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Urology/Combining Androgel and Flomax

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Question
I recently started on Androgel but have noticed an increase in difficulties urinating (slow stream, frequency).  Somehow t seems counterintuitive to combine something like Flomax or Avodart with a testosterone replacement. Would this combination "work against" each other?
Thanks.

Answer
Jimmy, androgel is given for documented testosterone deficiency.  There is no other medical rationale for prescribing this drug because of its many potential side effects.   These include elevation of the cholesterol, elevated red blood cell count, fluid retention, hepatitis, liver neoplasms, enlargement of the prostate,
flare up of pre-existing prostate cancer, acne, infertility, mood swings, high blood pressure, etc.   It may also cause some shrinkage of the penis & testicles as well as suppression of sperm production.  Therefore, because of possible complications, it should only be taken if a man is demonstrated to have a true testosterone deficiency and after an endocrinologist has determined that this is the best option for treatment.  However, in spite of potential side effects, when given for testosterone deficiency under medical supervision, the risk of cardiovascular diseases such as heart attacks, stroke, angina, thromboembolic events and worsening of the lipid profile are not increased.

As you can see, one of the side effects is enlargement of the prostate gland.  If this happens, symptoms such as urinary frequency, urgency, slow stream, post-voiding dribbling, night time frequency, etc. can occur.  There are many treatments for this including the use of drugs called alpha blocker (such as Flomax).  These medications work in just a few days by relaxing the prostatic capsule so that the gland can "spring open" to reduce resistance to flow and hence improve symptoms.  Medications such as Avodart and Proscar  actually shrink the prostate but this takes months to occur.

Alpha blockers have no effect on testosterone.  Avodart and other 5-alpha reductase inhibitors work by limiting the conversion of testosterone to DHT (dihydrotestosterone), the active form of testosterone that causes the prostate to enlarge.  Thus, they can effect therapeutic levels of testosterone.

If Androgel is truly medically indicated for your problems and you have symptoms of an enlarged prostate, alpha blockers are a good choice to consider.  Good luck.

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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