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BPH Tx notes

tx ideas for BPH

PRODUCTS IN NCNM MEDICINARY

ITI, Man $33.00 contains: maca root (Lepidum), Yohimbe/Pausinysthalia bark, Rhodiola rosea, Horny goat weed/Epimedum sagittum, Panax ginseng, Tongkat Ali/Eurycoma longifolia

Priority One, Prostate Health contains: Mg, Zn, Pygeum, prunus, africanum, Uva ursi, Pumkin seed, Bee Pollen, Serenoa, L-alanine, L-glycine, prostate, L-glutamic acid, flax seed oil

PURE, Saw Palmetto Plus $28.50, Serenoa, pumpkin seed, pygeum bark, urtica

Standard Process, Simplex M $16.00, Mg+, bovine orchic, adrenal, pituitary and thyroid PMG extracts

Standard Process, Tribulus, $43, contains tribulus terrestris aerial parts 725mg, contains furostanol saponins as protodioscin 100mg

HERBS

SERENOA REPENS
saw palmetto
160 mg twice daily
MOA (3):
weakly inhibits 5alpha reductase-->decr DHT
reduces number of receptors for DHT and Est
anti-inflammatory effect
4-8 weeks to results of therapy when used alone
works esp if nocturia
85% fatty acids, 0.2% sterols esp beta-sitosterol (also in soy, Pygeum, nettle, pumpkin seed)
improve sx, nocturia, residual urine, flow
as effective as finasteride/Proscare without SE's
does not affect PSA

Urtica spp. (Nettle root) – diuretic/prostate support. M/b an aromatase inhibitor.
root

PYGEUM AFRICANUM aka PRUNUS AFRICANUM
100 to 200 mg/day
from the bark of the African plum tree
one of the esters lowers chol, is also anti-inflammatory
lowers PRL, LH and T, incr adrenal steroid secretion
(PRL incr DHT syn and T secretion of prost)
sterols reduce inflammation: inhibit PGs and prostatic chol levels, precursors to T production
incr prostatic and seminal fluid secretions
greater improvement in nocturia and urinary flow than with residual volume

PUMPKIN SEEDS
good source of zinc
incr SHBG-->lower test
walnuts, all nuts and seeds
nuts are good sources of magnesium and selenium but additional supplementation mb necc

ZINC
intestinal uptake of zinc is inhibited by estrogen, coffee
excretion increased by: thiazides, steroids, methotrexate, tetracyclines, flouroquinolones
estrogen levels increase in the aging male, zinc may be low
reduces size and sx of BPH
MOA
inhibits 5-alpha-reductase
inhibits the binding of androgens to receptors
zinc inhibits prolactin-->fewer receptors for DHT

OTHER SUPPS
antioxidants
quercetin

EFAs
increase intake of omega-3 fatty acids
flax for PG synthesis

BRASSICA VEGETABLES
300-400mg/day
Diindolylmethane (DIM) (precursor = Indole-3-carbinol (I3C))
supports phase I conversion of Estrogen to 2OH, least carcinogenic relative to 16OH and 4OH
two pounds of broccoli/day
DIM costs more but is better than I3C
I3C converts to DIM c good stomach acid, also converts to other products, pushes both 2OH and 4OH
(useful for Moobs per Jones)

GENERAL STRATEGIES

AVOID XENOESTROGENS
eat organic foods, esp dairy, meats
filter drinking water
avoid using plastic containers for storage or heating of foods
avoid external chemical exposures

KEEP PROLACTIN LOW
PRL-->incr T secretion by prostate and incr DHT conversion
beer, tryptophan and stress all incr PRL-->aggravate BPH

KEEP CHOLESTEROL LOW
low chol better for BPH pts-->less proliferation

PHYSMED
Kegels.
Contrast Hydrotherapy – sitz baths. 1-2X/day
Yoga. Hip openers.

PHARM FOR BPH
Alpha blockers.
Finasteride (Proscar) – 5α reductase inhibitor.
Leuprolide (Lupron) – GnRH analog/agonist – non-FDA-approved use

proscar used allopathically, 5mg/day
1mg/day = propecia for hair
6-12mo to change in T
toxic to pregnant women, do not handle

*********************************
HERBS NOT RESEARCHED YET

UVA URSI
in ITI product, not sure why

LEPIDUM
maca
hormone balancer

YOHIMBE/PAUSINYSTHALIA
bark

RHODIOLA ROSEA
adaptogen

EPIMEDUM SAGITTUM
horny goat weed

PANAX GINSENG
adaptogen

EURYCOMA LONGIFOLIA
Tongkat Ali

BEE POLLEN

MYTHICAL TX, WHERE'S THE EVIDENCE?
aa's, glycine, glutamic acid, alanine
why are these three in so many prostate support supps?

GLANDULARS
protomorphogens, simplex m by standard process is beastie bits

SERMS
Soy to inhibit 5α reductase and block stronger estrogens
Also contains beta-sitosterol.


SECALE CEREALE
Rye Grass Pollen
Cernilton, Cernilton TS (TS for triple strength) = product c 180 mg of pollen extract, 1-2x/day
now called PollenAid and the cost is about $30.00 per month. Studies have shown improvement in nocturia, urinary frequency, and residual urine volume. Rye grass and flower pollen are also used for symptomatic relief of prostatitis and prostatodynia.





PHARM
avodart works on both alpha and beta to decr DHT
$150/mo



OTHER HERBS
Other herbal options may include: Chimaphila umbellata (Pipsissewa) – pelvic lymphagogue, diuretic, and urinary antiseptic, Galium aparine (Cleavers) – diuretic and lymphagogue, and

TINCTURE specific to pelvic/prostate/urinary sx: SP, Pipp, Cleavers, and Nettle in high doses.


PROSTATE CANCER PREVENTION

coffee drinkers get less prostate cancer:
http://www.medscape.com/viewarticle/745359?src=mp&spon=34
http://liveonearth.livejournal.com/tag/prostate

vitamin D deficiency linked to prostate cancer:
http://www.medscape.com/viewarticle/742625?src=mp&spon=22

5 ALPHA REDUCTASE
T metabolized/activated to DHT by 5-alpha reductase enzyme
T or DHT may be inactivated and cleared by enzymes that hydroxylate at 6, 7, 15, 16 positions
inhibitors: saw palmetto, finasteride/proscar

AROMATASE
T metabolized to Est by aromatase enzyme
aromatase is CPY19A1
once T is converted to Est (via aromatase) it doesn't turn back to T
bodybuilders get "moobs" dt aromatase action
inhibitors used off label by body builders who are taking anabolic steroids
inhibitors also used to tx breast & ov CA in postmenopausal women: keep est down
mb used to stim ovulation, or for endometriosis
also used to limit age-related decline in T
inhibitors: white mushrooms, nonselective: Aminoglutethimide, Testolactone, Selective: Anastrozole, Letrozole, Exemestane, Vorozole, Formestane, Fadrozole

HIGH DIHYDROTESTOSTERONE
-->alopecia: male pattern baldness
-->prostatic hyperplasia

DHT: dihydrotestosterone, a metabolite of T and 5x more potent androgen than T because it binds more strongly to androgen receptors and can enter the cell's nucleus and bind directly to the DNA. Areas of binding are called HREs, hormone response elements, influences gene trasncription with androgenic effecs. If there is a 5-alpha reductase deficiency a fetus will continue developing into a female with testicles.??? Produced in adrenal cortex??? I was under the impression that T could be converted to DHT at the tissues. DHT is an estrogen agonist so meds that reduce DHT may cause gynecomastia.

FINASTERIDE/PROSCAR
I can pee just FINa but I can't donate blood.
very popular drug
class: anti-androgen
indic: BPH, low dose (1mg) for male pattern baldness, high dose for prostate CA
48% of men taking propecia (finasterid 1mg) regrew hair, 42% had no more hair loss
must keep taking it to keep hair, works best in crown area

MOA: 5-alpha reductase inhibitor-->limits conversion of T to DHT
char: po qd for men only, wash your hands after dosing
CI: can't donate blood
CI: women who are or may become pregnant should not handle the product dt risk of birth defects
SE: decr libido, ED, impotency, depression, gynecomastia, breast swelling/tenderness

ALPHA BLOCKERS
I'm an aging alpha male and I can pee no prob.
drugs: Doxazosin/cardura, Terazosin/hytin, Tamsulosin/flomax, urimax, Silodosin/ureif
(tamulosin contains a sulfa moiety, beware sulfa allergies)
class: anti-andrenergic
indic: BPH, part of initial therapy along with a 5 alpha reducstase inhibitor
MOA: antagonizes alpha 1 andrenergic receptors-->relaxes smooth muscle in vasc of prostate and bladder neck-->decreased resistance to urine flow
char:
SE: weakness, orthostatic hypotension, nasal congestion

SILDENAFIL CITRATE/VIAGRA
Hey baby how do you like the results of my increased cGMP? A little headache won't stop me.
class: phosphodiesterase type 5 inhibitor (PDE5I)
indic: BPH, pulmonary hypertension
MOA: cGMP not broken down-->incr cGMP-->relaxation of smooth mm around BVs-->penis fills with blood
char: take 30mins-4 hours before sex, 25, 50 and 100mg tabs available but DrM says dose is 25mg
take no more than 1 tab/day
char: dose for pulm HTN: one 20mg tab tid, 20mg dose marketed as Revatio
SE: mc: headache, sinus/nasal congestion, flushing, dyspepsia
SE: vision changes, photophobia, cyanopia (see blue)
SE: priapism, ventricular arrhythmias, stroke, MI
CI: liver, kidney failure, recent MI, low BP
CI: don't mix with nitrates, could cause BP crash
CI: hereditary retinal degeneration disorders dt risk of incr intraocular pressure and acute closed angle glaucoma
(other drugs with same mechanism: Tadalafil/cialis, Vardenafil/levitra)

new PATHOPHYS OF BPH
veins draining testes and prostate are large
small vein drains from testes to prostate
vein draining testes degrades, blood then drains thru small vein from testes to prostate and out
this takes more hormone direct from testes to prostate, aggravating hyperplasia
Laura Fig sending me the study

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