Help!

[akb1951]

I am a 61-year-old, white male.  In the past, I had been VERY heterosexually active. I’m not gay.  I am now in an exclusive, monogamous relationship and have been for quite some time.  Three years ago, I was diagnosed with BPH, and prescribed a 5-alpha reductase inhibitor.  Urine stream improved.  Frequency abated.  I asked my urologist to consider putting me on the standard dosage of Depo Testosterone, strictly as an exogenous source of free testosterone, due to malaise, fatigue, etc.  He was reluctant, but did so anyway.  To summarize, I'm taking a daily dose of .05 mg of Avodart and a minimal dose of Depo Testosterone once per month.  My question:  Why does it feel as though my prostatic urethra is ON FIRE?  The pain  been persistent for over three years.  I'm most sensitive to the burning in the days immediately following the injection.  My urologist did a DRE and found no evidence of bacteria.  I had asked him to prescribe an antibiotic, and he adamantly told me no.  I have tremendous respect for him, and he says that there is no evidence of any kind of pathology whatsoever, except for BPH (prostate is now at approximately 30 g after Avodart therapy for nearly three years).  He attributes this burning sensation to aging and a possible symptom of pelvic inflammatory disease, however, it’s been relentless.  I'm wondering if I could be in the beginning stages of prostate cancer.  After adjusting for Avodart, PSA is well below the normal level of 3. Do I have an undetected sexually transmitted infection, such as HSV-2. Is it possible that an undetected chlamydial infection could be causing this burning.  I've never had any sort of "outbreaks," nor do I have any sort of “discharge.”  This burning began when I started taking Avodart AND Depo Testosterone injections concomitantly, just over three years ago.  I’m going to give up Depo Testosterone injections for six months to see if (and how) this resolves.  Your advice?

[Edward W Hook, MD]

Welcome to the Forum.  One of the things I am proud of as a physician is that when I'm not sure of something I say it.  As an Infectious Diseases specialist I am not familiar with these sorts of symptoms following depo testosterone injections and am not sure how to advise you.  There are no STDs which would account for these sorts of periodic symptoms.  It sounds like you are working with a good urologist and he has evaluated you for major pathology and found none.  While that does not explain the symptoms, it does provide some peace of mind.  In addition, if you have not already discussed it with your urologist, you might want to try piridium (a local urinary anesthetic) at about the time you take you injections for a few days each moth to see if that provides any relief.

Sorry I don't have better answers. EWH

[Edward W Hook, MD]

Glad I could help in some small way.  EWH

[akb1951]

"One of the things I am proud of as a physician is that when I'm not sure of something I say it."  And you SHOULD be proud, Dr. Hook.  I'm always amazed and appalled at the experts who have an answer for everything.  My heartfelt and humble thanks for your thoughtfulness.  You've at least corroborated the opinion of my own personal urologist, and you're right:  It DOES give me peace of mind.