T Nation

25 yo, Prostate Problems


#1

Edited to add this top bit:

Age - 25
Ht - 6'
Waist - wears size 34; no tape here
Wt - 195 lbs
Body/Facial Hair - Just a ittle chest hair, lots of lower body hair and a medium-thick beard
Carry fat - lower body; thighs, butt, some below navel; thin upper body, maybe a little bit of gyno...he says he has love handles; I guess so. He is lean enough on top to have those "lines" that women apparently go ga-ga over (and I suppose I do!)
Health conditions/symptoms/history - No previous health issues except nocturia and occasional weak stream. See below for further description.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - Ibuprofen. Penicillin as a child. Got pumped full of vaccines a couple of years ago for med school (wasn't vaccinated as a child). Possibly was on Accutane as a teen briefly - no one seems to be clear on this.

Labs - Negative bacterial culture, no others yet.
Diet - Drinks milk, quite a bit of fast food/dining out past couple of years, until past four years was very meat/dairy-heavy with few vegetables. Eats a moderately low-carb diet now that I'm the one in the kitchen. Has never hardcore dieted.
Training - SS cardio, lifting...definitely nothing extreme. Was previously a sprinter for several years.
Testes ache, ever, with a fever? No.
How have morning wood and nocturnal erections changed? They have not - like clockwork.


Asking for my husband - I'm the gym gal, not him, but I am failing miserably at finding info on the web otherwise and am hoping for some good thoughts here.

My husband is 25, 6', 195 lbs, definitely tends to carry fat and muscle in his lower body. It was more noticeable a few years ago because he was about 30-40 lbs less, but he's added some bulk to his upper body. He has not worked out regularly in the last couple of years because of med school, but he's not totally out of shape, either.

A week and a half ago, he was unable to urinate despite having the urge to do so - said it felt like things were on fire and he could feel spasms if he sat down. We thought it was a UTI so he drank a bunch of cranberry juice and it eventually passed. It happened a few days later and was shorter in duration this time (a few hours instead of several). Both of these things happened within an hour after having sex.

Things were fine for another few days (sex without incident), then he decided to take matters into his own hand and a half hour later, he was suffering again. He said there was no semen in the ejaculate, just fluid. He started chugging cranberry juice again, but we both had realized it was almost certainly not a UTI. He's a med student, so the knowledge of what they'd do at the ER was putting him off going, I guess. He drank over a half-gallon of liquid and couldn't urinate after several hours, so we went.

DRE, the doc said his prostate was enlarged. They did a cath, but the nurse said he "couldn't get past the prostate" and pulled it out, which ended up causing my husband to be able to relieve himself - it was horribly bloody, though (from the cath or otherwise).

We left with a FloMax and Cipro prescription. We're seeing a urologist later this week.

Anyway, it seems crazy that we're dealing with this when he's 25. He said he's always had a bit of a weak stream and nocturia (I can't remember a night when he didn't get up at least once). No sexual dysfunction - rather the opposite, actually.

I was hoping for some suggestions on how to deal with the urologist - warnings, tests to push for (E2?). Also any general thoughts - I know you're not doctors, but as a dietetics student I am extremely wary of "professionals" in general (coughADA*cough*) and would appreciate anything anyone has to throw out there. I was looking at saw palmetto, stinging nettle, etc. - my husband is horrified at the thought of starting proscar so young.


#2

My theory is that prostate and hair loss issues, which are normally attributed to higher DHT, are actually E2 issues instead...and 5AR inhibitors (to control DHT) end up reducing E2 by proxy...

I would definitely get the full blood workup noted in the stickeys...the following are most important:

-Total T
-Free T
-SHBG
-E2
-DHT
-Cortisol (some ties between adrenal function and ability to metabolize E2 I've learned recently)
-PSA (doctor may push back because this test is for "old men" but young men can get prostate cancer too, just much more rarely, but if he has prostate issues this test is a must, IMO

Other than that I don't have a lot of info...I would only use saw palmetto, stinging needle, and other herbs/supps after determining the cause...driving DHT too low can cause many sexual/mood issues that are hard to recover from


#3

Thanks for the suggestions...the uro we went to didn't even bother to do a DRE and wanted to dive right in and cut if he "found anything." So I googled awhile and found a doc who seems to be on the better side of things and will give him a try. If he doesn't run those panels, we'll just order the tests from one of those online services and get them done out of pocket.

I was reluctant to believe the uro hate, but...seeing is believing.


#4

I had the same problems a few years back. Turned out to be an infected prostate. My GP and Urologist both did a before and after urination DRE to look for pus and white cells. The cultures showed an e-coli infection.

Ended up taking a couple of years to completely clear up. The prostate is hard to get antibiotics into.

Don't forget to get a PSA in the labs.

Just for your husbands health, always wipe front to back.... E-coli lives in the gut.


#5

Thanks for the thoughts. I have had difficulty finding anyone with the urinary retention issues online, so it's good to hear that someone else has had this issue. I would rather it be an infection than a hormonal issue (I think).

I am convinced it's not a stricture, or even if it is, the uro should probably be doing what you mention before something more invasive (and expensive) like a cystoscopy. We found another uro who seems to be better qualified and also less cut-first-ask-later.

And I do, though you made me consider something. We are newlyweds, and several weeks ago were on our honeymoon at a bed and breakfast with a whirlpool tub. I did not take the measure of disinfecting the tub with a bleach or other solution because the place was so damn clean otherwise and I assumed they properly cleaned their tubs. Yeesh. A possibility I hadn't thought of before.


#6

I think a single infection from a hottub is one of the least likely scenarios


#7

Lol, you are probably right. Grasping at straws, I guess. Either way, got an appointment with an allegedly excellent and more open-minded uro coming up. Thanks, guys.