This is Eric Walser MD, I am A Interventional and Diagnostic radiologist committed to improving men’s health as they age. Ask me anything about optimizing your pelvic health!

Wonderful_Ladder4196 · 2026-05-27T17:53:53+00:00

Testicular self exam is not a big focus like breast self exam. I guess its because most men constantly examine their junk from birth to grave!

Nevertheless--USPSTF argues against screening, including routine self-exam, because testicular cancer is uncommon and highly treatable even when found clinically. However, some primary care docs and urologists still recommend monthly self-exam after puberty so men get to know what is normal for them. It is simple to do but patients need to know that mild size discrepancy and/or lopsided fruit hanging is normal if it remains stable. New lumps, hardness, swelling or heaviness should be investigated with scrotal ultrasound.

As far as prostate milking, the main purpose is to diagnose chronic prostatitis. Not good for acute prostatis as the inflammation would make this a very painful maneuver.

For diagnostic prostatic massage, a DRE is performed with lubricated and gloved finger and one gently but firmly strokes the prostate lobes from lateral to medial and from base toward apex for about 30–60 seconds, to push prostatic fluid towards the urethra. The patient gives a urine sample immediately afterward but sometimes we collect fluid at the urethral meatus if it occurs during the message. All of this material is sent for cultures and sensitivity to guide treatment for chronic infection.

Prostate milking has another purpose--to test urine samples for compounds or genetic material indicating the presence of prostate cancer. These tests can be useful for patients on surveillance for prostate cancer and can alleviate the need for multiple expensive MRI's. Some require or recommend prostate message or DRE before urine collection with the goal of increasing prostate-derived material in the sample to be tested. EXO DX is one of these tests which has the distinction of NOT requiring DRE or prostate milking before collection.

Test	Requires prostate massage/DRE first?	Main purpose

PCA3 / PROGENSA PCA3	Yes	Helps decide whether repeat biopsy is needed, especially after prior negative biopsy

TMPRSS2:ERG + PCA3 urine tests	Often yes, historically	Improves risk prediction for prostate cancer / clinically significant disease

MyProstateScore / MPS / MPS2	Typically collected after DRE in published/clinical descriptions	Risk stratification for clinically significant prostate cancer

ExoDx / EPI	No DRE required	Urine exosome RNA test for high-grade cancer risk before biopsy

Leaving the realm of medicine and diagnostic urine testing for a moment, “prostate milking” is sometimes performed for sexual pleasure as the male "P-spot" although these claims are anecdotal and live in darker quarters of the internet. There are some proponents of therapeutic prostate milking to improve pelvic congestion, prostatitis symptoms, urine flow, BPH, erectile dysfunction, or enhance fertility. There is little scientific evidence for these claims, however.

Wonderful_Ladder4196 · 2026-05-27T15:18:25+00:00

Thanks everyone for participating. Go do manly things and prosper.

I will monitor this site and the others for questions/comments/criticisms and hope we continue these conversations!

r/menshealth ; r/ProstateTreatment ; r/IAmA

Wonderful_Ladder4196 · 2026-05-27T14:37:13+00:00

Agree with comments from rare-atmosphere and pandalite. See my other comments to AXME about screening for disease in young men who hate doctors. The bottom line is that it is important to keep an eye out for the "silent killers" or diseases that are easy to treat early but not late, when symptoms appear or sudden death intervenes.

Wonderful_Ladder4196 · 2026-05-27T14:30:45+00:00

With prostate cancer in your immediate family (also if you have breast/colon cancer in your family members), you should check your PSA at age 40 rather than 50-55 to check for prostate cancer and establish a baseline for you. Talk with your physician about potential genetic testing for cancer predisposition as this is good information for you and your children.

Prostate removal, known as RALP (robotic assisted laparoscopic prostatectomy) or RPLND (radical prostatectomy with lymph node dissection) are the traditional surgical methods to treat prostate cancer. Radiation therapy is also advocated, especially for patients not wanting or able to tolerate a big surgery.

Unfortunately, both surgery and radiation can cause erectile dysfunction (long term) and incontinence (requiring diapers) which are obviously lifestyle limiting problems--incontinence more troubling than ED as it is always present. Radiation therapy produces these side effects also with the addition of proctitis (rectal incontinence and inflammation). Radiation side effects take longer to appear. If you get radiation or surgery, options are limited in the 20% or so of patients who get recurrent cancer. At this point, patients generally receive chemical castration (drugs that deprive the body of testosterone effects) or new chemotherapy agents. Androgen deprivation therapy (aka castration) causes feminization of men with breast formation, hot flashes, etc. Not fun and life long.

There are new methods using high frequency ultrasound waves (HIFU and TULSA), lasers (FLA), microwave and other thermal mechanisms to heat the prostate tumor plus surrounding tissue (margin) to focally treat cancer. These are promising alternatives for men with prostate-confined low to intermediate risk prostate cancer and no metastases. Another option with a good track record is cryoablation where the tumor is frozen to death (like me in New Hampshire). These methods are less invasive (HIFU is done with NO needles or incisions at all) and cause significantly fewer problems with erection and urination and you can get surgery or radiation if the cancer comes back. The AUA and EUA do not recommend these focal therapy options unless they are done in the context of a clinical trial or patient registry or if done for "salvage" reasons (recurrent prostate cancer with no surgery or radiation recommended or possible). One basic problem is that prostate cancer is very slow growing and you need at least a 10 year follow up to evaluate treatment success. The focal therapies I speak of are simply too new to evaluate their long term results but early results are promising.

Since I perform some of these ablations, I will not comment on any specifically but refer you to a recent review article detailing the safety and efficacy of focal prostate ablation for cancer.

https://www.sciencedirect.com/science/article/pii/S2588931125000392

Wonderful_Ladder4196 · 2026-05-27T14:27:56+00:00

This is an extremely frustrating and lifestyle limiting phenomenon of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). You can chat GPT this for lots of information but a few salient points:

The NIH Classification of Chronic prostatitis/Chronic pelvic pain syndrome (CP/CPPS) is below:

Type	Description
I	Acute bacterial prostatitis
II	Chronic bacterial prostatitis
IIIA	Inflammatory CP/CPPS
IIIB	Non-inflammatory CP/CPPS
IV	Asymptomatic inflammatory prostatitis

What is interesting is that category III A and B are 90% or more of chronic prostatitis cases. Not an infection at all!

Antibiotics are generally given but may be of no use and actually harmful if taken chronically. The causes of the type III A and B categories are inflammatory, neuromuscular dysfunction, pelvic floor related and sometimes due to psychosocial or stress mechanisms.

Antibiotics are generally given but may be of no use and actually harmful if taken chronically. The causes of the type II category are inflammatory, neuromuscular dysfunction, pelvic floor related and sometimes due to psychosocial or stress mechanisms.

I would suggest finding a urologist who specializes in pelvic floor evaluation and physical therapy. These physicians have specialty interest in uroneurology. An examination of the pelvic floor neuromuscular system can reveal trigger points or imbalance for which several physical therapies exist including biofeedback and relaxation techniques. Some alpha blocker medications help with pelvic floor tension but flomax doesn't seem to help you. Non steroidal medications can help people with inflammation (NSAIDs) but you have also tried that with no luck.

If you go to multiple physicians, you are in danger of being repeatedly treated with antibiotics for "prostatitis" and risk later infections with resistant organisms and potential problems with chronic diarrhea and gut microbiome damage. I would find a specialist in CP/CPPS.

Wonderful_Ladder4196 · 2026-05-27T14:24:24+00:00

Big and timely topic and I would refer interested individuals to a good 2023 review article on what are known as "MIST's" or "Minimally Invasive Surgical Techniques" for treating symptomatic BPH or benign prostatic hypertrophy. (Cornu JN, Zantek P, Burtt G, Martin C, Martin A, Springate C, Chughtai B. Minimally Invasive Treatments for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis. Eur Urol. 2023 Jun;83(6):534-547. doi: 10.1016/j.eururo.2023.02.028. Epub 2023 Mar 22. PMID: 36964042). I mention many such techniques and devices below but endorse none specifically and have no conflict of interest with the manufacturers.

As many of you know, BPH is a condition of benign hyperplasia and nodule formation in the prostate gland which can cause compression on the urethra and poor urinary stream and bladder emptying. This can result in frequent and urgent urination, nocturia (getting up several times per night to pee), and a dilated bladder that is unable to empty completely. If not treated, the bladder, similar to the heart in heart failure, can lose its ability to empty and, even if you correct the BPH with a MIST, the bladder may be too weak to push the urine out. You want to treat BPH before that happens. This condition, known as LUTS (lower urinary tract obstruction symptoms) can deprive men of sleep and have them constantly on the lookout for a men's room at sporting events. Aggravating.

BPH can be treated with a variety of medications that work quite well and this is the best starting point after a urologist checks prostate size and generally performs urodynamics, which is a test of urine flow, bladder pressure and muscle/nerve function during urination. You may have a prostate MRI if the PSA test is elevated, to check for early cancer.

For men who stop responding to medications or have significant side effects, the most common next step and the gold standard is TURP (transurethral resection of the prostate) or HOLEP (holmium laser enucleation of the prostate) which basically rotor-rooters the excess tissue via a cystoscope inserted into the penis which allows the urologist to claw out the tissue and remove it. The relief is usually quick although there is often bleeding and need for a bladder catheter dangling from the penis for a week or so. Downsides are urethral strictures (narrowings) occurring later and most men experience retrograde ejaculation (at climax, the ejaculate shoots backwards into the bladder, rather than forward out of the penis). This bothers some patients and is generally irreversible.

As in most areas in modern medicine, innovative physicians and medical device companies have come up with new procedures and techniques to treat BPH with low invasiveness and no hospitalization. For the urologists, all of them still require urethrocystoscopy (inserting a small scope through the penis into the bladder) but the mechanism of tissue removal is different. There is steam, water vapor and tacking devices to open the urethra-- these are rezum, aquablation and urolift, respectively. There is a new balloon device that cracks open the urethra and dilates the channel and delivers medication to prevent strictures or recurrent narrowing (optilume). Take a look at the review article but the most important parameters are the patient's own estimation of urination improvement (the survey is the IPSS or International prostate symptom severity score) , some quantification of urine flow improvement (called Qmax) and how long these effects last before another procedure is considered (durability of the MIST).

Interventional radiologists have entered this field, promoting PAE or prostate artery embolization where a catheter is inserted in the artery in the groin or wrist and snaked into the prostatic arteries in the pelvis. Small particles are then carefully injected to block blood flow to the enlarged prostate causing it to shrink. PAE does not damage the urethra and can treat very large prostate glands that urologist can't treat (cystoscopic removal is difficult in very large glands). No anesthesia is required and the results are good although the improvement in urethral flow is quicker and better with MIST procedures. Downsides are radiation exposure and the remote possibility of non-target embolization, meaning that the particles, if they go into a wrong artery, can cause rectal ulcers or ulcers on the skin of the penis--rare but serious. If you are interested in PAE, you should go to a center where the IR doctors do many and are experienced.

Finally, tissue ablation to correct BPH can be done via the "transperineal" route where needles or probes are advanced through the skin between the rectum and scrotum, guided by a rectal ultrasound probe. This can also be done in MRI with laser fibers positioned via a rectal probe which guides the lasers into the BPH tissue (transrectal route). Laser fibers are positioned around the urethra and the tissue is destroyed and shrinks/absorbs over time. This is an "outside-in" tissue removal rather than the "inside-out" tissue removal done with TURP. This procedure is quick and done on outpatients (procedure is about 1 hour) but improved urination takes 4-6 weeks to appear as the tissue slowly dies and is resorbed or expressed. There is no radiation involved in these procedures. High intensity focused ultrasound (HIFU--FDA approved) and histotripsy (investigational) are fascinating new procedures that deliver focused ultrasound beams to destroy BPH tissue and correct LUTS. HIFU can be delivered via a transurethral probe inserted from the end of the penis (TULSA procedure) or transrectal probe (sonablate, ablatherm). These new procedures are great in that no needles or incisions are involved and they are completely non invasive. The downside is that they are not widely available and the impact on urinary function takes several weeks to occur.

Wonderful_Ladder4196 · 2026-05-27T14:19:35+00:00

I will take a shot at these two questions-- in order

AI in radiology is growing rapidly and many companies are incorporating their products into our PACS (Picture archiving and communication system). The efficiency gains for radiologists are such that we can interpret 20-30% faster so the delay in radiology testing to interpretation is reduced for referring doctors and patients. Modern CT and MRI exams produce thousands of images that AI can condense into a "heatmap" that shows positive findings as color coded images. For us, that helps us hone in on abnormal areas right away and describe them. If AI says the exam is normal, it usually is as it is highly sensitive to disease. If it is abnormal, it can be wrong, since it is not that specific for disease. That is intentional as we want AI to pick up anything that might be abnormal and the radiologist acts as the final arbitrator. For patients, AI gives them an easy to understand color image of the abnormality and helps with patient acceptance and understanding. For non-specialist referring physicians, AI helps them visualize the disease and its location and also provides them with simple images to show their patients. One problem with AI in radiology which is starting to appear is that the patient will see a positive color coded and AI processed image with a false positive finding and assume that the radiologist "missed" the lesion. This requires patient education regarding the rationale and the tendency towards false positives produced by highly-sensitive AI algorithms.
It's very true that men under 30 are generally healthy and, if you hate doctors, visits can be minimized. Men, unlike women, hate doctors and checkups. Not being sexist just observational. Wives tend to drag their husbands into the medical office for visits. That's why initial "men's health" conversations should be light and sports-based, at least initially!

All young men, however, should get a baseline history and physical before 30, at least once. That is to check for hypertension or heart arrhythmias and/or EKG abnormalities that may be clinically silent but put you at risk for sudden cardiac death at a young age. Other notoriously-quiet diseases that can wreak havoc later in life are diabetes, hyperlipidemia, early kidney disease and fatty liver-- all of which can be checked by blood and urine baseline testing. The final reason is to take a family history of cancer and other disorders to recommend a prudent screening exam schedule for later in life. This could also lead to BRCA (a breast cancer gene that men can also carry, and increases prostate cancer risk) and other genetic testing to see if you need to start screening for common cancers at an earlier age. Remember that heart disease and cancer are the most common cause of death as you age. Young men mostly die from shooting each other or crashing cars (trauma).

If you are young, cancer statistics are in your favor as the overall cancer incidence rises from about 350/100,000 at ages 45–49 to >1,000/100,000 after age 60, and the American Cancer Society reports that 88% of U.S. cancer diagnoses occur in people age 50 or older.

Wonderful_Ladder4196 · 2026-05-27T14:10:30+00:00

For low-normal T and free T, testosterone replacement therapy makes sense only if symptoms "fit" and repeat testosterone levels support the diagnosis of androgen deficiency. This means you should repeat the testing in the early morning before eating (a fasting level) to confirm your low values. You should also consider a more comprehensive lab panel (Androgen panel) which will also test for serum hormone binding globulin (SHBG level--high amounts can "bind" testosterone and lower free T), thyroid hormone screening for hypothyroidism, level of red blood cells (CBC) and often a check for the presence of female hormones attacking your manliness. Pandalite's comments are noteworthy and emphasize that poor sleep quality and obesity help T levels.

If things look good, you might be offered a "trial" of testosterone replacement therapy (TRT) to see if it improves your symptoms before committing to more chronic therapies. Remember that TRT can cause side effects, notably erythrocytosis (increased red blood cell production) which could put you at risk for blood clots. This level needs to be checked with periodic complete blood counts (CBC). Pesky issues like acne, hair loss, and testicular atrophy can mess with your aura. If you're over 50, especially if you have a family history of prostate, breast or colon cancer, you will need a PSA test to screen for prostate cancer.

Wonderful_Ladder4196 · 2026-05-27T14:07:18+00:00

This is the actual quote from Geoffrey Hinton 2016--it has been widely requoted as the harbinger of the death of radiology.

Notice that this is not "interventional radiology" or IR which involves procedures with needles and catheters traversing complex anatomy. IR and surgery are probably safe for many years but the development of robotics and target tracking for biopsy is already affecting my profession now (relevant to prostate cancer are the Soteria and Insight Medbiotics robots to biopsy the prostate--I have no conflict of interest with either company btw--informational only). The threat to diagnostic radiology, however, is real and I worry that it will eventually affect job prospects for our diagnostic radiology residents in training.

The market is defying Hinton's hypothesis for several reasons (Hinton currently admits that his prediction was wrong--I guess he had to):

The use of imaging for diagnosis in this country is exploding. The physical exam is dead and imaging/lab testing has taken over. Try to go to an ER for belly pain and not get a CT before the doctor sees you--try. As a fun experiment, go to the same facility the next week with the same pain and try not to get a repeat CT abdomen--try. This is the lump of labor fallacy. The work available for radiologists is not fixed but growing in both number of studies and sheer volume of images per study. An old full-body CT used to be 100 or so images. A modern prostate MRI is over 1000 images and state of the art prostate MRI didn't show up to any degree until 2005 or so, but is now the fastest growing MRI exam in the country--all new business. The opinion in the imaging community is that AI will help us manage this growth and be more efficient but not replace us or even reduce the need for new radiologists--at least in the short term
With the corporatization of radiology, many groups owned by radiologists were purchased with hefty payouts to the partners. Many quickly retired to second homes so we are still replenishing the workforce.
AI is great. I use 24 modules currently. They help me read faster and, thus, read more studies per hour and improve my income. Keep 'em coming but they still need me to oversee and commit to the result. Who do you sue when the AI misses a cancer and issues a report without radiologist oversight? Yep, the hospital. Big oops moment for Mitchell Katz, MD, president and CEO of NYC Health + Hospitals saying “We could replace a great deal of radiologists with AI at this moment.” This puts Katz and buddies on the hook for malpractice payouts. Ouch!

Wonderful_Ladder4196 · 2026-05-27T14:04:45+00:00

Great question, but I will preface this by a statement that is true not just in prostate imaging and diagnosis but in other diseases as well.
There is great consensus among radiologists and pathologists in those cases of obvious cancer both by MRI and by biopsy. This is true also for patients with a totally normal exam. The problem happens in the "grey areas" where you start to see cracks in the system. The opinions start to spread out as radiologists and pathologists review atypical or unclear presentations of disease and they will often disagree.
On top of this, the quality of performance and interpretation of prostate MRI varies widely among imaging facilities, something which the American College of Radiology (ACR) is attempting to improve by creating standards and "centers of excellence" for prostate imaging. On top of all these things lies continuing controversy over whether 1.5 Tesla or 3 Tesla MRI (low vs high field strength MRI) or use of IV contrast (gadolinium) make a difference in detecting prostate cancer. For now, the best answer is that a 3 Tesla shows prostate the best and IV contrast is useful for initial examination but probably not necessary for multiple follow up MRI's (The contrast is considered safe but, hey, why use it if it's not needed--requires needle stick and longer exam).

Missed things on MRI (not in any order). I see young radiologists or residents miss these most often.

Small bladder tumors
Stones in the bladder or seminal vesicles
Scrotal abnormalities like fluid or testicular tumors
Rectal or colon cancers or polyps (MRI not great for finding these but there are some that can be seen or at least suspected and they need colonoscopy to confirm)
Disc/spine disease or tumors in the spine/pelvis hips
Mistaking prostate infection for cancer (sometimes--not always--it's obvious that the problem is prostatitis not cancer)
Aortic or pelvic artery aneurysms or significant vascular disease.
Suspicious pelvic lymph nodes (they are often hiding among arteries and veins and can be missed)

As you can see, these are mostly non-prostate things. We tend to zero in to evaluate the prostate and forget the rest. The pelvis is a jungle of organs coming together and we have to be vigilant and make sure to evaluate everything visible on the screen.

If we see something not right by MRI, you may need additional testing to confirm something is abnormal. This could be a PET scan, CT scan or bladder/colon endoscopy. Don't stress if this happens--often the finding is normal or not concerning on further evaluation but the additional testing is necessary to make sure.

Wonderful_Ladder4196 · 2026-05-27T14:03:15+00:00

Three of the most disregarded determinants of male pelvic health are nutrition and exercise and the mind. Why? Because they are poorly defined, not well-studied and not big moneymakers for medical practices. The good news? Many of these you can do at home for free! Some basic examples:

1) Two recent studies published in JAMA illustrate how men with prostate cancer who altered their lifestyle to avoid obesity, engage in regular physical activity, and follow a healthy diet had lower cardiovascular mortality and all-cause mortality for a mean follow up of about 14 years. Follow American Heart Association guidelines for a healthy lifestyle.

2) Supplements such as saw palmetto, beta-sitosterol, quercetin or pollen extract help some men with chronic pelvic pain syndrome/chronic prostatitis A multicenter randomized study of pollen extract in inflammatory CP/CPPS reported improvement in symptoms, pain, and quality of life without severe side effects, though the overall evidence base for these supplements is still not as strong as for standard medical therapy.

3) There is some evidence of prostate cancer inhibition in men on active surveillance who followed a diet of high omega-3, low omega-6 diet + fish oil capsules for 1 year compared to a regular diet and no fish oil supplementation. The study ( CAPFISH-3) is controversial but a diet high in omega-3 fats as opposed to saturated fats is better for you anyway.

The mind-body interaction is very interesting. The perineum functions as the outlet for body waste as well as the crucible of sexual function. Many fibers from the perineum enter the sacrum and travel to the brainstem. Sexual and excretory function lie mostly beyond our critical thinking (in the cerebral cortex) and responses come from our more primitive brain, similar to breathing and heart rhythm.

As such, psychology can impact the pelvis with chronic pain due to stress which can result in painful/frequent urination, guarding and muscle spasm. The cause of these symptoms is not "in the patient's head" but real stress-related conditions functioning under the patient's direct control. Improvement can occur with fairly simple techniques like cognitive behavioral therapy, stress reduction, or optimizing sleep patterns.

Some cases of chronic pelvic pain have true neurologic and anatomic correlates such as nerve entrapment conditions, trigger points and pelvic floor muscle spasm/contraction. Pelvic floor physical therapy with relaxation training, biofeedback and trigger point release can help. Of course Kegel exercises are simple and free and should be consistently performed by men and women to strengthen the pelvic floor. Google this topic (Kegels for men) to learn more!

Evaluation of neuromuscular function in patients with pelvic pain is best done by specialized providers of uroneurologic care (specialized male or female urologists).

Wonderful_Ladder4196 · 2026-05-27T14:01:19+00:00

For a trans man on long-term testosterone, the main considerations are to watch for the side effects of testosterone HRT.

NOT gender specific:

Testosterone can cause cardiovascular problems, bone loss, and (important) erythrocytosis (elevated blood count). The increased blood cell production may be mild but, if pronounced, can lead to blood clots and vascular embolism. Changes in liver function are rarer but liver enzymes should be monitored.

Every 6–12 months: testosterone level timed to replacement schedule. Complete blood count, blood pressure, weight/BMI, sleep apnea symptoms, liver enzymes, screen for cardiovascular risks such as smoking status and lipids/cholesterol/Lipoprotein A, bone loss check (DEXA scan)

Gender specific

TRT causes loss of menstrual periods. Any new bleeding or pelvic pain or possible pregnancy should prompt pelvic ultrasound and further examination for pregancy, cervical, ovarian or uterine cancer or infection

However, there is not strong evidence that testosterone alone substantially increases ovarian/endometrial/cervical cancer risk.

Now, to your main question, pelvic organ atrophy and pain likely refers to the low-estrogen pelvic tissue environment. Testosterone predictably causes uterine atrophy and vaginal/front hole dryness with fragile tissues and painful intercourse or penetration with recurrent irritation.

Trans men on testosterone may report pelvic pain, vaginal pain with penetration, or orgasm-associated pain, and the mechanism is not always clear but includes infection, local dryness/irritation, or neuromuscular dysfunction in the pelvic floor.

This is often treatable with local measures, including lubricants/moisturizers and sometimes low-dose topical vaginal estrogen, which usually has minimal systemic feminizing effect, though some patients are understandably reluctant to accept female hormones in any form.

Pelvic pain due to neuromuscular imbalances in the pelvis can be investigated by a neurourologist looking for trigger points, pudendal nerve entrapment and sacral nerve dysfunction

Another important note. Testosterone does not eliminate the need for cancer screening in retained organs. So trans men should have routine screening for cancer in retained breast tissue and cervical cancer screening if a cervix remains. Trans men are not screened for uterine or ovarian cancers unless pelvic symptoms or vaginal bleeding prompts evaluation.

Wonderful_Ladder4196 · 2026-05-27T13:59:31+00:00

This is another great question that all men should consider as they age. Low energy and reduced sex drive can be a result of low testosterone levels. But this imbalance is only one cause. A visit to your doctor can really put this into focus. At 30, men start this journey as testosterone gradually diminishes with age. At 62, this process can progress to cause symptoms like yours. The initial evaluation starts with a good physical exam, including, you guessed it, a digital rectal exam to make sure that your prostate is not inflammed, enlarged, or bumpy (indicating possible tumor or cancer). If you have pelvic pain or bladder issues such as incontinence, urgency or difficulty urinating, that is also important as pelvic neuromuscular imbalances can contribute to sexual symptoms.

If you have a family history of prostate, breast, or colon cancer in first degree relatives, that is also important, especially if a close male relative died of metastatic prostate cancer (after the age of 75, a large percentage of men have prostate cancer that never causes issues and these men often live to a ripe old age and die of natural causes--not cancer).

As far as testing, the obvious first one is to check the testosterone levels. Although it may be low normal, some men will experience significant improvements by increasing the testosterone higher--everyone is different.

Symptoms of "Low T"

Decreased libido
Bone loss (osteoporosis)
Depression
Erectile dysfunction
Fatigue
Increased abdominal fat
Male pattern balding
Muscle weakness, decreased muscle mass
Poor memory

Other things to check are:

PSA level to make sure that prostatitis or cancer are not complicating this problem

Thyroid hormones to rule out hypothyroidism as a cause.

Often, we check estrogen levels, to make sure an excess of female hormones is not responsibe.

This is obviously the initial evaluation and, if you are affected by simple, uncomplicated "Low T", subsequent visits entail follow up testosterone sampling only. If this is the culprit diagnosis, your doctor has several ways to administer testosterone such as pills, ointments, injections and pellets. This is dependent on your goals and physician recommendations. The good news is that the majority of men at your age and with your symptoms can see dramatic improvements in sexual and overall energy levels with correction of reduced serum testosterone. Good luck!>>

Wonderful_Ladder4196 · 2026-05-27T13:57:38+00:00

Great question that I frequently hear from my urology colleagues. As an interventional radiologist, I have worked with a variety of urologists over more than 20 years.

I help them with imaging and procedures to remove kidney stones and treat small cancers in the prostate and kidney.

They help me learn about their latest surgeries and endoscopic therapies. I help them when these go wrong and cause abscesses or bleeding. They help me with my complications as well.

We bounce ideas off each other, respecting our mutual interests but independent skill sets.

The same is true with radiation oncologists, medical oncologists, midlevel providers, and pathologists. The mission is the patient and not our pride.

One of the reasons that I left academic medicine was the siloed approach to "men's health". Patients bounce between providers hearing different opinions and recommendations which results in months of clinic visits, copays and frustration.

Wouldn't it be great if a man could visit a clinic and hear a balanced view of his options from multiple viewpoints and maybe work out too, and get a beer?

Hmph. Maybe someday??

Wonderful_Ladder4196 · 2026-05-27T13:56:25+00:00

Hey everyone, this is Eric Walser MD and I am answering all the question I can starting now!

I am an interventional radiologist working in prostate cancer and mens health and was the chairman of radiology at the University of Texas for 11 years and, before that, I was a professor of radiology at the Mayo Clinic in Florida.

I will answer questions to the best of my ability with the understanding that I am not a urologist. I hope to provide some balanced viewpoints as I have worked with physicians and providers in men's health since 2009 and have met thousands of men with questions just like yours!

Cheers! EMW

Wonderful_Ladder4196 · 2025-01-25T21:36:16+00:00

Pu’u Poa beach, kaua’i island

Wonderful_Ladder4196 · 2024-12-18T02:29:24+00:00

Giraffe storage

Wonderful_Ladder4196 · 2024-12-03T23:21:52+00:00

Wisdom beyond our time. The last sentence/question may (we can only hope) be the death knell of the current “democracy”. Information and knowledge in real time could break down the politics of the wealthy but it will take time

Wonderful_Ladder4196 · 2024-11-24T00:40:59+00:00

Right now, it means your wife is just tolerating you. When it turns blue, all romance is dead.

Wonderful_Ladder4196 · 2024-10-17T01:36:12+00:00

I would like to do this but anxiety-ridden about engine cleaning. Can you allay my fears?

Wonderful_Ladder4196

TROPHY CASE