Severe Urination Issues after 4yrs on TRT

[ssaunders]

Hi Everyone,

I'm new to this forum and trying to get some answers. Please be patient with my story as I'm in dire need of help and direction.

I've been on TRT for 4yrs and up until 4mths ago I've been doing fairly well on my protocol. Some background before I go into my issues and concerns. I'm 49 yrs old and started TRT because my test was on the low end of the range. I was fatigued most of the time and had a low libido. Also my workouts lacked any drive or motivation which accounted for not great results. Since going on TRT protocol I definitely saw improvements in all areas I described above. I started on Test Cyp at 100ml a week with 250x2 HCG . My doc eventually put me on cream (I know not preferred by most ppl here) mainly due to his justification that the injection caused more inflammation to the prostate. I agreed and have been on cream the last two years. Has it been great, no, but it hasn't been that bad. My lifestyle in general is very active with business, family and what not, so due to the amount of stress I deal with on a regular basis I accounted my "not so great" days to this factors. Also having a child during this time that doesn't sleep through night really affected my sleep patterns. I would say that I have hit burnout phase at this point in my life and wondering if the issues I describe below account the problems I'm having.

To make a long story short, 3 mths ago my doc and I decided to go back to Test cyp mainly due to my labs results for Test/Free Test/Est being too low and the cream absorption being minimal at best. Also for convenience. Within the first week I notice energy improvement and libido increase but shortly after I started peeing like there was no tomorrow. Most days every hour or two. Prior to the urination issue I was like a camel going maybe 3-4x a day and drinking all the water I wanted. To add to this my PSA prior to this was getting up there but still within normal range (norm 1.5-4). It was at 3.7 but I had no symptoms of BPH. I basically went from 0-60 within 2 weeks of switching to Test Cyp injections. I went off the injections and back to the cream after a week of putting no test in my body. Doc wanted me to let the Test Cyp leave my body and see if the urination improved. Need less to say this was over 3mths ago and I'm still having frequent urination and now major agitation throughout my whole urinary tract and bladder. I've had several tests (blood work, antibiotics, ultrasounds, Cystoscopy, etc.) done to rule out UTI, Bladder issues or prostate concerns. Basically the urologist says that I have slight BHP and maybe prostatitis but can't account for irritation throughout my whole urinary system. I can even feel it into my intestines and lower abdomen on bad days. My PSA levels are still within normal (lat two readings 2.8 and 3.2). This issue is basically causing major issues in my daily life to point where I'm getting depressed not knowing if this will ever go away. To add to this, every time I do urinate or have a BM is feel completely drained. My hope is that someone can shed some light with some experience with my symptoms and point me in the right directon. At this point my doc wants me to do a 10-day round of antibiotics (Doxycycline 100mg) to rule out any other bacteria or virus. I have tried alternate medicine such Homeopathy. My Homeopath uses urine to read my system says that my body is in chronic burnout mode (use carbohydrate reading which anything under 3.5 is low and I'm at 2). Interesting enough I'm still pushing myself to workout and seeing dramatic improvement in strength but muscles can't hold glycogen and water therefore I can't get muscle growth. I system keeps flushing. One day I lost 8lbs of water just from peeing.

I know this is a lot of information without labs results atm to add but mainly I'm looking for anyone with any of these experiences to assist.

Please and thank you.

[Ashop]

I would get a 2nd and even 3rd opinion from other urologist. Prostatitis can be horrific for some but to me it sounds like its something more severe
that's getting overlooked. Something simple to ask. Do you drink plenty of water daily? Sometimes pounding water all day will initiate better streams
if their weak.

[HoldMyBeer]

Ask your doctor about finasteride. Seems like it would treat the prostate and mpb issues.
I pee every 1-2 hours myself. Have for years. I have narrowed it down to two things
1. I workout a lot and therefore drink a ton of water
2. Ab workouts seem to irritate my bladder and make me feel like I have to pee
Could be the same for you. On the injections you feel better, so you go to the gym more, and the above happens. But I'm not a doctor! Just my experience.

[ssaunders]

I have dealt with same issue as you are dealing with..all the above.. I am 64 years old been on TRT for over 10 years...Tried about everything out there.. creams injections..In the meantime i have had 3 back surgerys..Still live in pain everyday..the last dr i seen put me on meloxicam 15mgs..Its been a game changer..My body feels much better..Heres the bonus it made me pee much better is it perfect NO.. But much better..The drug is a anti inflammatory...Going back when i first started trt my psa was around 0.7 to 1.0 my first blood test after going on trt my psa went up 2 points..Last time tested around a 4.0..my prostate does not agree with test..Cant take anything back now i just deal with it...SUCKS BIG TIME..

Thanks testytim I appreciate the feedback. It does suck especially when I had no issues what so ever and then BAM. The urine frequency has definitely decreased (maybe 5-6; also due to less intake throughout the day) on it own but the irritation and fatigue (not to mention the effect on my libdo) is what is concerning. I definitely think there is more going on especially considering my muscles are not holding out to water/glycogen. I have my doctor doing more tests but we're both hoping is just not my prostate now not agreeing with the test.

[ssaunders]

I thought about finasteride but my libido is not good with this pee/irritation issue atm, I hear finasteride doesn't help the libido as well. Thoughts?

[ssaunders]

I would get a 2nd and even 3rd opinion from other urologist. Prostatitis can be horrific for some but to me it sounds like its something more severe
that's getting overlooked. Something simple to ask. Do you drink plenty of water daily? Sometimes pounding water all day will initiate better streams
if their weak.

Get a second opinion atm but new doc and urologist say my doc and referred urologist are doing the right things. Doing more tests (ie, GI tract, stomach, etc.) to start ruling out anything else.
I did drink plenty of water but slowed down due to this issue. Also stream is not weak. The odd thing is I pee fully everytime which is contradicting to typical prostate issues of weak streams and hardly any pee.

[fossilk1]

I have been struggling with this for 2-3 years now. You may just have an OAB, or weak pelvic floor muscles. I would test some meds out though to see if it will help. Amitriptyline helped me get over my issues. Myrebetriq helped as well to retrain my bladder. Benzodiazepines also helped but be careful. Your basically going to have to do a 24 hour bladder diary. Measure how much you intake, and how much you void in volume. You are gonna have to try some biofeedback techniques like pelvic flood exercises, and avoiding bladder irritants. The way my doctor put it is, i’m like a kid again, and I have to retrain my bladder. The key thought is to take sips of water throughout the day and to not cause dehydration. You have to also not think too much into this now that you are hyper aware. Sometimes you may trigger fight or flight mechanisms. As long as you ruled out diabetes, diabetes inspidus, UTI, STD, yeast, kidney, voiding, IC, prostate issues.... it will come down to OAB.

I have gone through it all, and spent mad money. Turns out I have some sort of Thyroiditis now, but I am still battling it out and looking for some answers. I think what ruined me was abusing AI’s heavily.

Good luck, in my honest opinion this is by far the closest you will get to hell.

[ssaunders]

Has anyone with my issues stopped trt to see if their condition improve? It's the constant irritation that's affecting me the most. The frustrating thing is everything was fine and then my within 1-2 week everything changed. Makes no sense. I don't want it to be the Test but in the back on my mind I feel it is.

I'm considering a PCT to see if my condition improves despite the lows I will feel with no TRT.

[fossilk1]

Has anyone with my issues stopped trt to see if their condition improve? It's the constant irritation that's affecting me the most. The frustrating thing is everything was fine and then my within 1-2 week everything changed. Makes no sense. I don't want it to be the Test but in the back on my mind I feel it is.

I'm considering a PCT to see if my condition improves despite the lows I will feel with no TRT.

I’m not on HRT/TRT... Testosterone or abused AI is what doomed me. I know when people come off Testosterone you deflate and purge all water weight. It will increase frequency of urination. I wouldn’t come off you may aggravate your issue, but listen to your doctors. If they want you off then so be it.

Is TRT causing your issues?? Highly unlikely. Testosterone is supposedly able to aid in inflammation and autoimmune response. Not only that but it raises your estradiol, which causes you to possibly retain more water. Only when I am on Tren do I have frequency. Urologist would have picked up on IC during your cystoscopy, (referring to your irritation) also some patients bleed a little bit on passing urine so a urine analysis would have confirmed with IC. Now directing your BPH or prostate, a Urologist would see this with taking an ultra sound of your bladder, then having you void to relook at your bladder afterwards making sure you void correctly. But you stated you don’t have UTI’s, so patients with BPH or incomplete voiding issues related to the prostate will have a higher chance of developing a UTI. Now if you ruled out your kidneys & bladder and atomically everything is alright then all you have left is OAB or pelvic floor dysfunction. The medication Amitriptyline will help with this, no more than 50mg. This medication has the least amount of side effects and may help with you stress as well. Also one of the side effects is it slows down urination! It’s also cheap, give it a shot and also give it a month before it works. Since your doctor is giving you antibiotics, DO NOT take Cyprofluxin unless you have a confirmed diagnosis of UTI.

You may be happier on Amitriptyline since not only will it help your bladder but also your mood. This medication also helps with very nice deep sleeps allowing REM to set in. I have a feeling you have severe anxiety/stress and it is causing a fight or flight response to be triggered. Do you have frequent spells at night? If not what does that tell you. Because i’m fine when I sleep, I only have issues during the day. The only down side with this medication is it can cause some weight gain with doses higher than 50mg. Your doctor may have you start at 10mg and have you judge your own dose building up to 50mg. This is also medication you take prior before retiring. If you take it at the day time you should test this out on a weekend when you are not working or driving. It may make you tired, but hell I love sleeping lol.

There is also the chance that some people drink too much water and not realize. Also dehydration concentrates the urine. That’s why I wanted you to try a intake and void diary.

And if all fails you can do Botox, which is heard works well. My Urologist has this silly saying, “... To Pee... or to not to Pee... that is the question”. Obviously your body is pushing out toxins, people who can’t urinate are in deeper shit. You will need to retrain the way you think about peeing, right now your body is afraid and from the tone of your writing you seem desperate, but not in a bad way. Just trying to find hope, seeing if others experience what you are going through. Amitriptyline will help you remap your brain, give it a shot, you don’t have anything to lose. This issue started when I was 27yr (younger) and now i’m 30... I still live with my issue, but I don’t let it control me. Some days I can hold it for 5-6 hours others 1-2 hours. And bad days 30 mins... you just need to find a way to look at it differently. Because at times I wanted to punch myself in the dick, but then I realize... I am not gonna let this control me. Feel free to read all my posts and my stories on this forum... i’m also on excelmale.com user name Checkdis. I have taken some nasty substance and still breathing. But I have elaborate more in my threads.

[ssaunders]

I’m not on HRT/TRT... Testosterone or abused AI is what doomed me. I know when people come off Testosterone you deflate and purge all water weight. It will increase frequency of urination. I wouldn’t come off you may aggravate your issue, but listen to your doctors. If they want you off then so be it.

Is TRT causing your issues?? Highly unlikely. Testosterone is supposedly able to aid in inflammation and autoimmune response. Not only that but it raises your estradiol, which causes you to possibly retain more water. Only when I am on Tren do I have frequency. Urologist would have picked up on IC during your cystoscopy, (referring to your irritation) also some patients bleed a little bit on passing urine so a urine analysis would have confirmed with IC. Now directing your BPH or prostate, a Urologist would see this with taking an ultra sound of your bladder, then having you void to relook at your bladder afterwards making sure you void correctly. But you stated you don’t have UTI’s, so patients with BPH or incomplete voiding issues related to the prostate will have a higher chance of developing a UTI. Now if you ruled out your kidneys & bladder and atomically everything is alright then all you have left is OAB or pelvic floor dysfunction. The medication Amitriptyline will help with this, no more than 50mg. This medication has the least amount of side effects and may help with you stress as well. Also one of the side effects is it slows down urination! It’s also cheap, give it a shot and also give it a month before it works. Since your doctor is giving you antibiotics, DO NOT take Cyprofluxin unless you have a confirmed diagnosis of UTI.

You may be happier on Amitriptyline since not only will it help your bladder but also your mood. This medication also helps with very nice deep sleeps allowing REM to set in. I have a feeling you have severe anxiety/stress and it is causing a fight or flight response to be triggered. Do you have frequent spells at night? If not what does that tell you. Because i’m fine when I sleep, I only have issues during the day. The only down side with this medication is it can cause some weight gain with doses higher than 50mg. Your doctor may have you start at 10mg and have you judge your own dose building up to 50mg. This is also medication you take prior before retiring. If you take it at the day time you should test this out on a weekend when you are not working or driving. It may make you tired, but hell I love sleeping lol.

There is also the chance that some people drink too much water and not realize. Also dehydration concentrates the urine. That’s why I wanted you to try a intake and void diary.

And if all fails you can do Botox, which is heard works well. My Urologist has this silly saying, “... To Pee... or to not to Pee... that is the question”. Obviously your body is pushing out toxins, people who can’t urinate are in deeper shit. You will need to retrain the way you think about peeing, right now your body is afraid and from the tone of your writing you seem desperate, but not in a bad way. Just trying to find hope, seeing if others experience what you are going through. Amitriptyline will help you remap your brain, give it a shot, you don’t have anything to lose. This issue started when I was 27yr (younger) and now i’m 30... I still live with my issue, but I don’t let it control me. Some days I can hold it for 5-6 hours others 1-2 hours. And bad days 30 mins... you just need to find a way to look at it differently. Because at times I wanted to punch myself in the dick, but then I realize... I am not gonna let this control me. Feel free to read all my posts and my stories on this forum... i’m also on excelmale.com user name Checkdis. I have taken some nasty substance and still breathing. But I have elaborate more in my threads.

Thanks fossilk1, reading your comment gives me hope in the fact that it may not be a Test issue as I was afraid of going off knowing the downslide of trying come off try after 4-5yrs. My symptoms are so in-consistent that myself, my doc and the urologist are at a loss. They're going through the proper protocols to rule out anything serious but it's taking so long. Next is checking out my GI tract as I'm getting agitation in my lower abdominal and intestinal regions. My system is definitely pushing out toxins although my frequency of urination has subsided quite bit (6-8 times daily from 10-20). The irritation, fatigue and muscles not holding on to water and glycogen to biggest problem atm. I'm not keeping weight on even though I'm forcing enough calories to do so. My metabolism is in over drive which would be good if I was over weight but I'm not (extomorph by nature).
As of now I don't have a UTI, my bladder is good, prostate is slightly enlarged but nothing to worry about according to urologist. Ultrasounds show nothing in reproductive areas even though the agitation is always there.

Being a type-A personality I've also taken upon myself to think outside the box and look at anything endocrine related since the endocrine system regulates hormones and my symptoms all point to hormone imbalance. One area I'm looking into are any endocrine disruptors such as Parabens which come from may skincare products as well as may other household products. In Canada there are no urine tests for Parabens in your system so I went ahead and order a kit from the US. Through my own research paraben toxicity is a real thing but not really treated if discovered in your urine. It's excepted that paraben secretion is always happening but it's also proven to cause major problems for endocrine especially in females relating to breast cancer as well as messing up male hormone and reproductive systems. If my urine comes back with high levels of Parabens I will be pushing my doc to see endocrinologist asap. If anyone has any insight to paraben toxicity or endocrine issues related to my symptoms please fill me. I really won't stop until I figure this out. As I mentioned starting this thread, I was all good, no indication of any issues and then bam it all changed.

Thank you for everyones comments and insight, it's greatly appreciated.

BTW - I'm going to the US to get all my bloodwork even though it's free here. Anything aside from Test, Free Test, Estardiol, SHBG, DHT, DHEA-S, PSA, Free T4 and T3, CMP please let me know.

[fossilk1]

Thanks fossilk1, reading your comment gives me hope in the fact that it may not be a Test issue as I was afraid of going off knowing the downslide of trying come off try after 4-5yrs. My symptoms are so in-consistent that myself, my doc and the urologist are at a loss. They're going through the proper protocols to rule out anything serious but it's taking so long. Next is checking out my GI tract as I'm getting agitation in my lower abdominal and intestinal regions. My system is definitely pushing out toxins although my frequency of urination has subsided quite bit (6-8 times daily from 10-20). The irritation, fatigue and muscles not holding on to water and glycogen to biggest problem atm. I'm not keeping weight on even though I'm forcing enough calories to do so. My metabolism is in over drive which would be good if I was over weight but I'm not (extomorph by nature).
As of now I don't have a UTI, my bladder is good, prostate is slightly enlarged but nothing to worry about according to urologist. Ultrasounds show nothing in reproductive areas even though the agitation is always there.

Being a type-A personality I've also taken upon myself to think outside the box and look at anything endocrine related since the endocrine system regulates hormones and my symptoms all point to hormone imbalance. One area I'm looking into are any endocrine disruptors such as Parabens which come from may skincare products as well as may other household products. In Canada there are no urine tests for Parabens in your system so I went ahead and order a kit from the US. Through my own research paraben toxicity is a real thing but not really treated if discovered in your urine. It's excepted that paraben secretion is always happening but it's also proven to cause major problems for endocrine especially in females relating to breast cancer as well as messing up male hormone and reproductive systems. If my urine comes back with high levels of Parabens I will be pushing my doc to see endocrinologist asap. If anyone has any insight to paraben toxicity or endocrine issues related to my symptoms please fill me. I really won't stop until I figure this out. As I mentioned starting this thread, I was all good, no indication of any issues and then bam it all changed.

Thank you for everyones comments and insight, it's greatly appreciated.

BTW - I'm going to the US to get all my bloodwork even though it's free here. Anything aside from Test, Free Test, Estardiol, SHBG, DHT, DHEA-S, PSA, Free T4 and T3, CMP please let me know.

You didn’t mention anything about Amitriptyline, which I believe is a great start. I do not know anything of Parabens? I wouldn’t even know where to start in treating it lol.

Did you rule out diabetes insipidus? I would check your bloods for: Cortisol, ACTH, ADH, A1C, Full Thyroid (don’t forget TSH, and RT3) including Antibodies (TPO & TSI). Check for Lyme’s while you are at it. Also a 24 hour urine analysis checking Osmality of how well your kidneys concentrate urine. And Estradiol sensitive should be gathered, not Estradiol alone.

You will be fine but for the time being Amitriplyline bro... it’s been used for a long time and will definitely help you. All the other OAB medication is very expensive and causes dry mouth and some other sides I hated.

[ssaunders]

Quick update. Major improvements but not quite 100%. Doc and urologist could not find anything aside from pushing to see an endocrinologist.
Went to see a new Naturopath (nothing to lose) who started me on acupuncture and within a week or two dramatic improvements in my frequency of urinating and irritation went away. This has decreased my anxiety or depression quite a bit. Naturopath accounts things to stress and burnt out manifesting physically but who knows.
Just to test things out went back on injections and no ill effects the last 4 weeks. All of the early mentioned symptoms are almost gone but now I'm having regular BPH symptoms which were more than likely masked with everything else going on. Going in for bloodwork tomorrow to checkout PSA, Test, Free Test, etc. Overall still not back to myself but at least everything is manageable. Libido is still low which really sucks. I personally feel my doc (even though a nice guy and very accommodating) lacks the knowledge I need to dial my TRT in. He never checks my SHBG, DHEA-S or Cortisol (which could be a major culprit). Basis everything on how I feel. Thinking I either need to get BW done myself and post here all the while getting my scripts covered by my doc. Unfortunately not many TRT specialist in my area.

[fossilk1]

Quick update. Major improvements but not quite 100%. Doc and urologist could not find anything aside from pushing to see an endocrinologist.
Went to see a new Naturopath (nothing to lose) who started me on acupuncture and within a week or two dramatic improvements in my frequency of urinating and irritation went away. This has decreased my anxiety or depression quite a bit. Naturopath accounts things to stress and burnt out manifesting physically but who knows.
Just to test things out went back on injections and no ill effects the last 4 weeks. All of the early mentioned symptoms are almost gone but now I'm having regular BPH symptoms which were more than likely masked with everything else going on. Going in for bloodwork tomorrow to checkout PSA, Test, Free Test, etc. Overall still not back to myself but at least everything is manageable. Libido is still low which really sucks. I personally feel my doc (even though a nice guy and very accommodating) lacks the knowledge I need to dial my TRT in. He never checks my SHBG, DHEA-S or Cortisol (which could be a major culprit). Basis everything on how I feel. Thinking I either need to get BW done myself and post here all the while getting my scripts covered by my doc. Unfortunately not many TRT specialist in my area.

That is awesome you are improving. I was just diagnosed with Grave’s Disease. Apparently frequent urination is also a symptom... who would have known. Do my a favor and test your Thyroid Antibodies, TGII, TSI, TG, TPO.

Did you ever feel a strange feeling of high or drunk kind of light headed?

Also a cool article which seems to pertain to me.

https://academic.oup.com/jes/article...UN-575/5483335


and here is a writing on graves symptom for frequent urination. Might be worth investing.

https://www.google.com/amp/s/www.liv...e-thyroid.html