Madman has given you great info.
Here’s the full combined reply:
Vic, your situation is genuinely complex and you deserve a thoughtful, nuanced answer — not a one-size-fits-all response.
Your history — HIV since 1986, non-Hodgkin’s lymphoma, chemotherapy-induced hypogonadism and adrenal insufficiency, decades of successful TRT, and now BPH with urinary retention triggered by testosterone — puts you in a category that most TRT discussions simply don’t address adequately.
Let’s work through this carefully.
Why is testosterone causing urinary retention after Aquablation?
This is the key question. Testosterone stimulates prostate tissue partly through its conversion to DHT (dihydrotestosterone), which can worsen lower urinary tract symptoms (LUTS). However, you had Aquablation specifically to resolve BPH obstruction — so immediate retention after low-dose gel suggests one or more of these possibilities:
∙ The prostate is still healing or inflamed post-procedure
∙ You may be a high DHT converter
∙ There could be a secondary issue worth investigating — urethral stricture or bladder dysfunction
Before giving up on testosterone entirely, there is a very reasonable next step.
Consider an Alpha-1 Blocker First
Rather than a 5-alpha reductase inhibitor (finasteride, dutasteride) — which I would not recommend given their well-documented risk of sexual side effects including erectile dysfunction, loss of libido, and in some men persistent post-finasteride syndrome — alpha-1 blockers are a far better fit for your situation.
Medications like tamsulosin (Flomax, 0.4mg) or silodosin (Rapaflo) work by relaxing smooth muscle in the prostate and bladder neck. Key advantages for you specifically:
∙ No hormonal interference — they don’t affect DHT or blunt testosterone’s benefits
∙ Fast acting — urinary symptom relief often within days, not months like 5-ARIs
∙ No sexual side effects — some men actually report improved sensation
∙ Well tolerated in older men and generally in HIV+ patients, though drug interactions with your antiretrovirals should be reviewed with your pharmacist or HIV specialist
∙ Tamsulosin is the most commonly used and best studied option
One important caution: Alpha blockers can cause orthostatic hypotension (dizziness when standing up), which is worth monitoring carefully at 70, particularly if you take any blood pressure medications.
A Practical Path Forward
Here is a reasonable stepwise approach to discuss with your doctors:
1. Start an alpha-1 blocker (tamsulosin 0.4mg is the typical first choice) and allow 2–4 weeks to assess urinary symptom relief
2. Allow adequate healing time post-Aquablation — prostate tissue can remain reactive for several months after the procedure
3. Cautiously reintroduce very low-dose testosterone — a small 25 mg subcutaneous injection 3 times per week may actually be easier to titrate than gel, and avoids the variable absorption that gel carries
4. Monitor closely — urinary flow rate, symptom scores, and testosterone levels together
Don’t overlook the bigger picture
At a testosterone level of 90 ng/dL, you are almost certainly experiencing real consequences — fatigue, muscle loss, cognitive changes, mood shifts, and accelerating bone density decline. These are not trivial at 70, and they are especially significant given your HIV history.
Long-term HIV and antiretroviral therapy are themselves independently associated with hypogonadism, metabolic dysfunction, and osteoporosis. Your HIV/infectious disease specialist should be part of this conversation alongside your
urologist and endocrinologist. This is a case that calls for a team approach.
Your adrenal insufficiency history also matters here — low testosterone in that context is not just a quality-of-life issue. It has real physiological implications.
You have been navigating extraordinarily complex medical terrain for nearly 40 years. You deserve better than simply being told to stop testosterone and live with it. Push for a joint consultation between your
urologist and endocrinologist, specifically asking about:
∙ Alpha-1 blocker therapy as a bridge and ongoing support for urinary function
∙ Low-dose testosterone reintroduction once urinary symptoms are controlled
∙ Bone density assessment (DEXA scan) given your cumulative risk factors
∙ Review of drug interactions between any new medications and your HIV regimen
You have options. Don’t give up on this yet.
— Nelson
PS: also poz here since 1986 and had lymphoma.
