T Nation



Hey guys,
Any advise for TRT for a guy with BPH? e.g., will exogenous T make the BPH worse? What's the best way to treat both low T and BPH at the same time?
Profile: age: 55, PSA ~9, biopsy neg, prostate volume >200cc (not where I wanted to get Heoooge! LOL!), urination symptoms, on Rapaflo.
Started experienceing symptoms of low T. Lab came back <300. Bingo!
Thanks in advance for the help!


Most experts agree that too much DHT is a leading cause of BPH so you should reduce your DHT (which metabolizes from T). IMO, these experts aren't good to listen to.

DHT is required to maintain healthy libido and overall sexual functioning.

I also do not think DHT is the primary cause of BPH. The DHT levels in young men are sky high, yet how many of them actually have BPH? Not many--these symptoms don't start appearing until men start aging (weight gain? cortisol productin line metabolism downregulation?).

I acknowledge that reducing DHT will reduce BPH (at a high cost to your well being) but I strongly suspect it is because of other mechanisms that are at play and are also affected by the reduction in DHT. I think cortisol and E2 are the most likely candidates.

Do some legwork on google trying to correlate lowering E2 (estradiol) with improved BPH symptoms. Dr. Crislers forum has a god thread about improving the cortisol production line in order to keep T form dumping to E2 and allowing it and DHT to wreak havoc on the prostate. I'm sure at some point I've come across literature suggesting the same.


from all that I have read, too much estradiol is the main culprit in BPH, not DHT, but there are a lot of conflicting opinions out there, and I haven't dug that deeply.

you need a lot of blood tests to see where your whole system is at (per the blood test sticky). Get Estradiol, DHT, SHBG, Total T, 8am Cortisol, TSH, etc. etc. etc.

if you estradiol is high, then controlling that while going on T can improve BPH.


I noticed an improvement in "flow" once I added an AI into my protocol. I know E2 was high, but I have no idea as to how high - I was having nipple issues. The addition of the AI fixed that and improved urine flow.


Thanks guys, I appreciate the help. My Urologist treating my BPH only got total T from the lab (201!). A shot of T (to see how I'd react) made me feel like my old self again - for about a week. I read that sticky with the long list of blood tests, which I'll take in with me next time. I've been reading about the E2 connection. I'll check into the Cortisol now too.


Here's a link that may be of interest for you on your next visit to your doctor print this off and discuss this opinion over BPH meds first.