A Psychedelic Pharmacist Warns MDMA Could Make It Hard to Urinate for Men With Enlarged Prostates
Dr. Ben Malcolm, a pharmacist who specializes in psychedelic drug interactions, is flagging a risk that rarely comes up in MDMA discussions: men with an enlarged prostate (benign prostatic hyperplasia, or BPH) may have trouble urinating after a dose. MDMA strongly boosts norepinephrine, which tightens the muscle where the bladder meets the prostate, the opposite of what prostate drugs like tamsulosin (Flomax) do. Emergency doctors have published case reports of MDMA-linked urinary retention since 1995, in the BMJ and BJU International, and a 2008 case described lasting bladder problems after heavy, chronic use. Malcolm is clear about the limits. He calls the BPH link "an extrapolation" and says "this is not a contraindication," since no study has looked at men with BPH taking MDMA. His advice: empty the bladder before dosing and every couple of hours after, see a urologist first if you already have trouble urinating, and get care if you can't go for six to eight hours despite the urge. He also suggests clinicians ask about urinary symptoms, which patients rarely volunteer, and consider keeping men on their prostate medication during sessions.
Why it matters now: Resilient Pharmaceuticals' MDMA drug, Rysanso, is under FDA review for PTSD, and many of the people it would treat, including older veterans, are in the age group most likely to have an enlarged prostate. Malcolm sells consulting and paid memberships through Spirit Pharmacist; this post isn't tied to a product. This is journalism, not medical advice, and MDMA is not FDA-approved for any use.