Up until this point, I had no signs of trouble with my prostate, and I was in generally good health. Yes, my blood pressure had been a little bit high, and meds were prescribed that brought it under control. Yes, my blood sugar was “high” (A1C of 6.9). Yes, my cholesterol and triglycerides are high. However, my last two PSA tests, in 2019 and 2022, were 2.8 and 2.3. While I had some difficulty urinating first thing in the morning, my PVR (post void residual, a semiautomated test using ultrasound to see how much urine is in your bladder) at my appointment that evening was 64 ml- not exactly abnormal. But, all things considered, I was diagnosed with BPH and given a prescription for Flomax (tamsulosin). After all, I’m 55: and apparently a majority of men my age have some prostate swelling.

A month later, my infection has resolved, and my PVR is down to 27. It’s not entirely clear to me from the results at the toilet that it’s “working”, but can’t argue with numbers.

Later that year, at my annual checkup, my cholesterol numbers are still elevated, and I’ve now got a A1C of 7.1, so I agree to increase my dose of rosuvastatin from 20 to 40mg, and start metformin ER. I suspect that’s when I began to run off the modern medicine rails.

At my followup, my kidney numbers start taking a turn, and I’ve got elevated protein in my urine. Suspecting a worsening effect of T2 diabetes on my kidneys, my doctor prescribes Jardiance (empagliflozin), which one tablet in sends me into the ER with low blood pressure/dizzyness. OK, so that doesn’t work. But my kidney numbers still are getting worse, and I am sent for a battery of tests including an ultrasound. Tests include various STD panels (negative for HIV, hepatitis, treponema/syphilis), panels for less common causes (TSH, antistreptolysin, ANCA, C3/C4, IGG, Smith Antibodies), but my EGFR (75) and urine protein (178 mg/dL) and creatinine (127 mg/dL) levels are still in “partial kidney failure” mode, and I have both casts and a tiny amount of blood measured in my urine. Ultrasound shows both tiny stones and a large number of cysts, and I get sent back to the urologist, who “isn’t worried” about my kidneys but says the ultrasound of my prostate (done very quickly at the end of the kidney ultrasound) looks “unusual”. I’m now scheduled for a cystoscopy. I asked the urologist what he thought of Proscar(finasteride), and his response was that based on the “shape” of the prostate, he doesn’t recommend it at this time.

Meanwhile, I ask my GP if stopping the statin was good idea, to see if that’s the cause of my kidney numbers, and she agrees. I’m due for another set of measurements of my kidney function. Mind you, I can’t “feel” any of these things- no pain in my kidneys, no “unusual” pain urinating. I think for a lot of men, we don’t often think about our urogenital health unless the darn thing falls off.

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OK, so now you know a lot of medical information about a complete stranger. But here’s another thing: I don’t see myself as a “typical” middle aged man. You see, I don’t really identify with being a man at all- I know i’m male, and use he/they pronouns (with the “they” a pretty recent addition), and have identified as bi for over 30 years, but… I’m not squeamish about my urogenital or sexual health. I’m not worried about being perceived as a “man”, certainly not a typical one. I also have no distinct memory of ever having difficulty with erections. When I look around at what other men are calling out as their “state”, it really doesn’t seem like I’m having a typical trajectory. Some of my peers, slightly older, have gone through prostate surgery of some form, and many are using various ED medications. So, I’m not sure: am I about to join the majority of my peer group and start having issues with my urogenital health?

This is the big unknown that I’ve started this Substack to address- what’s it like to be on either side of the prostate-enlarged divide? I feel like I’ve had my prostate very visibly inflicted on me- to this point, I only very tangentially know, and have never sought to learn much, about my prostate. I feel like my prostate has been inflicted on me- like, now, at the age of 55, I’ve finally been “prostated”.

I’d like to summarize what I’ve learned, what I suspect and don’t understand, and what I actively disagree with. It’s going to be a journey, and you’re joining in-flight. I’m going to try to be very, if not excessively, open. There will be TMI.

One of the biggest unanswered questions I have goes back to the inciting event- epididymitis. Presumably, the theory goes, bacteria (from where?) traveled from my urethra, through the prostate, into the seminal ducts and down the vas deferens, through a 25+ year old vasectomy scar, and into my epididymis. But that seems… implausible.

Despite being a scientist with cconsiderable biology training, I have to confess I either don’t remember or were never taught how the basic plumbing of the testicles to the penis operates. So I’m in need of education, and if I learn things, I’d like to share that knowledge here in a single source of (hopefully) truth. I’d like to know more, particularly since I’m now on a journey from where I started, two years ago, where I was “healthy”, to wherever I am heading. Perhaps, back to “healthy”. Or, elsewhere.

What’s it like to get a cystoscopy, for instance? I’ve had routine colonoscopies, so a big-ass camera that looks like something out of the Matrix movies going up my urethra is probably not the image I want to be left with. I’ve heard stories from “a few minutes with a local” to “I needed to be knocked out”, but the doctor seems to be scheduling on the idea a camera will be threaded through my penis all the way up into my bladder in “a few minutes”. Next month, I’ll let you know.

I don’t know yet what posting frequency or cadence I will maintain on this subject, but my intent here is to post at least twice a month. I will be discussing the health of “men”, that is, people AMAB. I will cover topics of prostate health, sexual health, personal anecdotes, and other related topics as thy come up. Please join me on this journey.

thanks,

-matt

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