1. health and fitness
2. disease
3. cancer

PROSTATE PROBLEMS:
IS TESTOSTERONE REALLY THE CULPRIT?
For both men and women, tes­
tosterone is a vital hormone that
performs many functions.
For men, the “prime of life”
coincides with a time when tes­
tosterone levels are at their peak.
Yet testosterone does not work
alone. It combines with a plenti­
ful enzyme called aromatase to
produce small amounts of the
estrogens, when and where they
are needed.
and growing hair. This hormone
shift, known as “andropause,” is
a gradual one that can have dev­
astating effects on male strength,
energy, and sexual enjoyment. It
also coincides with the onset of
prostate problems.
Testosterone and the estrogens
complement each other, work­
ing to keep each other’s power
in check, while serving many
important health roles. In fact,
male sexuality depends upon
estrogens—as well as testos­
terone—because estrogens are
essential to the brain chemis­
try that triggers natural sexual
function.
As men age, the ratio of testos­
terone to the estrogen hormones
slowly changes. Between the
ages of 25 and 50, a man’s tes­
tosterone level decreases by
approximately 50%, while his
estrogen levels increase by 50%.
In addition, older men produce
larger quantities of aromatase,
causing them to convert more of
their testosterone to estrogens,
which then begin to “turn off”
functions triggered by testoster­
one, such as building muscles
For many years, it was thought
that any increase in testoster­
one levels contributed to the
risk of prostate cancer. This fear
spurred significant controversy
over the use of tes­­tos­terone ther­
apy. However, a review of the
relevant medical literature pub­
lished in The New England Journal
of Medicine concluded that tes­tos­
terone therapy is not associated
with increases in the rate of pros­
tate cancer, or any other prostate
illness.
What is the
Prostate?
Adrenals
Kidneys
Bladder
Urethra
Prostate
Testes
The prostate, the testes and the adrenal
glands all produce male hormones
(known as androgens). The prostate
wraps around the urethra where it
connects to the bladder.
A healthy prostate gland is about
the size of a walnut (see figure).
It is located just below the blad­
der and above the rectum, and it
surrounds the urethra. Its main
role is to produce a thick liquid
that makes up a substantial por­
tion of a man’s semen. Muscles
in the prostate help move sperm
through the ejaculatory duct,
and also help open the bladder
to allow urine to pass through
the urethra. Thus, a healthy
prostate gland is required for
satisfactory performance of both
sexual and urinary functions.
We don’t know exactly how
testosterone and the estrogen
hormones work to maintain
prostate health, but we do know
Continued on Page 2
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that their role is undeniable.
The prostate gland is highly un­
usual in that it increases in size
four different times in a man’s
life—at birth, puberty, young
adulthood, and around age
50. It is probably not a coinci­
dence that these growth spurts
coincide with major hormonal
changes.
Prostate Problems
When hearing “prostate prob­
lem,” men often think first of
prostate cancer. Fortunately,
prostate cancer tends to be very
slow growing and, when diag­
nosed early, is one of the most
curable cancers. For this reason,
most physical exams for men
age 50 and over now include
a thorough digital rectal exam
to check the prostate. If there
is any concern about potential
prostate problems, the patient
or healthcare prac­titioner may
also request a blood draw for a
PSA test, which measures a prostate specific antigen (see box). The
healthcare practitioner is like­
ly to consider the individual’s
symptoms and family medical
history, in addition to the exam
and PSA test results, when eval­
uating prostate health.
The three primary health con­
ditions that affect the prostate
gland are prostatitis, enlarged
prostate (or benign prostatic
hyperplasia, often shortened to
BPH), and prostate cancer.
Prostatitis
Prostatitis, or inflammation of
the prostate, is the least common
prostate condition. It is most of­
ten found in men younger than
45, and is characterized by pain
and discomfort in the pelvic
area, irregular urination, and in
acute cases, chills and fever.
“The prostate receives a plentiful
blood supply, and periodically
becomes congested—two of the
characteristics of organs that are
vulnerable to infections, both
acute and chronic,” explains
Aaron E. Katz, MD, founder of
the Center for Holistic Urology
at Columbia University Medical
Center.
About 10% of prostatitis cases
are bacterial and easily treat­
ed with antibiotics, with the
remainder being a chronic, nonbacterial form whose origins
are not well understood. In his
2006 Guide to Prostate Health, Dr.
Katz notes that holistic medi­
cine is an important part of the
treatment for chronic prostatitis,
which often does not respond
to conventional therapies. His
recommendations include life­
style changes, hydrotherapy, and
herbal and nutritional remedies.
Enlarged Prostate (BPH)
By far the most common prostate
illness is “enlarged prostate,”
or benign prostatic hyperplasia
(BPH), which is the abnormal
but non-cancerous growth of
prostate cells. Half of all men in
the United States over age 60,
and most men over the age of
70, will experience one or more
of the following symptoms of an
enlarged prostate:
PSA Test: What Does It Mean?
The PSA test is a blood test that checks for prostate specific antigen (PSA),
which is a protein produced by the prostate gland that may “leak” into
the bloodstream. In Surviving Prostate Cancer Without Surgery, Dr. Bradley
Hennenfent explains that “The more diseased your prostate, the more likely your prostate is to be swollen and to be leaking its PSA into your bloodstream and the more likely you are to be suffering from prostatitis, BPH or
prostate cancer.”
In general, the higher the PSA level, the more likely cancer is present. However, PSA levels must be interpreted individually and compared over time.
While readings lower than 4.0 were previously thought to be normal, there
is growing consensus that an absolute cutoff level may not exist.
Since its inception in 1986, the PSA test has been credited with detecting
more than 70% of all prostate cancers. Yet it is not a perfect gauge. A few
men with prostate cancer have normal PSA levels. Conversely, most men
with mildly or moderately elevated PSA levels do not have cancer; many
have either BPH or prostatitis. Dr. Hennenfent cites studies showing that
only 25 percent of men who had biopsies after a moderately elevated PSA
test turned out to have prostate cancer. He argues that many biopsies could
be avoided if practitioners simply treated BPH and prostatitis first.
Dr. Hennenfent believes that the single-minded focus on cancer detection
negatively impacts men’s prostate health. “Why allow PSA levels as high as
4.0 to be considered normal, when anything over 1.0 probably indicates
disease?” writes Hennenfent. “Clearly doctors can step in much earlier to
treat prostatitis and BPH, and possibly prevent prostate cancer.”
Continued on Page 3
2
“Why allow PSA levels as high
as 4.0 to be considered normal, when anything over 1.0
probably indicates disease?”
symptoms start to worsen, Dr.
Katz cautions that treatment
should be considered because
severe BPH can lead to seri­
ous health problems over time,
including permanent bladder
damage. Men who experience
any symptoms of BPH—how­
ever minor—would be wise to
see their healthcare practitioner
to be evaluated for the most seri­
ous prostate condition: prostate
cancer.
Prostate Cancer
n Increased frequency
of urination
n Difficulty initiating urination
n Decreased force
of urination
n Reduced urinary flow
n Urinary leakage
n Bladder fullness
even after urination
n Painful urination
n Need to get up to urinate
at night
n Extreme need to urinate
n Urinary blockage (a medical
emergency).
As the prostate grows larger, it
pushes against the urethra and
bladder, blocking the normal
urinary flow. Because the ure­
thra—the tube that carries urine
from the bladder to the penis—
passes through the middle of
the prostate gland, even a small
amount of prostate enlargement
can cause troublesome urinary
symptoms.
No one really knows what
causes the prostate gland to
grow, but a few theories are
emerging, some of which involve
a potent metabolite of testoster­
one called dihydrotestosterone
(DHT). The prostate gland
produces DHT by con­verting
testosterone in the presence of
an enzyme called 5-alpha re­
ductase. As men age and their
testosterone levels fall, DHT lev­
els remain high, suggesting that
this imbalance may be to blame.
According to Dr. Katz, some
studies suggest that men who do
not produce DHT typically do
not develop BPH.
Estrogens are also believed to
play a role in the growth of both
benign and cancerous prostate
cells in aging men. In The Testosterone Syndrome, Dr. Eugene
Shippen mentions a Japanese
study in which men with the
least prostate enlargement had
higher testosterone levels, while
those with the largest prostates
had higher estrogen levels.
When BPH causes only mild
symptoms, healthcare practi­
tioners may advise “watchful
waiting,” using frequent PSA
tests and physical exams to
monitor changes to the prostate.
During this vigil, practitioners
may also recommend lifestyle
changes, and/or herbal medi­
cines and supplements. As
According to the National Can­
cer Institute, prostate cancer is
the second leading cause of can­
cer death among U.S. men, with
nearly 31,000 men succumb­
ing to this dis­ease each year. It
is believed to affect as many as
40 percent of men over age 50,
and the incidence rises with age.
Most patients are older, with 72
being the median age of diagno­
sis. If a man has a fam­­­ily history
of prostate cancer, there is an in­
creased risk, particularly if the
relative was diagnosed prior to
age 50. African Americans are
also at higher risk for this cancer.
In its early stages and as the dis­
ease progresses, prostate cancer
symptoms usually mirror those
of BPH. Typically, the diagnosis
is made when suspicious tissue
is discovered during a digi­
tal rectal exam, prompting the
healthcare practitioner to order a
PSA test. When these results in­
dicate the likelihood of cancer, a
biopsy is performed.
While the cause of prostate
cancer remains unknown, hor­
monal changes are strongly
implicated. Low­ering testoster­
one levels and/or manipulating
its metabolism have proven to be
Continued on Page 4
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important tools for treating
existing prostate cancer. Thus,
treatments for prostate cancer
include a range of hormone
therapies, often referred to as
“androgen blockade.”
As its name implies, andro­
gen blockade is designed to
block one or more of the an­
drogens (male hormones).
The three organs shown in
the figure on page 1 produce
these hormones. The testicles
produce testosterone—by far
the most plentiful male hor­
mone. The adrenal glands
secrete a small amount of
several hormones known
collectively as the “adrenal
androgens” and the prostate
produces DHT.
Other treatments for pros­
tate cancer include surgery
to remove the prostate, ra­
diation, and chemotherapy.
The options offered to any
patient will vary depending
on individual factors, such as
their overall health and the
cancer’s aggressiveness. Pros­
tate cancer is typically very
slow-growing (although this
is not always the case). For
older men with less aggres­
sive tumors and men who
are already in poor health,
healthcare practitioners may
simply advise “watchful
waiting.”
Holistic practitioners often
incorporate nutritional in­
terventions to help thwart
cancer. For example, Dr.
Katz recommends that pros­
tate cancer patients change
their diets to reduce two
factors that may feed pros­
tate cancer: oxidation and
inflammation. According to
Katz, cancerous prostate tis­
sue has higher measurements
of oxidation than non-cancer­
ous tissue. Eating foods rich
in antioxidants, such as fruits
and vegetables, can help
combat oxidation.
Oxidative stress goes hand
in hand with inflammation,
says Dr. Katz. He states that
“some of the best minds in
urological research are mak­
ing a compelling case that
chronic inflammation is a
precursor of prostate cancer.”
Dr. Katz recommends us­
ing anti-inflammatory herbs
or supplements as a precau­
tionary measure. Such herbs
include holy basil, ginger,
turmeric, green tea, oregano,
rosemary, and several tradi­
tional Chinese herbs.
Testosterone Therapy
& Prostate Cancer Risk
Numerous studies have estab­
lished that severely limiting
testosterone can cause pros­
tate cancer to shrink, at least
temporarily. From this fact
grew the corresponding belief
that raising testosterone levels
would promote the growth of
prostate cancer.
A review of the medical lit­
erature performed by Dr.
Ernani L. Rhoden and Dr.
Abraham Morgentaler (pub­
lished in the January 2004
issue of The New England
Journal of Medicine) found no
evidence that testosterone
treatment causes prostate can­
cer, or that men with higher
testosterone levels have high­
er rates of prostate cancer. In
fact, they note that prostate
cancer becomes more preva­
lent exactly at the time in a
man’s life when testosterone
levels decline.
Testosterone therapy also did
not consistently worsen the
urinary symptoms experi­
enced by men with prostate
enlargement, say the authors.
“The impact of testosterone
therapy on benign prostate
“Men with low testosterone levels who
received testosterone therapy realized improvement in every parameter measured.”
Continued on Page 5
4
“Normal concentrations of
testosterone and its more
powerful derivative may well
be harbingers of prostatic
health, not illness.”
growth appears to be mild,”
writes Rhoden, “and rarely of
clinical significance.”
A 2002 study published in the
International Journal of Andrology claims that testosterone
therapy may even benefit
prostate health. The authors
say 187 of 207 men with low
testosterone levels who re­
ceived testosterone therapy
realized improvement in ev­
ery parameter measured:
their prostate glands all de­
creased in size, their PSA
numbers went lower, and
urinary symptoms such as
frequency and urgency all
improved.
hormone processor. When
the liver is unable to process
hormones as quickly or effec­
tively as it should, a hormone
imbalance can result.
Estrogens, in particular, are
slowly metabolized by the
liver. For this reason, it is
thought that improving es­
trogen metabolism may help
improve hormone balance in
older men.
Hormone
Metabolism
Cruciferous vegetables, such
as broccoli and cabbage, have
been identified as helpful in
maintaining balanced estro­
gen metabolites. When your
body digests these vegetables,
it produces a phytochemical
called indole-3-carbinol (I3C).
Some studies show that it can
inhibit the growth of prostate
cancer cells.
When seeking to understand
the effects of testosterone
levels on the prostate gland,
it is important to understand
how the body metabolizes
(breaks down) hormones. The
key organ in this metabolism
is the liver, which acts as a
Food supplements can have
both positive and negative
effects on estrogen metabo­
lism, notes Dr. Shippen, who
explains that grapefruit tends
to inhibit the liver’s break­
down of estrogens, while
cruciferous vegetables, such
as broccoli and cauliflower,
stimulate it. Zinc is believed
to be especially helpful be­
cause it inhibits aromatase,
the enzyme used by testos­
terone to create estrogens.
“Many men will restore a
proper balance of testosterone
to estrogen purely through
the use of zinc,” says Shippen.
A vicious cycle can begin for
a middle-aged man strug­
gling to achieve and maintain
hormone balance, Dr. Ship­
pen explains. A declining
testosterone level “predispos­
es him to weight gain. Weight
gain increases his estrogen
level and estrogen stimulates
SHBG [sex hormone-bind­
ing globulin, a protein in the
blood that binds testosterone]
... crippling the effective­
ness of the hormone, which
may cause more weight gain,
which increases estrogen
and so on.” In addition, alco­
hol use can lower the liver’s
ability to properly eliminate
estrogens from the body, Dr.
Shippen adds, while age and
zinc deficiencies may increase
aromatase, causing more of
a man’s testosterone to be
turned into estrogens, further
stimulating SHBG, which re­
peats the cycle.
Conclusion
All organs of the male repro­
ductive system, including the
prostate, tend to stay healthy
in the presence of adequate
levels of key hormones, in­
cluding testosterone, says Dr.
Shippen. “Normal concen­
trations of testosterone and
its more powerful derivative
may well be harbingers of
prostatic health, not illness.”
Continued on Page 6
5
References
n The Testosterone Syndrome by Eugene
Shippen, MD, and William Fryer; M.
Evans and Company, Inc.; New York,
NY; 1998.
The following materials were used as re­
sources in writing this newsletter.
n A New Perspective on Male Hormones:
The Yin Yang of Estrogen and Testosterone
published by Women’s International
Pharmacy; November 2000.
n Surviving Prostate Cancer Without Surgery by Bradley Hennenfent, MD;
Roseville Books; Roseville, IL; 2005.
n “Androgen administration in mid­
dle-aged and aging men: effects of
oral testosterone undecanoate on di­
hydrotestosterone, oestradiol, and
prostate volume,” by A. V. Pechersky,
V. I. Mazurov, V. F. Semiglazov, A. I.
Karpischenko, V. V. Mikhailichenko, A.
V. Udintsev; International Journal of Andrology, 25 (2), 119–125; April 2002.
n “Risks of Testosterone-Replacement
Ther­apy and Recommendations for
Mon­itoring” by Ernani Luis Rhoden,
MD, and Abraham Morgentaler, MD;
The New England Journal of Medicine,
Volume 350: 482492; January 29, 2004.
n Dr. Katz’s Guide to Prostate Health by
Aaron E. Katz, MD; Freedom Press; To­
panga, CA; 2006.
n The Liver’s Role in Hormone Balance
published by Women’s International
Pharmacy; May 2005.
Connections is a publication of Women’s International Pharmacy, which is dedicated to the education and management of PMS, menopause, infertility, postpartum depression, and other hormone-related conditions and therapies.
This publication is distributed with the understanding that it does not constitute medical advice for individual problems.
Although material is intended to be accurate, please seek proper medical advice from a competent healthcare professional.
Publisher: Constance Kindschi Hegerfeld, Executive VP, Women’s International Pharmacy
Co-Editors: Michelle Davenport and Carol Petersen, RPh, CNP; Women’s International Pharmacy
Writer: Kathleen McCormick, McCormick Communications Illustrator: Amelia Janes, Midwest Educational Graphics
Copyright © September 2007, Women’s International Pharmacy. This newsletter may not be reproduced or distributed without the permission of Women’s International Pharmacy.
®
For more information, please visit www.womensinternational.com or call (800) 279-5708.
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