Dr also did a DRE and said that the prostate "didn't seem that bad". I have been on the Bactrim for 4 weeks but other than the immediate relief from the severe pain there hasn’t been significant relief (some days better, some days worse). Main concern with the prostatitis is simply this: Is there anything else that I can be doing?
Also am concerned that the whole prostatitis problem is tied in with this: The blood tests confirmed "low total serum testosterone". Had asked Dr to do a full hormone work-up, he declined to have other male hormone related tests done (i.e., testostrerone-estrogen ratios, DHT levels, etc). Just had the basic blood work up done: blood sugar levels - "glucose imbalance" with "somewhat of a low blood sugar level", PSA levels - which must have been okay as he didn't comment on them, cholesterol levels - which he said were actually pretty good, etc. Based upon blood test showing the low "total testosterone" levels, he prescribed "AndroGel" - only been taking it for 2 weeks now so I haven't really noticed any real effect. Overall, I would say that this is a good thing that I received the testosterone replacement as I believe that my testosterone levels HAVE been declining.
My other concern is that we are dealing with 1 problem (low test levels) and possibly making the prostate problem worse?
Therefore wasn't overly concerned when some minimal symptoms developed several months ago. Around mid June symptoms escalated. I saw regular Dr 6/23/04 & symptoms were very strong / full-time. No blood work done at that time, only a urine sample given. Scheduled for blood work the next week. Plus he felt that there were indicators of low testosterone (moody, anxiety, low self-esteem, fatigue, bodyfat gain, no libido, etc).
On the afternoon of 7/1/ ended up in ER as my symptoms had increased to the point where I was agony & having recurring hot flushes & chills. At the ER they did blood work, x-rays, etc., and diagnosed as "severe prostatitis". The ER doctor prescribed Bactrim. The ER doctor said not to worry about the erectile dysfunction and loss of libido, that it would "correct itself" when the prostatitis cleared up. Been on the Bactrim 7/1/04. My Dr on 7/13/04 renewed the prescription for Bactrim, and concurred with being "severe prostatitis" and that it "might take six weeks to clear up". My Dr also did a DRE and said that the prostate "didn't seem that bad". I have been on the Bactrim for 4 weeks but other than the immediate relief from the severe pain there hasn’t been significant relief (some days better, some days worse). Main concern with the prostatitis is simply this: Is there anything else that I can be doing?
Also am concerned that the whole prostatitis problem is tied in with this: The blood tests confirmed "low total serum testosterone". Had asked Dr to do a full hormone work-up, he declined to have other male hormone related tests done (i.e., testostrerone-estrogen ratios, DHT levels, etc). Just had the basic blood work up done: blood sugar levels - "glucose imbalance" with "somewhat of a low blood sugar level", PSA levels - which must have been okay as he didn't comment on them, cholesterol levels - which he said were actually pretty good, etc. Based upon blood test showing the low "total testosterone" levels, he prescribed "AndroGel" - only been taking it for 2 weeks now so I haven't really noticed any real effect. Overall, I would say that this is a good thing that I received the testosterone replacement as I believe that my testosterone levels HAVE been declining.
My other concern is that we are dealing with 1 problem (low test levels) and possibly making the prostate problem worse?
Doctor's Answer
by Kevin Pho, MD, Jul 30, 2004 12:00AM
, Jul 30, 2004 12:00AM
Although possible, I am not aware of a connection between the low testosterone levels and the chronic prostatitis. A couple of points. Your physician is correct in saying that sometimes chronic prostatitis may take 4-12 weeks of treatment.
In terms of further workup for the low testosterone, it was not unreasonable to start Androgel after a total testosterone levels. No further specialized testing is needed in most cases. It may take more than 2 weeks to notice an appreciable difference. You may want to repeat the testosterone levels to ensure the dose of the Androgel is appropriate.
If the prostate symptoms continue, you may want to consider a transrectal ultrasound to image the prostate to ensure no abscess is present.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
In terms of further workup for the low testosterone, it was not unreasonable to start Androgel after a total testosterone levels. No further specialized testing is needed in most cases. It may take more than 2 weeks to notice an appreciable difference. You may want to repeat the testosterone levels to ensure the dose of the Androgel is appropriate.
If the prostate symptoms continue, you may want to consider a transrectal ultrasound to image the prostate to ensure no abscess is present.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Member Comments
by P.B., Sep 09, 2004 12:00AM
To: Prostate
0
