Differential Diagnosis for Bladder Leakage in a Biological Male with Low Testosterone and Anti-Androgen Medication

• Single Most Likely Diagnosis
  • Benign Prostatic Hyperplasia (BPH): The patient's symptoms of bladder leakage following urination, combined with the effects of low testosterone and anti-androgen medication, suggest an enlarged prostate. BPH is common in males and can cause urinary retention, leading to leakage.
• Other Likely Diagnoses
  • Urinary Tract Infection (UTI): Bacterial infections can cause irritation to the bladder and urethra, leading to leakage. The patient's use of anti-androgen medication may increase the risk of UTIs.
  • Overactive Bladder: This condition can cause a sudden, intense urge to urinate, resulting in leakage. The patient's low testosterone levels and anti-androgen medication may contribute to overactive bladder symptoms.
  • Detrusor Underactivity: This condition, characterized by a weak bladder muscle, can cause incomplete bladder emptying, leading to leakage. The patient's medication and hormonal status may affect bladder muscle function.
• Do Not Miss Diagnoses
  • Prostate Cancer: Although less likely, prostate cancer can cause urinary symptoms, including leakage. Given the patient's age and use of anti-androgen medication, it is essential to rule out prostate cancer.
  • Neurogenic Bladder: A neurological condition affecting bladder function can cause leakage. Conditions like multiple sclerosis, spinal cord injuries, or diabetes can lead to neurogenic bladder, and it is crucial to consider these possibilities.
• Rare Diagnoses
  • Urethral Stricture: A narrowing of the urethra can cause urinary retention and leakage. Although rare, it is essential to consider this possibility, especially if the patient has a history of trauma or instrumentation.
  • Bladder Neck Contracture: Scarring at the bladder neck can cause urinary retention and leakage. This condition is rare but can occur in patients with a history of prostate surgery or radiation therapy.