Men and hormonal changes? Yes, the times are changing in the field of men’s health. “Prostate” is now a household word when barely a decade ago men didn’t even know they had one. And the notion that a man may also experience “hormonal changes” is new to many of us. Considering the countless number of men who complain about prostate problems, it is time rethink the subject and consider the facts.
The Prostate and Hormonal Changes
The truth is, around the age of 40, testosterone levels begin to decline in men. Although not as significant and all-encompassing as the hormonal changes women experience during menopause, it does have some definite effects. And they are not all positive! As testosterone levels decline, there is also an increase in one of its metabolites, called dihydrotestosterone. This hormone causes overproduction (called hyperplasia) of cells within the prostate gland, which ultimately result in enlargement of these tissues.
Benign Prostate Hyperplasia — BPH
This process is called benign prostatic hyperplasia or benign prostatic hypertrophy– often simply called BPH. Because the prostate sits beneath the bladder, when inflamed it may put pressure on the urethra, creating a variety of uncomfortable urinary complaints. Quite simply, the enlarged prostate obstructs the flow of urine. This results in symptoms of incomplete emptying of the bladder, dribbling, difficulty starting urination, reduced force of the stream, frequent urination of small amounts, and sometimes the inability to urinate at all.
The data varies, but BPH interferes with the urinary system to some degree in up to 80% of men over the age of 60. It is reported that at least 50% of men over the age of 45 have some prostate enlargement, whether it is accompanied by symptoms or not. These numbers characterize benign prostatic hyperplasia as an “epidemic” rather than an isolated health concern that is troublesome to a small group of men.
Other Prostate Conditions
A secondary health problem often associated with BPH is actual infection in the prostate gland. Incomplete emptying causes “stagnation” in the bladder, which sometimes results in a bacterial infection. However, in only 5% of the cases can an identifiable bacteria be cultured from the prostatic fluids.
Cancer of the prostate also needs to be mentioned. This year the American Cancer Society estimates that 165,000 men in the US will be diagnosed with prostate cancer and 35,000 will die of it. Presently, the only malignancy killing more men is lung cancer. The overall incidence has soared 39% since 1973. However, prostate cancer is rare before the age of 50. It occurs in at least 50% of men who live to be 80 and beyond, the average age of diagnosis being 73. And men who are over 65, African-American, or whose fathers had prostate cancer are at greatest risk for developing it (1).
Western Treatment
The purpose of this article is to focus on the treatment and prevention of BPH rather than cancer of the prostate. Conservative measures for an enlarged prostate include prostatic massage and reducing or eliminating coffee and alcohol. Antibiotics are frequently prescribed whether an identifiable pathogen is present or not. And surgery is considered in some of the more serious cases of prostate enlargement, as well as for some individuals with cancer.
In terms of Western drugs, Proscar is the currently the most widely prescribed. Available for only the last few years, it slows down the formation of dihydrotestosterone, the “bad” hormone that increases cell growth in the prostate. It does so by inhibiting the action of an enzyme called 5-alpha reductase, responsible for the conversion of testosterone to dihydrotestosterone. Clinically speaking, Proscar shrinks enlarged prostatic tissue, but its effects are sometimes slow– from 3 to 12 months for a change in urinary symptoms. Proscar is an expensive medication, with annual costs of approximately $600 to $700. And it must be taken for life, even though the full range of its side-effects will not be known for some time.
Herbal Medicine for the Prostate
On the bright side, natural therapies have a long history of use in this country and abroad to support optimal prostate health. Saw Palmetto (Serenoa repens berry) has been traditionally used in treating male urogenital conditions. Serenoa is a small palm tree indigenous to the Atlantic seaboard from South Carolina to Florida. It produces a small berry that contains approximately 1.5% fat made up of fatty acids and sterols which affect testosterone metabolism. Like the drug Proscar, it too is a 5-alpha reductase inhibitor– blocking the formation of dihydrotestosterone, which is responsible for prostate enlargement. In addition, no toxicity has been reported for Saw Palmetto.
Recent research on this herb shows what clinical medicine has known for centuries– it works! Since 1983, there have been numerous double-blind trials involving hundreds of patients. All of the studies show that Saw Palmetto extract is effective for both subjective and objective measurements of prostatic enlargement (2). For instance, in one study of 110 men with BPH symptoms, the herb decreased night-time urination by 45%, increased urinary flow rate over 50%, and reduced post-urination residual volume (the amount of urine left in the bladder after urination) by 42% (3). Other studies show that Saw Palmetto extract selectively antagonizes 52% of the dihydrotestosterone receptors in the prostate, thus inhibiting the hormone from binding to them, and therefore minimizing its stimulation of cell growth (4).
For men suffering from prostate enlargement, Saw Palmetto is the place to start. You may use a capsule that contains what is called a “lipophilic” extract. This is merely a standardized concentrate of the fat soluble sterols in the berry which have been shown to be responsible for its beneficial activity. You may also consider a liquid extract. And the herb may be used alone or in a combination. In either case, take one dose three times daily for at least one month before evaluating its effectiveness. For those who do not have symptoms, considering taking the herb three times daily for one to two weeks out of the month for prevention.
Two other botanicals deserve mention here. Although not as widely studied as Saw Palmetto berry, both Nettle and Pygeum have been shown to be effective for symptoms of BPH. One recent study shows that Nettle (Urtica dioica root) inhibits membrane activity of the prostate, which may subsequently suppress prostate cell metabolism and growth (5). This, of course, reduces inflammation and enlargement of these tissues. And Pygeum (Pygeum africanum bark) contains “pyto-sterols” which have been shown to have anti-inflammatory properties. In clinical trials, extract of Pygeum was found to reduce symptoms of enlarged prostate, and is available as an over-the-counter medication for BPH in Europe (6). Both Nettle and Pygeum may be used alone, or combined with Saw Palmetto for a more effective protocol for prostate health.
When an enlarged prostate is accompanied by actual infection, botanicals with anti-microbial properties are indicated. In these cases, both Echinacea (E. angustifolia or E. purpurea) and Goldenseal (Hydrastis canadensis) may also be considered as part of a program. Studies show that Echinacea and Goldenseal possess anti-viral and anti-bacterial properties, and each has considerable traditional use in America for treating and preventing infections, although there are no studies directly associating them to the prostate.
The Benefits of Nutrition
In terms of nutritional medicine, practitioners have been using Zinc for decades to support a healthy prostate. This beneficial mineral is deficient in many American diets, and is needed for proper immune function as well as prostate health. Zinc has been shown to reduce the size of the prostate and reduce symptoms of BPH by inhibiting the activity of 5-alpha reductase (7,8). Zinc may be taken in a dosage of from 20 to 60 mg per day, and it combines well with the botanical remedies mentioned above. In addition, nutritionists find that Vitamin E, in doses ranging from 50 iu to 400 iu per day, is often effective for BPH. Furthermore, that dosage range reduces cardio-vascular risk and provides antioxidant protection for the body (9).
Homeopathy and BPH
Homeopathy is also a useful tool for treating the prostate. The remedy Sabal serrulata (which is actually Saw Palmetto in homeopathic dilution!) is often effective in treating prostatitis. According to Boericke’s Materia Medica, it is useful for irritation of the genito-urinary system, including enlargement of the prostate and its resulting urinary symptoms (10). If Sabal fails, you may consider other remedies, including the Staphysagria, Thuja, Merc, or Causticum. Lower potencies– 3X, 6X, or 12X– taken three to four times daily usually provide good results. Obviously, it is best to consult a Materia Medica or your health care practitioner to find the appropriate remedy for your case or constitution.
Tonic Herbs and Prevention
One note about prevention according to Traditional Chinese Medicine (TCM). The Chinese, who are masters at treatment before illness, believe that as age progresses the “energy” of the reproductive and hormonal systems weaken. The practitioner of TCM will often use tonic herbs in order to strengthen body function, which maintains a higher level of resistance and naturally helps to prevent disease. American Ginseng (Panax quinquefolius root) and Siberian Ginseng (Eleutherococcus senticosus root) are two of these widely used toning herbs that are especially helpful for men over the age of 40. After the acute symptoms of prostatitis are resolved, these tonic remedies may be used to support energy in general and the urogenital tract in specific. They are best taken in combination as a liquid extract, tablet, capsule, or tea for a month following an acute episode of BPH. They may be used preventatively one or two weeks per month.
A Rotational Program for Prostate Health
So, you ask, how do I begin? Although all cases of enlarged prostate need to be treated individually, the following is a simple rotational program for optimal prostate health for men in their 40’s and 50’s:
- WEEK 1
Herbal support:
1. Use Saw Palmetto, or a Saw Palmetto-based formula
Suggested use: One dose, three times dailyNutritional support:
1. Use a Zinc supplement
Suggested use: 10-20 mg, three times daily - WEEK 2
Herbal support:
1. Use an herbal tonic formula including Siberian & American Ginseng
Suggested use: One dose, two times daily
Nutritional support:
1. Use a Vitamin E supplement
Suggested use: 50-200 iu’s, two times daily - WEEK 3
Herbal support:
1. Use Saw Palmetto, or a Saw Palmetto-based formula
Suggested use: One dose, three times daily
Nutritional support:
1. Use a Zinc supplement
Suggested use: 10-20 mg, three times daily - WEEK 4
Herbal support:
1. Use an herbal tonic formula including Siberian & American Ginseng
Suggested use: One dose, two times daily
Nutritional support:
1. Use a Vitamin E supplement
Suggested use: 50-200 iu’s, two times daily
Note: With acute symptoms of BPH, use both the herbal and nutritional support remedies for up to one month. Also, include the appropriate homeopathic medicine and consider the addition of an Echinacea and Goldenseal combination.
The above is a sampling of the many options available for men interested in the treatment and prevention of prostate problems. This era in medical care is very exciting for many men who now have the opportunity to take better care of their health.
Footnotes:
- Cited in article, Harvard Health Letter, February, 1994
- Cited in article, Health and Healing, Julian Whitaker, March 1992
- Chempault, et al, Medical treatment of prostatic adenoma, Annals of Urology, 1984
- Sultan, et al, Inhibition of androgen metabolism, Journal of Steroid Biochemistry, 1984
- Hirano, et al, Effects of stinging nettle root…, Planta Medica, 1994
- Bassi, Standardized extract of Pygeum africanum in the treatment of BPH, Minerva Urologica, 1987
- Leake, et al, The effect of zinc…, Journal of Steroid Biochemistry, 1984
- Judd, et al, Zinc… inhibits prolactin secretion, Brain Research, 1984
- Stampfer, et al, Vitamin E consumption…, New England Journal of Medicine, June, 1993
- Boerick, Materia Medica with Repertory, 1927,, p. 562
Janet Zand, OMD, L. Ac., is a respected naturopathic physician who lives and practices in the Los Angeles area. She has developed a unique and effective method of combining herbal medicine with nutrition, homeopathy and acupuncture. Her credentials include a Doctor of Naturopathy, Doctor of Oriental Medicine, and Certified Acupuncturist. Dr. Zand has over fifteen years of clinical experience treating with natural medicine, as well as having formulated her own line of herbal supplements.