Lowering DHT can help shrink the prostate over time and reduce BPH symptoms. These drugs block the conversion of testosterone into dihydrotestosterone (DHT), a hormone that makes the prostate grow. Testosterone replacement therapy (TRT) can help improve these symptoms. Doctors may switch the type or lower the dose of TRT if a man develops worsening urinary symptoms. Keeping testosterone within a normal range helps reduce risks. To reduce this risk, some doctors use medications called 5-alpha reductase inhibitors, such as finasteride or dutasteride. The current consensus among medical experts is that TRT, or testosterone replacement therapy, does not directly cause prostate cancer. In 1996, the US Food and Drug Administration approved the systemic chemotherapy mitoxantrone for those with castration-resistant prostate cancer based on trials showing that it improved symptoms even though it failed to enhance survival. Two studies around the time found cancer in as many as 10% of surgical specimens, suggesting prostate cancer was a fairly common cause of prostate enlargement. Conversely, those who consume high levels of dietary fats, polycyclic aromatic hydrocarbons (from cooking red meats), or calcium may be at an increased risk of developing advanced prostate cancer. Increased risk also runs in some ethnic groups, with men of African and African-Caribbean ancestry at particularly high risk – having prostate cancer at higher rates, and having more-aggressive prostate cancers that develop at earlier ages. However, the prostate is a hormone-sensitive gland, and testosterone plays a role in how it grows and functions. Despite this obvious caveat, numerous men are still treated for symptoms of hypogonadism with either normal serum levels or without level having been checked at all.50 The biochemical diagnosis of hypogonadism should be made carefully, as there are significant intra-individual fluctuations in testosterone levels49 and no accepted cut-off that defines "low testosterone". Vignozzi et al.42 showed the presence of prostate and bladder inflammation in rabbits with metabolic syndrome; this inflammation was exacerbated when the rabbits were made hypogonadal and returned to baseline when they were treated with testosterone. When compared with those without metabolic syndrome (and corrected for age and serum testosterone), they had a worse IPSS, larger TPV, and larger PVR volume. This is not a new concept; as early as 1939, Walther and Willoughby33 used testosterone to treat 15 men with "BPH" with the improvement in their LUTS over 2 years; although this treatment seemed to have been dismissed or forgotten for some time. A health care professional may recommend medicines to treat your BPH such as Lifestyle changes may also help reduce your symptoms. The tests will help diagnose lower urinary tract problems related to BPH. A health care professional may also check for Very large prostate glands may require open surgery. Surgery may be endoscopic or conventional open surgery, depending on the size of the enlarged prostate. During surgery, a surgeon may remove some enlarged prostate tissue. These procedures may destroy enlarged prostate tissue. Medical professionals may suggest one of several minimally invasive procedures that relieve BPH symptoms when medications do not work. Learn about some of the best medications for an enlarged prostate. As the prostate grows, it can press against the urethra, the tube that carries urine out of the body. Benign Prostatic Hyperplasia, or BPH, causes the prostate to grow larger. An endocrinologist focuses on hormones like testosterone. Some men may need more than one doctor to manage their care. Tell a health care professional right away if you Tell a health care professional if you are taking Some medicines can make BPH symptoms worse. This condition is called urinary retention. As the prostate grows, it squeezes the urethra. An enlarged prostate can cause problems with emptying your bladder. While the exact cause of BPH is still unknown, research suggests that it’s a combination of hormonal and age-related factors. Years ago, doctors believed that more testosterone always meant a higher risk of prostate growth or even cancer. That’s why it's important to look at the full picture—age, hormone levels, urinary symptoms, and prostate health—before starting or continuing TRT. For example, early studies once suggested that high testosterone could lead to a higher risk of prostate cancer. Elevated PSA levels can indicate prostate problems, including infection, inflammation, benign prostatic hyperplasia (BPH), and prostate cancer. The concern stems from the fact that testosterone can fuel the growth of existing prostate cancer cells. Because testosterone can fuel the growth of prostate cancer cells, it’s crucial to detect and treat any existing cancer before starting TRT. However, it may stimulate the growth of existing prostate cancer cells, so careful screening and monitoring are essential before and during treatment.
