A 67-year-old white man presented in November 1995 complaining of scrotal pain and right inguinal pain 1 month in duration despite 3 courses of antibiotic therapy, which included ciprofloxacin, tetracycline and trimethoprimsulfamethoxazole. Medical history was significant for an ankle fracture, cholecystectomy and several inguinal herniorrhaphies. He had no known drug allergies. Other history was significant for arthritis and urinary calculi (calcium oxalate). Medications included simvastatin, hydroxyzine pamoate and diclofenac sodium. An excretory urogram obtained elsewhere ruled out urinary calculi. Other urinary symptoms included nocturia 2 to 4 times and a weak stream with spraying. Physical examination revealed a well developed, well nourished man with a circumcised penis free of plaques or lesions and no evidence of gynecomastia. The testes were descended into the scrotum, and were normal in size, shape, position and consistency, with small bilateral hydroceles. The prostate was tender, boggy and nonnodular. Laboratory evaluations included a prostate specific antigen of 1.9 ng./ml. (normal 0 to 4) and a low total testosterone of 240 ng./dl. (normal 300 to 1,000) with a low free testosterone of 2.06 ng./dl. (normal 2.50 to 10.50) and a free testosterone of 0.86% (normal 0.6 to 1.75). Prostatitis and epididymitis were diagnosed. Amoxicillin was prescribed for prostatitis as well as sitz baths and doxazosin for BPH. Subsequently, a recurrent right inguinal hernia was discovered and herniorrhaphy was performed in December 1995. The patient remained on doxazosin during this period. Followup in February 1996 revealed that the symptoms had improved. However, because of persistent prostatic tenderness and nocturia times 2 he was started on finasteride. In April the patient presented for evaluation of unilateral gynecomastia. He had a 3-month history of tenderness in the left breast followed by enlargement with no change in libido or sexual function. Of note, he had episodic sexual dysfunc-