Premature Balding in Men

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
• Infertility

Dr. Cavaiola stated that young men can suffer from similar symptoms:

• Insulin resistance
• Obesity
• 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 between 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 Resistance

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).

Treatment Options

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.

Conclusion

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.