Men's health: The Prostate Gland

Are you experiencing these signs and symptoms?

• Difficulty in passing urine
  
• Dribbling, unable to stop urine completely towards the end of urination, wetting the underwear
• Increased frequency of urination
• Increased night urination
• Raised PSA (Prostate Specific Antigen; Normal levels <4ng/ml)
• Age group 51-60 years old (affects 1 in 2 men of this age group)
• Suffering silently, thinking that it is due to natural aging process
• Avoiding travelling and social functions

The prostate is not one big gland but a tissue containing some sparse gland embedded in abundant fibrous tissue and surrounded on the outside by a capsule mainly made of muscles.

On the outside, a robust muscular capsule surrounds the prostate. Its muscular fibres are nourished and maintained mainly by testosterone. When the levels of testosterone drop with aging, the deficiency allows the capsule to degenerate and its muscle fibres to be slowly replaced by fibrous tissue. The fibrosis prevents the prostate from contracting and propelling prostate liquid from the glands into the urethra during intercourse, an essential function of the prostate.

Inside the prostate, about 65% of the space is occupied by hard, fibrous tissue called stroma. The stroma increases depending on the levels of female hormone estradiol. When estradiol levels are too high, stroma overwhelms the inside of the prostate, occupying up to 95% of the space, while it should normally not exceed 65%.

The rest of the prostate is made of small glands that give the soft feeling to the healthy prostate upon digital rectal exam. These glands also depend on male hormones for their well-being, in particular on dihydrotestosterone (DHT). If levels of DHT decline, for example, with aging or by taking finasteride (Proscar®), which decreases dihydrotestosterone production by blocking the enzyme 5-alpha-reductase that converts testosterone to DHT, the glands atrophy and perish. A long term use of finasteride and other 5-alpha-reductase blockers can adversely affect the prostate.

Men who suffer from benign prostatic hypertrophy (BPH) have dysuria (difficulty urinating) and are often prescribed blockers of the production of DHT such as finasteride. The first few months of intake of a 5-alpha-reductase blocker, patients may feel relieved and experience urination improvement. The improvement is due to shrinkage of the small glands within the prostate, caused my the decreased level of DHT. Unfortunately, on long-term basis, the coexistence of low DHT and high estradiol levels stimulates wild proliferation of the stroma. The expansion of stroma considerably increases the size of the prostate, but, worse, it transforms it into a hard, fibrous mass that further blocks urine outflow through the urethra. Therefore, 5-alpha-reductase blockers are never a long-term answer for BPH.

The better treatment is to treat the high estradiol levels instead.

How to lower high estradiol levels in men?

Aging men often have elevated levels of estrogens in the blood, especially estradiol.One reason for this is that older men tend to have more body fat than younger men. Fat tissues is rich in aromatose that converts testosterone to estradiol. The fatter men become, the higher the estradiol levels usually are.

Prolonged exposure to high levels of estrogen is associated with various "old man" problems: gynaecomastia (breast development), impotence, benign prostate hypertrophy with urinary difficulties, and myocardial infarction. The benign prostate hypertrophy usually results form an excessive proliferation of stroma (fibrous tissue) in the prostate stimulated by the high estradiol levels. The increased stroma hardens and enlarges the prostate, and thereby compresses the urethra and decreases the urine flow. Studies have shown metaplasia (abnormal cell transformation) of the prostate glands in animals given estrogen treatment. Other studies have shown a direct correlation between estrogen levels and myocardial infarction. The higher the levels, the more severe the heart attack.

As testosterone (T) can convert into estradiol (E2) with the help of the enzyme aromatase (in fats), T treatment may increase the E2 levels. The reverse can also be true, namely that T treatment may reduce the E2 level through an inhibition aromatase enzyme and a stimulation of the 5-alpha-reductase, the enzyme that converts T to DHT. Careful observation can help the physician to predict which men will usually produce more E2 or DHT when given T therapy. Men with obesity, gynaecomastia and deficient body hair are rich in aromatase, and will generally make more E2 than DHT from the testosterone therapy.

 

In contrast, the reverse is true for men with higher-than-average body hair development, who are proportionately richer in the 5-alpha-reductase enzyme that produce DHT. These men have no or a low tendency to produce high E2 levels, are at low risk of developing breasts or obesity, but are inclined to lose hair at the top of the head, the typical form of male pattern baldness.

Various causes increase the levels of estradiol in men. The most common causes are heavy drinking of caffeinated beverages and alcohol, obesity (due to the abundant adipose tissue producing aromatase), and wearing tight underwear and trousers.

Tight underwear will compress the testicles' blood vessels.

The compression slows the blood flow, causing ischemia (a lack of fresh blood and oxygen) for the testosterone-producing Leydig cells. The Leydig cells suffer more from the asphyxia than the estradiol-producing Sertoli cells, which are able to compensate by overproducing E2. The correction of all these causes is often sufficient to normalize the level of E2. If a man presents one or more of these conditions, correcting them all together may lower the level of E2 by 20 to 70% and thus normalize it.