Testosterone and the Prostate
Written by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.
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In the past, doctors were reluctant to prescribe Testosterone, believing that it might promote prostate cancer. Now, we know that testosterone plays a role in prostate growth and helps prevent inflammation in the lower urinary tract. Nonetheless, physicians continue to be cautious in prescribing it to patients.
Testosterone increases prostate growth
In men, testosterone plays a vital role in prostate growth. While testosterone increases a man's feelings of well-being, some evidence suggests that testosterone may trigger prostate cancer. It is also known to make the disease more aggressive. Despite the risk, testosterone replacement therapy for older men may improve a man's quality of life.
While the urological dogma holds that testosterone is harmful to the prostate, new research suggests that testosterone treatment can benefit men with prostate health. Testosterone has been linked to a range of health benefits, including relief of the symptoms of late-onset hypogonadism and prostate cancer. It also improves the flow of urine during voiding.
One study showed that men with low levels of testosterone were at greater risk for prostate cancer. The researchers studied blood samples of 19,000 men between 1959 and 2004. Sixteen percent of these men developed the disease. Serum testosterone levels were found to be significantly lower in men with prostate cancer than in healthy controls. Researchers hypothesized that this was due to tumor-mediated suppression of gonadotrophins. In addition, they found that men with lower testosterone levels had higher levels of androgen receptor expression, which is a sign of prostate cancer.
Testosterone appears to be a key factor in prostate enlargement. This hormone is produced by the testes throughout a man's life. However, it begins to decline during his late twenties or early 30s. When it reaches low levels, the prostate converts testosterone into DHT, which causes more prostate cells to grow.
Testosterone is produced in the prostate by Leydig cells and by peripheral conversion from its precursors. Other precursors to testosterone include androstenedione (4-dione) and dehydroepiandrosterone (DEH). The adrenal glands regulate the production of testosterone. Normal testosterone levels are safe, but high doses can cause liver damage and increase LDL cholesterol.
There are several studies that indicate that elevated serum levels of testosterone increase the risk for prostate cancer. However, further research is needed to confirm this correlation. In the meantime, serum free testosterone levels should be routinely measured before prostate surgery along with serum PSA levels. This way, a prostate cancer risk can be determined.
The FDA requires a warning label on testosterone products to protect consumers from potentially serious side effects. This warning is based on the common misconception that testosterone increases prostate growth. But, in reality, testosterone increases prostate growth in a different manner than commonly believed. It affects the prostate and the lower urinary tract differently than commonly assumed.
Testosterone inhibits inflammation
The action of testosterone is a powerful anti-inflammatory, which suppresses the immune response by inhibiting a specific signaling pathway in prostate cells. The JAK/STAT1 pathway is involved in the generation of cytokines, which contribute to prostate inflammation. When the pathway is suppressed, cytokines are reduced, and the production of reactive oxygen species is inhibited.
Testosterone inhibits prostate inflammation through several mechanisms. Firstly, it suppresses UPEC colonization and inhibits the formation of IBCs. Furthermore, it inhibits the expression of the STAT3 protein. By inhibiting these pathways, testosterone prevents the growth of UPEC.
Additionally, testosterone inhibits UPEC's ability to form biofilm-like intracellular bacterial communities. This is due to the fact that testosterone inhibits the STAT3 and JAK/STAT1 signaling pathways. These pathways are involved in UPEC-induced prostatitis, and testosterone has shown to suppress them.
The anti-inflammatory effects of testosterone are not only beneficial for the prostate, but can also help to treat other diseases associated with inflammation. It also suppresses the expression of pro-inflammatory cytokines, such as IL-1 and IL-6. In addition, testosterone inhibits the JAK/STAT3 pathway, which has been linked to inflammation.
This study found that testosterone administration reduced the levels of the inflammatory marker IL-1b in prostate tissue. However, it did not affect the level of the protein PSA in the prostate. Furthermore, testosterone administration did not affect muscle strength, urination, or sexual function. Further, testosterone inhibits the growth of UPEC-infected prostate cells.
Using RWPE-1 prostate cells, researchers pretreated them with testosterone at five, ten, and twenty mg/mL. Next, the cells were infected with UPEC. Then, the cells were plated on LB agar. The number of colonized cells was measured using Image J software.
Currently, testosterone replacement therapy is the gold standard treatment for LOH. It not only helps treat the symptoms, but also reduces the risk of associated medical conditions like type II diabetes and obesity. Further research needs to be done to understand the relationship between prostate inflammation and BPH. The relationship between prostate inflammation and ARIs may be more complicated than previously thought.
As part of the study, the authors conducted a sensitivity and specificity study using the same chromatographic fractions. This study was powered to detect a 25% change in prostate dihydrotestosterone levels from a prior study. Using the nQuery Advisor software version 6.0, the researchers calculated the power to detect a change of 25%.
Testosterone improves lower urinary tract symptoms
Testosterone is a hormone that is derived from androgens and is found in the urothelium, prostate, urinary bladder, and urethra. It functions by modulating the autonomic nervous system and by activating endothelial NO synthase. This increases NO concentration and dilates pelvic vessels, thereby alleviating the pain associated with pelvic ischemia. In addition, testosterone may improve LUTS/bladder functions, such as increasing bladder capacity and compliance, and reducing detrusor pressure at maximal flow.
One study examined the role of testosterone in patients with nocturia, a condition characterized by inability to go to the bathroom after waking up. In men, this condition is often a sign of a more severe form of LUTS, such as a chronic urinary tract infection. Although testosterone is a hormone that regulates the bladder, it also plays an opposing role in other conditions.
Testosterone Deficiency and the Prostate
What is Testosterone Deficiency?
A hormone called testosterone is crucial for prostate development and function. When levels are low, the prostate may develop problems such as benign prostatic hyperplasia and prostate cancer. This is because the hormone binds to the androgen receptor on the prostatic epithelial cells. When this receptor is blocked, the cells of the prostate become cancerous. This is known as prostate cancer and is one of the most common types of cancer in older men.
Studies have shown that androgen supplements can activate the RAS system in the prostate. This pathway stimulates the production of inflammatory cytokines. These cytokines contribute to the damage and repair of prostate tissue and to the development of BPH. Additionally, androgens may calcify prostate ducts and blood vessels, thereby increasing the risk of LUTS and other problems.
The development of the prostate begins early in the development of all male mammals, and in humans it occurs at about ten to twelve weeks. It develops from a mesenchymal layer derived from the endoderm and an epithelial layer from the mesoderm. The epithelial cells proliferate under the action of testosterone.
Testosterone levels naturally peak around 10 years after birth, assuming that the hypothalamic-pituitary-gonadal axis remains intact. The hormonal changes associated with sexual maturity and reproductive maturity are also driven by testosterone, and the spermatogonial stem cells begin to undergo meiotic division and form spermatozoa. The prostatic epithelial cells then start to proliferate, triggering a period of prostate growth and prostatic secretion.
Testosterone replacement therapy
In a recent paper in the International Journal of Urology and Nephrology, Dr. Diokno reviews the role of testosterone in prostate health and offers ten recommendations for improving prostate health. One of these recommendations is annual monitoring to detect late onset of testosterone deficiency.
Men treated with TRT experienced a significant increase in serum levels of testosterone. However, testosterone levels in prostate tissue were not significantly different from those of placebo-treated controls. This means that the risks of prostate cancer from TRT may be less than once thought. However, more research is needed to determine the safety of testosterone replacement therapy in large groups of elderly men.
While testosterone replacement therapy can be effective for men with low blood levels, it should be used with caution. Consult an experienced physician who will assess the risks and benefits. The primary goal of treatment is to improve symptoms associated with low sex drive and fatigue. However, it is important to treat other nutritional, sleep, and exercise deficiencies first.
However, TRT may have side effects, particularly in men with active prostate cancer. The drug itself can make the cancer worse, so doctors often choose another drug to block testosterone production instead. The side effects of this type of therapy can include intense fatigue and weight gain. In addition, this therapy may kill some cancer cells.
Traditionally, testosterone replacement therapy has been considered contraindicated for men with prostate cancer. However, recent data have begun to challenge this perception. In fact, testosterone replacement therapy has been studied in both men with and without prostate cancer.
Bipolar androgen therapy for CRPC
Bipolar androgen therapy is a type of therapy that alternates between two polar extremes. This therapy is effective in achieving supraphysiologic serum testosterone levels through the intramuscular injection of testosterone cypionate. Over a four-week cycle, patients are exposed to low testosterone conditions. The resulting decline in testosterone levels causes CRPC cells to die.
Treatment of patients with CRPC and testosterone deficiency requires a specialized treatment approach. While androgen deficiency is common among men with low testosterone levels, many patients with prostate cancer experience resistance. Current treatments, such as surgery and radiation, aim to suppress the ligand-binding activity of the androgen receptor (AR). However, resistance can develop rapidly. A rise in PSA levels is one sign of resistance. This suggests that the patient's cancer cells are becoming tolerant of androgen-ablative therapy.
Bipolar androgen therapy (BAT) is a non-invasive treatment that can be integrated into treatment plans for patients with advanced PC. In one study, 16 patients with asymptomatic mCRPC were treated for 3 months using BAT. The cycles were repeated every 28 days, and results showed a PSA decrease in 50% or more. Furthermore, 50% of the patients experienced assessable imaging regression.
Bipolar androgen therapy is an effective treatment for men with CRPC with testosterone deficiency. It is an alternative treatment option for men who have failed to respond to chronic androgen deprivation therapy. The bipolar approach reduces androgen levels in the body and inhibits cancer cell growth. This therapy is more effective than chronic androgen therapy, but it comes with certain risks.
ADT produces transient double-strand DNA breaks in CRPC cells and recruits TOP2B and AR. However, the single-agent etoposide, which inhibits TOP2B, had minimal activity in this study. It may be the cause of resistance to ADT or to Abiraterone acetate.
Effects of testosterone replacement therapy on LUTS/BPH
Several studies have found that testosterone treatment can improve symptoms of LUTS/BPH. Testosterone increases the amount of nitric oxide in the prostate and urinary bladder. This causes smooth muscle relaxation and eases passage of urine during voiding. However, the FDA's warning about testosterone should be reconsidered.
In addition to these findings, the FDA has mandated a black box warning on all testosterone products, stating that TRT may worsen symptoms of BPH. While this warning is based on a widely held misconception that testosterone affects prostate growth in a linear manner, studies have shown that testosterone replacement therapy does not increase BPH or LUTS symptoms.
A recent study by Dr. Khera showed that testosterone replacement therapy did not worsen symptoms of LUTS/BPH in patients with lower PSA levels. Instead, long-term treatment with testosterone may improve symptoms of BPH. Although these results are preliminary, it is a positive step for patients who are suffering from LUTS/BPH.
The study was designed as a prospective, randomized clinical, placebo-controlled trial. It included 72 male patients with a range of symptoms related to LUTS and BPH. The participants were aged 24 to 76 years, had a score of at least 27 on the Ageing Male Symptom Questionnaire (AMS-Q), and had a serum testosterone level below 350 ng/dl (12.1 nmol/L.). Some patients had elevated PSA levels and were therefore excluded.
In this study, serum testosterone levels and nocturia were correlated. The positive correlation was statistically significant. This suggests that testosterone may be a contributing factor in nocturia. While TRT has a few side effects, it is not a cure for BPH or hypogonadal men. Further studies are necessary to fully understand the effect of testosterone on BPH and LUTS.
Effects of testosterone replacement therapy on prostate cancer
Testosterone replacement therapy is an option that may be used to treat prostate cancer. This therapy has a number of benefits, including increased sexual function, reduced PSA levels, improved body composition, and improved bone density. It also has some risks, which must be discussed before undergoing treatment. One major risk of testosterone therapy is the increased risk of developing prostate cancer. It may also cause an increased risk of overtreatment of subclinical indolent prostate cancer, which is often undetected.
While testosterone does not cause cancer in most men, it can make prostate cancer cells grow faster. This condition is known as hormone-refractory prostate cancer, and some types of prostate cancer are resistant to testosterone therapy. In these cases, other hormone therapies may be used, including abiraterone and newer anti-androgens.
Another treatment option is androgen deprivation therapy (ADT). This treatment involves removing the testicles, which produce androgens. This therapy will suppress the growth of the cancer, thereby slowing down or stopping its growth. It can also be effective for those who have been diagnosed with prostate cancer and do not want to undergo surgery.
Although men who have prostate cancer may suffer from side effects associated with the hormone therapy, there are ways to deal with them. The first thing they can do is keep a diary of their injections. A diary can also help men remember when to take their injections. A few days late might not be a problem, but if the injection is missing for a few weeks or months, the cancer may start growing again.
The results of one study have shown that testosterone treatment can reduce the incidence of prostate cancer. One year after testosterone treatment, about 6% of men who received testosterone therapy had PSA levels higher than 1.7 ng/mL, and 2.5% and 3.5% had PSA levels above 3.4 ng/mL. However, this study was not large enough to establish cutoffs. However, these results provide important information that is useful in making decisions regarding referral to a urologist.
Conclusion
In men, testosterone exerts various physiological effects on different tissues. Early in puberty, it stimulates the production of fluid from the prostate gland and increases the size of the gland. Studies have been conducted on the effects of testosterone on prostate cancer, but the results are conflicting. However, there is no evidence to suggest that testosterone causes prostate cancer. It is important to note that the levels of testosterone in men change throughout their lives.
A study from the Journal of the National Cancer Institute reviewed eighteen studies on testosterone and prostate cancer. They found that low testosterone levels were not associated with lower cancer rates in men. In addition, the study did not compare men with low T values to men with high levels of testosterone. While this study has its limitations, it provides valuable information for men interested in testing the relationship between testosterone and prostate cancer.
Testosterone and the Prostate: A recent meta-analysis concluded that men on testosterone replacement therapy had the same incidence of prostate cancer as those who had not undergone hormonal treatment. This finding contradicts earlier research that suggested that testosterone treatment caused an increased risk of prostate cancer in men. However, it should be noted that low testosterone levels are a greater risk factor than high levels.
Another study found that low serum levels of testosterone affected gene expression in the prostate. In other words, low levels of testosterone may cause the prostate to become less functional. However, when testosterone levels were normal, the prostate did not develop a dysfunctional response.
