Benign Prostatic Hyperplasia

The average male can expect to experience a problem with his prostate gland during his lifetime. Benign Prostatic Hyperplasia (BPH), a noncancerous enlargement of the prostate gland, is the most common prostate disease and is thought to affect roughly half of men by the age of 60, and up to 90% of men older than 80!

Symptoms

The enlarged prostate can compress the urethra and cause lower urinary tract symptoms including difficulty urinating, weak or frequent urination, and a sense of incomplete urination. If left untreated, BPH can increase the risk of developing a urinary tract infection due to incomplete voiding.

Why does this happen?

Prostate growth has long been known to be under hormonal control, specifically by androgens such as testosterone and a testosterone metabolite called dihydrotestosterone (DHT). This hormone is ten times more potent than testosterone and is responsible not only for prostate growth but also male pattern hair loss. As such, medications that block the conversion of testosterone into DHT have proven to be an effective treatment for BPH.

However, androgens don’t tell the whole story. In fact, BPH prevalence increases as men age, precisely at the stage of life when androgens start to decline. It is now thought that estradiol, a type of estrogen, may also play a role in prostate growth. When circulating estradiol levels are too high in men, especially in relation to the testosterone levels, this could potentially contribute to growth of the prostate gland. This relative estrogen dominance could potentially explain the increasing prevalence of BPH in the elderly when testosterone levels drop.

Diagnosis and Lab Testing

Lower urinary tract symptoms in men will often invoke an investigation into their cause as these symptoms can be caused by many diseases other than BPH including infections and prostate cancer. Your doctor will likely start with a digital rectal exam (DRE) to feel the size of the prostate and assess it for any nodules or tenderness. A urinalysis and urine culture may be done in addition to a blood test for prostate specific antigen (PSA). If PSA levels are significantly elevated, your doctor may suggest a prostate biopsy.

Testing

  • Digital rectal exam (DRE)
  • Urinalysis and urine culture
  • Prostate specific antigen (PSA)
  • Hormone testing (testosterone, DHT, estradiol)

As part of the assessment for BPH in my own practice, I usually look into hormone levels including DHT, testosterone, and estradiol to determine the most effective route of treatment for each of my patients.

Before starting any treatment plan, and a few months after beginning treatment, it is useful to fill out the International Prostate Symptom Score (I-PSS) questionnaire. This quick worksheet will allow you to track symptom changes over time and help determine if your specific treatment is working. Get started by downloading the symptom questionnaire on the right and determine your baseline values.

Click the image to view the full-sized PDF

Natural Treatments for BPH

Although there are a multitude of pharmaceutical treatments for BPH including alpha-adrenergic blockers such as Flomax (tamsulosin), and 5-alpha reductase inhibitors such as finasteride, occasionally patients may need to discontinue these medications due to side effects such as dizziness or sexual dysfunction. Luckily there are some research-backed natural alternatives that may be tried instead. I like to use a combination product that combines many of these herbs and nutrients into a single capsule for ease of dosing.

Saw Palmetto (Serenoa repens)

Saw Palmetto is the most commonly prescribed herb for the treatment of BPH within naturopathic medicine. This herb acts both as a 5 alpha reductase inhibitor and as an androgen antagonist in order to decrease circulating DHT and testosterone. This berry appears to have similar efficacy for the treatment of mild to moderate BPH as finasteride and has been shown to effectively improve both urinary flow and urinary symptom scores.

Pumpkin (Cucurbita pepo) Seed Oil

In a study on BPH, men given pumpkin seed oil noticed improvement in their urinary symptoms after 3 months of use. Interestingly, combining the pumpkin seed oil with saw palmetto also resulted in a reduction of serum PSA values.

Stinging Nettle (Urtica dioica)

In 2005 there was a double-blind, placebo-controlled study published on the use of stinging nettle in the treatment of BPH. After 6 months of use, 81% of participants in the stinging nettle group noticed an improvement in urinary symptoms compared to only 16% of participants in the control group. The international prostate symptom score decreased on average by 8 points compared to only by 1.5 in the control group. Further, peak flow rate improved by, on average, 8.2ml/second. Best of all, there were no side effects identified!

Zinc

The prostate gland naturally has high levels of the mineral zinc which is thought to have anti-proliferative effects. We know that men who have BPH generally have a reduction in both tissue zinc and plasma zinc. Replenishing zinc levels via supplementation may help prevent further growth of the prostate via improving tissue zinc levels and making use of it’s antiproliferative action.

Lifestyle

Frequent and heavy beer drinkers are more likely to develop BPH than their peers due to exposure of an extract found in hops that increase the symptoms of BPH. Men who are experiencing BPH may want to consider decreasing their consumption of beer or trading in their beer for a hop-free alcohol such as wine in order to better manage their condition.

My Personal Approach to Treatment

The first step I take in treating men with BPH is to do hormone testing to check their levels of testosterone, DHT, and estradiol. The benefit of knowing serum levels of these hormones is to target treatment to individual imbalances.

For example, if we know there is elevations in DHT, 5-alpha reductase inhibitors or herbs like Saw Palmetto may be recommended. If there are decreases in testosterone or relative increases in estrogen, then I will work on estrogen detoxification and attempt to raise testosterone levels to balance out the ratio between these two hormones.

The end result of this approach is not only a decrease in the urinary symptoms of BPH but also potentially improvements in other aspects of hormone health such as weight management, libido, mood, and energy.

In health,

Dr. Nicole Hartman

About Dr. Nicole Hartman

Dr. Nicole Hartman is a naturopathic physician, a world traveler, a hiker, and a blogger. She focuses her practice in fertility and women's health and takes an integrative, evidence-based approach to healthcare.