Chapter 28: Male Hormonal Problems

Both activity and size of the prostate gland depend on the presence of...

testosterone, the main androgen secreted by the testes and adrenal glands.

Prostate gland activation

The gland has testosterone receptors in the nucleus of each cell that bind circulating testosterone. When bound, these receptors trigger the genes for prostate cell growth and activity.

Benign prostatic hyperplasia

An enlargement of the prostate gland as a result of an increased number of cells in the gland.

What causes BPH

Circulating testosterone decreases with age while the number of testosterone receptors in the prostate gland increases. Because of this, even small amounts of testosterone are more likely to bind with receptors and eventually cause the prostate gland to enlarge.

BPH symptoms

can be uncomfortable and interfere with sleep and rest. Urine can stay in the bladder and lead to increased UTI risk. It can also block the bladder, causing urine to back up into the kidneys, possibly leading to kidney damage or failure.

Drugs used for BPH

DHT inhibitors and selective alpha-1 blockers are used. The actions of both drugs differ, so they can be used alone or together to improve urine flow.

DPH inhibitors

These drugs work directly on the prostate gland. They are a "counterfeit" drug that looks like testosterone and binds to the enzyme that normally converts testosterone into DHT. This counterfeit drug cannot be converted into DHT, and although it is bound to the enzyme, the enzyme is not available to convert the real testosterone to DHT. With much less DHT in the prostate, the cells in the prostate gland do not receive the signal to grow. The gland shrinks and puts less pressure on the urethra.

How do selective alpha-1 blockers work to treat BPH

Acts to relax the smooth muscle tissue in the prostate gland, the neck of the bladder, and the urethra. These smooth muscle receptors contain alpha-1 adrenergic receptors. When these receptors are bound with selective alpha-1 blockers, the smooth muscle relaxes, placing less pressure on the urethra and improving urine flow.

What does testosterone do?

It is responsible for the development and maintenance of male sex characteristics. It is needed for maintaining muscle mass, adequate levels of RBCs, bone density, sense of well-being, and sexual/reproductive functions.

What can cause testosterone deficiency?

Injuries, infections, chemotherapy, genetic abnormalities, high iron, dysfunction of the pituitary gland, inflammation of the lungs, medications, chronic illnesses, stress, alcoholism, and obesity

Symptoms of testosterone deficiency?

Low libido, decreased sense of well-being, depression, irritability, difficulty concentrating, erectile dysfunction, decreased muscle mass, increased body fat, anemia, decreased bone density, and decreased body hair

Testosterone replacement therapy

promotes the growth and development of male sex organs, as well as help maintain secondary sexual characteristics. Testosterone is a schedule III drug, it has a moderate to low risk for dependence. Oral tablets are generally not used because of risk for liver damage.

What causes erectile dysfunction?

-Abnormalities that affect erection processes, such as the CNS, PNS, hormonal, and vascular systems

-Physical disorders like cardiovascular disease, diabetes, drug side effects, alcohol use, smoking, pelvic surgery/trauma, hormone deficiency, neurological disease, obesity, and radiation to the pelvis.

-Psychological issues like stress, depression, or anxiety.

Signs of erectile dysfunction

difficulty getting erections, difficulty keeping an erection, decreased libido.

How do phosphodiesterase-5 inhibitor drugs work erectile dysfunction?

This drug relaxes the smooth muscle and allows the penis to fill with blood. These drugs can also be prescribed to increase blood flow in the lungs for people with pulmonary vascular problems, pulmonary arterial hypertension, and some forms of pulmonary fibrosis.

Phosphodiesterase-5 inhibitor drug information

They begin working 15-30 minutes to an hour. The effects last for up to 4 hours.