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Progesterone and the Prostate

lab-logoPicture this…You receive your Labrix testing result for a male patient, and the report shows progesterone insufficiency (estrogen dominance). Progesterone supplementation is mentioned in the interpretation, but you don’t know where to start. Isn’t progesterone a female hormone? What could progesterone therapy offer a male?

If this scenario sounds familiar, you are not alone. To understand how to utilize progesterone, it is important to understand the hormonal fluctuations of the aging male. As we are aware, testosterone levels decline with age and have been linked to many health concerns including cardiovascular disease and diabetes. Testosterone, however, isn’t the only sex hormone found in the male body. In fact, just as women produce testosterone, men produce small amounts of estrogens and progesterone. As men age, estrogen levels appear to rise as a result of increased aromatization, while testosterone and progesterone levels decline.

The term “estrogen dominance,” more correctly progesterone insufficiency, was coined by the late Dr. John Lee to describe this state in which the influence of estrogen overshadows that of other hormones, leading to an imbalance. In fact, research has shown elevations of estrogen in men to be an independent risk factor for metabolic syndrome. Insulin resistance leads to estrogen dominance and an increased risk for breast cancer. It also appears this same information can be extrapolated for prostate health.

In addition to estrogen dominance affecting the prostate, dihydrotestosterone (DHT) has also been shown to play a role. The 5-α reductase enzyme aids in the conversion of testosterone to DHT. Some research demonstrates that DHT has been linked not only to hair loss, but also to increased prostatic cell proliferation . If prostate health is a concern, patients will typically present to clinic with symptoms such as increased urinary urgency or frequency. This makes sense given the previous mentioned physiology, but how can we help bring balance to this picture?

The answer is simple: transdermal progesterone. Progesterone has been shown to restore normal inhibition of 5-α reductase by stimulating the inhibition of the conversion to DHT. It also stimulates the action of p53 (tumor suppressor gene) and helps to preserve testosterone, a direct antagonist of estradiol. A recent article published in the “Journal of Steroid Biochemistry & Molecular Biology” examines the progesterone receptor (PR) and its effects on BPH as well as prostate cancer (PCa). This research is exciting as it suggests that the progesterone receptor “may exert an inhibitory effect on benign prostatic hyperplasia, reactive stroma development, and PCa progression.” Along with all of the positive effects of progesterone for the prostate, progesterone also exhibits neuroprotective effects, another benefit in the aging male.

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Maggio M. et al J Androl. 2010 Mar-Apr;31(2):155-62
Song, C., Kim, Y., Min, G. E., & Ahn, H. (2014). Dihydrotestosterone enhances castration-resistant prostate cancer cell proliferation through STAT5 activation via glucocorticoid receptor pathway. The Prostate Prostate, 74(12), 1240-1248. doi:10.1002/pros.22841
Petrow et al. J Pharm Pharmacol. 1984 May; 36(5):352-3
Lee, J. R. (2003). Hormone Balance for Men What your doctor may not tell you about prostate health and natural hormone supplementation. AZ.

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