Premature Balding in Men
A Symptom of Metabolic Syndrome and Benign Prostatic Hyperplasia
According to Statistic Brain, 35 million men in the US experience hair loss, 40% of which have hair loss by the age of 35. The same hormonal imbalances that contribute to early onset balding may also cause more serious conditions. Because of its strong association with hormone imbalances, prostate enlargement, and metabolic syndrome, premature balding in men could be indicator of deeper health concerns.
A Male Version of PCOS?
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder common among women of reproductive age. At the Progressive Medical Education meeting in Irvine, CA in August 2017, Dr. Matthew Cavaiola presented a hypothesis published by Kurzrock et al. He stated because the primary defect underlying PCOS may not be a defect in the ovaries themselves, it is possible that this condition can also occur in men.
Symptoms of PCOS in women include:
- High androgen hormones (like DHEA and testosterone) in the blood
- Obesity focused on the waistline
- High insulin levels
- Development of diabetes
Dr. Cavaiola stated that young men can suffer from similar symptoms:
- Insulin resistance
- Increased risk for diabetes and cardiovascular disease
- Early onset of male pattern baldness
- Excessive body hair
- High levels of testosterone and dihydrotestosterone (DHT, the active form of testosterone)
In addition to the symptoms listed above, sex hormone binding globulin (SHBG) levels may be low which further increases the amount of available testosterone and DHT in the body. Dr. Cavaiola also pointed out that when SHBG levels are low, insulin levels are abnormally high. Persistently high levels of insulin may lead to metabolic syndrome, prediabetes, and diabetes.
Prostate Enlargement and Insulin Resistance
Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is the enlargement of the prostate gland and is a common condition as men age. Common signs and symptoms of BPH include a frequent or urgent need to urinate, increased frequency of urination at night (nocturia), difficulty starting urination, a weak urine stream or a stream that stops and starts, dribbling at the end of urination and an inability to completely empty the bladder. There appears to be a strong correlation with early onset balding and BPH, as men with BPH tend to have more inherited baldness and an increased severity of baldness. Some studies also point to an increased risk of prostate cancer.
Insulin is a hormone made by the pancreas. It allows cells in the body to use glucose (sugar) for energy. Insulin resistance (also called metabolic syndrome or prediabetes) is a condition where cells throughout the body don’t recognize insulin as they should. This causes the cells to have trouble absorbing glucose, which causes a buildup of sugar in the blood. It also causes the body to produce more insulin leading to high insulin levels in the body. These high levels of insulin may be a major contributor to BPH and early onset balding as postulated by Ajit Vikram et al.
Insulin resistance may also be associated with, high blood pressure, high triglycerides and acanthosis nigricans (dark patches of skin usually on the back of the neck, groin, and armpits).
Addressing Baldness and Prostate Enlargement with Finasteride
Drug companies have come up with a possible solution for hair loss and prostate hyperplasia with a synthetic molecule, finasteride. Finasteride is the generic name for two prescription drugs: Propecia and Proscar. Propecia has been approved by the FDA to treat male pattern baldness at a dose of 1 mg per day. Proscar is the same drug in a 5 mg dose, and has been approved to treat BPH. Finasteride inhibits the 5 alpha reductase enzyme, which is the enzyme responsible for converting testosterone into its more active form, (DHT). Studies suggest high levels of DHT may be responsible both for male pattern baldness and BPH.
Negative Side Effects of Finasteride
There are a number of negative side effects that have been associated with finasteride. The Post Finasteride Syndrome Foundation studies these persistent adverse effects, which include:
- Loss of penis sensitivity
- Decreased ejaculatory force and volume
- Loss of libido and low penile temperature
- Reduced feeling of pleasure or emotions
- Lack of mental concentration
- Loss of muscle tone/mass
- Severe depression, suicidal ideation, and suicide
Why Not Progesterone?
Progesterone, a hormone that naturally occurs in the human body, also acts as a 5 alpha reductase inhibitor, as well as having a great number of other important functions in the body. The drug, finasteride, structurally resembles progesterone. The prostate has receptors for progesterone in addition to receptors for androgens (testosterone and derivatives) and estrogens. While many studies have explored the relationship of prostate enlargement and prostate cancer to androgen and estrogen receptors, little research exists for the relationship to progesterone.
Progesterone is produced in men by the testes and the adrenal glands. Men have progesterone levels similar to a woman’s progesterone levels during the follicular phase of the menstrual cycle. RuiQi Chen et al. present a case for inhibition of prostate enlargement—and possibly prostate cancer—using progesterone.
Some men may consult a practitioner when confronting hair loss and may be prescribed Propecia in an attempt to grow hair back, but why use a synthetic drug when rebalancing hormone levels with progesterone, a hormone natural to the body, may help? Hair loss may be the first sign of hormone imbalances that could lead to metabolic syndrome and prostate hyperplasia. Other potential risks may include high blood pressure, high cholesterol, obesity, diabetes, and heart disease. By proactively considering hormone balancing solutions, men may forestall the loss of their hair and prevent more drastic declines in their health.
- Statistic Brain. Hair Loss Statistics. https://www.statisticbrain.com/hair-loss-statistics/. August 2016. Last accessed September 2019.
- Cavaiola M. Environmental Medicine: Focus on Men’s Health & Longevity. A presentation at the Progressive Medical Education Meeting. August 2017.
- Kurzrock R, Cohen PR. Polycystic ovary syndrome in men: Stein-Leventhal syndrome revisited. Med Hypotheses. 2007;68(3):480-3. Epub 2006 Nov 28. (3)
- Oh BR, et al. Association of benign prostatic hyperplasia with male pattern baldness. Urology. 1998 May;51(5):744-8.
- Papa NP, et al. Early onset baldness and the risk of aggressive prostate cancer: findings from a case-control study. Cancer Causes Control. 2018 Jan;29(1):93-102. doi: 10.1007/s10552-017-0981-0. Epub 2017 Nov 14.
- Vikram A, et al. Insulin-resistance and benign prostatic hyperplasia: The Connection. Eur J Pharmacol. 2010 Sep 1;641(2-3):75-81. doi: 10.1016/j.ejphar.2010.05.042. Epub 2010 Jun 9.
- Post-Finasteride Syndrome Foundation. https://www.pfsfoundation.org. Last accessed: April 2018.
- Ling YZ, et al. Synthesis and in vitro activity of some epimeric 20 alpha-hydroxy, 20-oxime and aziridine, pregnene derivatives as inhibitors of human 17 alpha-hydroxylase/C17,20-lyase and 5 alpha-reductase. Bioorg Med Chem 1998;6:1683-1693. https://www.ncbi.nlm.nih.gov/pubmed/9839000
- Chen R, et al. Progesterone receptor in the prostate: A potential suppressor for benign prostatic hyperplasia and prostate cancer. J Steroid Biochem Mol Biol. 2017 Feb;166:91-96. doi: 10.1016/j.jsbmb.2016.04.008. Epub 2016 Apr 25.
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