BPH is a non-cancerous swelling of the prostate gland. When it becomes swollen, symptoms including dysuria, poor urine flow, sensation of incomplete emptying, dribbling, and frequent urges to urinate are common.

Roughly 50% of men over the age of 60 are believed to be suffering from BPH.

Due to urinary obstruction, BPH can lead to an increased chance of urinary tract infection. In some cases, especially in combination with heavy alcohol use, the prostate can become so swollen that urine flow is blocked completely, which is a medical emergency and needs immediate catheterization to correct.

It is not fully understood what causes BPH, however, there are several popular theories:

Androgen Deficiency

An older theory involves the role of androgens (both testosterone and dihydrotestosterone) causing a gradual increase in prostate size with age.

Female Hormone Ratio

Another theory involves a shift in the ratio of male androgens to female estrogens with age, with relatively higher estrogen activity promoting prostate growth.

Inflammation

Inflammation is another proposed mechanism, arising either from systemic inflammation, infection, or autoimmune processes within the prostate.

Hyperinsulinemia

High circulating insulin may trigger prostate growth, which would help explain the common link between BPH and insulin resistance.

• Old age
• Sex (Male)
• Smoking
• Ethnicity
• Dietary fat consumption
• Hormonal dysfunctions

Symptoms relate to urinary obstruction and bladder irritation. Common features include a weak or hesitant urine stream, straining to begin urination, dribbling at the end of urination, a sensation of incomplete bladder emptying, increased urinary frequency, urgency, and waking at night to urinate (nocturia).

• MSU

• Prostate specific antigen (PSA) test

  • Used to screen for prostate cancer
  • Greater than 10.0 ug/L (indicate high probability for prostate cancer)
  • 40.0 ug/L to 10.0 ug/L (may indicate BPH, prostatitis or prostate cancer)

• Screens for prostate cancer

• Biopsy

  • Needle biopsy of the prostate gland

• Cystoscopy

  • Fiberoptic visualization of the bladder

• Transrectal ultrasound

• Digital rectal exam (DRE)

  • Insertion of a finger into the male rectum to palpate rectum and prostate

• Testosterone Testing

  • Free testosterone
  • Total testosterone
  • Sex hormone binding globulin (SHBG)
  • Free androgen index (from total testosterone and SHBG)
  • Dihydrotestosterone.

• Prolactin Testing

  • Reference ranges:
    • Female: <750 mU/L
    • Male: 150-500 mU/L

• Salivary Hormone Testing

  • Testosterone (TT)
  • Estradiol (E2)
  • DHEA-S
  • Cortisol

Hormone Testing Interpretation:

High Levels	Low Levels2
high prescribed hormone dosing	Low endogenous hormone production
high endogenous hormone production	Low metabolic funcitoning (thyroid, stress, adrenal, exhaustion)
Adrenal imbalance	Inability to synthesize hormones
Thyroid imbalance	Normal decrease with age
Poor liver detoxification	Poor diet (low in fat or protein)

• Quercetin, often combined with bromelain
• Beta sitosterol
• Zinc
• Selenium
• Essential fatty acids
• Antioxidants Vitamins A, C, & E
• Amino acids
  • Glycine
  • Alanine