Saw Palmetto

[cjsabbath]

Forgive me if this has been addressed before - but I could not find it.

Anyhoo - as is the case with a lot of older bros I am dealing with frequent night time urination. I can't seem to sleep more than 5 hours without having to get up and pee - sometimes twice a night it seems. As I already deal with anxiety and depression - it can be a challenge falling back to sleep sometimes.

I watch my fluid intake and limit coffee/soda esp - but still no relief.

The question I have is - is there any harm in trying saw palmetto to help alleviate this issue? My PSA's are fine both pre and post TRT - so I am wondering whether this is a viable option for me.

I'm currently on Paxil (10mg), Dilantin (600 mg) and, of course, TRT (Androgel 5mg).

Thanks guys!

CJ

[HeadDoc]

did the doc do a digital rectal eval to check for swelling of the prostate before starting trt? This would rule out bph. There is no contraindication for saw palmetto as best I know. It may help to reduce the urgency and swelling. Many middle aged males start saw palmetto in their forties. Getting up one time per night in the 40's and twice in 50's is not unlikely. Taking the paxil early or late in the day may be another factor to test. People have different sensitivities to the elevated seritonin. Marianco may want to chime in on this.

[cjsabbath]

Originally Posted by HeadDoc

did the doc do a digital rectal eval to check for swelling of the prostate before starting trt? This would rule out bph. There is no contraindication for saw palmetto as best I know. It may help to reduce the urgency and swelling. Many middle aged males start saw palmetto in their forties. Getting up one time per night in the 40's and twice in 50's is not unlikely. Taking the paxil early or late in the day may be another factor to test. People have different sensitivities to the elevated seritonin. Marianco may want to chime in on this.

No he did not - just the standard PSA pre and post TRT with no change whatsoever in the readings (well within normal range.)

I have started tinkering with the time I take Paxil in the hopes that it may improve my sleep patterns.

Thanks HeadDoc!

[pmgamer18]

Originally Posted by cjsabbath

Forgive me if this has been addressed before - but I could not find it.

Anyhoo - as is the case with a lot of older bros I am dealing with frequent night time urination. I can't seem to sleep more than 5 hours without having to get up and pee - sometimes twice a night it seems. As I already deal with anxiety and depression - it can be a challenge falling back to sleep sometimes.

I watch my fluid intake and limit coffee/soda esp - but still no relief.

The question I have is - is there any harm in trying saw palmetto to help alleviate this issue? My PSA's are fine both pre and post TRT - so I am wondering whether this is a viable option for me.

I'm currently on Paxil (10mg), Dilantin (600 mg) and, of course, TRT (Androgel 5mg).

Thanks guys!

CJ

When I went on Prozac it slowed my voiding down and made it hard to reach an orgasm. Now this was before TRT over 21 yrs ago. They then put me on Paxil and this med was worse. Try doing "Wellburtin spelling is not right" SSRI's did this to me and some sinis meds. They slowed down my voiding after going on TRT when this came back later it was high E2 Estradiol doing it.

[marianco]

Originally Posted by cjsabbath

Anyhoo - as is the case with a lot of older bros I am dealing with frequent night time urination. I can't seem to sleep more than 5 hours without having to get up and pee - sometimes twice a night it seems. As I already deal with anxiety and depression - it can be a challenge falling back to sleep sometimes. ----- The question I have is - is there any harm in trying saw palmetto to help alleviate this issue? My PSA's are fine both pre and post TRT - so I am wondering whether this is a viable option for me. ----- I'm currently on Paxil (10mg), Dilantin (600 mg) and, of course, TRT (Androgel 5mg). CJ

Summary: Problem of night time urinary frequency in an older man causing impairment in sleep. Additional problems of anxiety, depression, hypogonadism, and (?)epilepsy (though Dilantin is sometimes used to stabilize mood and reduce anxiety). On Paxil, Dilantin, and Androgel. Interested in the use of Saw Palmetto to treat urinary frequency.

1. Here is a summary from American Family Physician, March 15, 2003 (http://www.aafp.org/afp/20030315/1281.html):

Key Points About Saw Palmetto:
Efficacy Reducing symptoms of BPH: effective
Treatment of chronic prostatitis: evidence lacking
Adverse effects: Mild gastrointestinal distress: infrequent
Not known to interfere with the diagnosis of prostate cancer
Interactions: No known drug interactions
Dosage: Varies; most studies have used 160 mg twice daily or 320 mg once daily
Cost: $6 to $20 per month, depending on brand, for a dosage of 160 mg twice daily
Bottom line: Safe herbal medicine; effective for treatment of symptoms of BPH

2. The problem of treating nighttime urinary frequency with saw palmetto is that the actual cause of the urinary frequency is not known. Thus the treatment is a shot-in-the-dark. Maybe it will work, maybe not.

3. From what I know, so far, at least saw palmetto is relatively safe. Saw Palmetto further appears to inhibit the type of alpha-reductase enzyme that exists only in the prostate as opposed to the rest of the body. Thus it reduces DHT (dihydrotestosterone) levels primarily in the prostate. Rarely have I seen it reduce overall DHT levels - both in person and on anecdotal accounts in various forums.

4. Paxil is an interesting medication. None of the antidepressants are pure in what they do. This accounts for many side effects. Serotonin-Reuptake Inhibitors (such as Paxil) not only inhibit serotonin reuptake (their primary effect), but also to various degrees: 1) inhibit norepinepinephrine reuptake, 2) inhibit dopamine reuptake, 3) reduce dopamine production, 4) block muscarinic acetylcholine receptors, 5) inhibit nitric oxide synthetase, 6) block cytochrome 450 enzyme 2D6, 3A4, and 1A2, etc. Paxil, itself, is unique in that by blocking 2D6 strongly and by being a substrate itself of 2D6, its pharmacokinetics is almost exponential. This means if you double the dose, the effective concentration of Paxil may go up up to 9 times - not 2 times.

5. There are many causes of urinary frequency, including:
1) prostatic hypertrophy (enlarged prostate). This mechanically prevents a person from fully emptying the bladder, leading to frequent filling of the bladder, and urinary frequency.
2) urinary retention from blocking muscarinic acetylcholine receptors (usually called the anticholinergic effect of a medication such as Paxil - which depends on age and susceptibility to this side effect). This prevents a person from relaxing the bladder sphincter, preventing full emptying of the bladder, causing a similar problem to prostatic hypertrophy.
3) conditions causing fluid retention and lower extremity edema (such as heart failure or insufficiency). When the person lies down, the fluid is shifted from the legs to the trunk, allowing the kidneys to filter it and send it to the bladder, contributing to urinary frequency. Heart failure itself may contribute to anxiety and depression.

An evaluation from a physician is needed to find out what is causing the urinary frequency.

6. Unless there are psychological and genetic roots to the anxiety and depression, in older men, a common cause of depression and anxiety is having low testosterone activity (hypogonadism). Without testosterone, estrogen's effects become unbalanced. Testosterone has a calming, mood elevating effect. Estrogen causes irritability, anxiety, and may contribute to depressed mood (through multiple actions).

7. Treatment with testosterone replacement before antidepressant treatment - in my current framework - should be done since it sets up the floor on which the antidepressant - if needed at all - can work. Without testosterone replacement (or progesterone and testosterone replacement in women), people with significant depression and anxiety will only get a partial response to treatment with antidepressants.

8. Another problem with starting first with antidepressant treatment (such as with an SSRI) is that by increasing serotonin levels, dopamine levels are automatically reduced. This itself may reduce testosterone production. Further SSRIs can block nitric oxide production - which is needed to have an erection. Starting first with Testosterone replacement avoids these problems.

9. Wellbutrin is a great antidepressant. It works primarily by increasing norepinephrine levels in the brain. It generally is "clean" in causing few side effects. However, it has some "anticholinergic-like" actions (the exact mechanism of action is not clear) - including dry mouth, constipation, dry eyes, possible urinary retention. Wellbutrin may increase the likelihood of seizures. It acts primarily as a stimulant - thus may increase anxiety and stress, increase blood pressure, contribute to insomnia, cause jitteriness and tremors. By its stimulant effects, it helps improve attention (e.g. in attention deficit/hyperactivity disorder). I generally would not give Wellbutrin to an anxious person until anxiety is significantly reduced.

[pmgamer18]

Wow marianco that was so dam good to read I think I hurt my self.

[cjsabbath]

Originally Posted by marianco

Summary: Problem of night time urinary frequency in an older man causing impairment in sleep. Additional problems of anxiety, depression, hypogonadism, and (?)epilepsy (though Dilantin is sometimes used to stabilize mood and reduce anxiety). On Paxil, Dilantin, and Androgel. Interested in the use of Saw Palmetto to treat urinary frequency.

1. Here is a summary from American Family Physician, March 15, 2003 (http://www.aafp.org/afp/20030315/1281.html):

Key Points About Saw Palmetto:
Efficacy Reducing symptoms of BPH: effective
Treatment of chronic prostatitis: evidence lacking
Adverse effects: Mild gastrointestinal distress: infrequent
Not known to interfere with the diagnosis of prostate cancer
Interactions: No known drug interactions
Dosage: Varies; most studies have used 160 mg twice daily or 320 mg once daily
Cost: $6 to $20 per month, depending on brand, for a dosage of 160 mg twice daily
Bottom line: Safe herbal medicine; effective for treatment of symptoms of BPH

2. The problem of treating nighttime urinary frequency with saw palmetto is that the actual cause of the urinary frequency is not known. Thus the treatment is a shot-in-the-dark. Maybe it will work, maybe not.

3. From what I know, so far, at least saw palmetto is relatively safe. Saw Palmetto further appears to inhibit the type of alpha-reductase enzyme that exists only in the prostate as opposed to the rest of the body. Thus it reduces DHT (dihydrotestosterone) levels primarily in the prostate. Rarely have I seen it reduce overall DHT levels - both in person and on anecdotal accounts in various forums.

4. Paxil is an interesting medication. None of the antidepressants are pure in what they do. This accounts for many side effects. Serotonin-Reuptake Inhibitors (such as Paxil) not only inhibit serotonin reuptake (their primary effect), but also to various degrees: 1) inhibit norepinepinephrine reuptake, 2) inhibit dopamine reuptake, 3) reduce dopamine production, 4) block muscarinic acetylcholine receptors, 5) inhibit nitric oxide synthetase, 6) block cytochrome 450 enzyme 2D6, 3A4, and 1A2, etc. Paxil, itself, is unique in that by blocking 2D6 strongly and by being a substrate itself of 2D6, its pharmacokinetics is almost exponential. This means if you double the dose, the effective concentration of Paxil may go up up to 9 times - not 2 times.

5. There are many causes of urinary frequency, including:
1) prostatic hypertrophy (enlarged prostate). This mechanically prevents a person from fully emptying the bladder, leading to frequent filling of the bladder, and urinary frequency.
2) urinary retention from blocking muscarinic acetylcholine receptors (usually called the anticholinergic effect of a medication such as Paxil - which depends on age and susceptibility to this side effect). This prevents a person from relaxing the bladder sphincter, preventing full emptying of the bladder, causing a similar problem to prostatic hypertrophy.
3) conditions causing fluid retention and lower extremity edema (such as heart failure or insufficiency). When the person lies down, the fluid is shifted from the legs to the trunk, allowing the kidneys to filter it and send it to the bladder, contributing to urinary frequency. Heart failure itself may contribute to anxiety and depression.

An evaluation from a physician is needed to find out what is causing the urinary frequency.

6. Unless there are psychological and genetic roots to the anxiety and depression, in older men, a common cause of depression and anxiety is having low testosterone activity (hypogonadism). Without testosterone, estrogen's effects become unbalanced. Testosterone has a calming, mood elevating effect. Estrogen causes irritability, anxiety, and may contribute to depressed mood (through multiple actions).

7. Treatment with testosterone replacement before antidepressant treatment - in my current framework - should be done since it sets up the floor on which the antidepressant - if needed at all - can work. Without testosterone replacement (or progesterone and testosterone replacement in women), people with significant depression and anxiety will only get a partial response to treatment with antidepressants.

8. Another problem with starting first with antidepressant treatment (such as with an SSRI) is that by increasing serotonin levels, dopamine levels are automatically reduced. This itself may reduce testosterone production. Further SSRIs can block nitric oxide production - which is needed to have an erection. Starting first with Testosterone replacement avoids these problems.

9. Wellbutrin is a great antidepressant. It works primarily by increasing norepinephrine levels in the brain. It generally is "clean" in causing few side effects. However, it has some "anticholinergic-like" actions (the exact mechanism of action is not clear) - including dry mouth, constipation, dry eyes, possible urinary retention. Wellbutrin may increase the likelihood of seizures. It acts primarily as a stimulant - thus may increase anxiety and stress, increase blood pressure, contribute to insomnia, cause jitteriness and tremors. By its stimulant effects, it helps improve attention (e.g. in attention deficit/hyperactivity disorder). I generally would not give Wellbutrin to an anxious person until anxiety is significantly reduced.

I cannot thank you enough Doctor. I am also going to see my endo about possible hormonal imbalance as well - which after years on Paxil and Dilantin - may also be a contributing factor in my sleep.

I truly do not want to increase Paxil and/or go back on benzo's...

This board is fantastic.