Lower urinary tract symptoms (LUTS) in men have often been blamed on increased androgens, particularly dihydrotestosterone (DHT).  A study just published in The Journal of Sexual Medicine provides more evidence for what I have noticed clinically for a long time: elevated estrogen causes more urinary tract symptoms than DHT and other androgens. The authors first observe:

“In male, lower urinary tract symptoms (LUTS) have been associated, beside benign prostatic hyperplasia, to some unexpected comorbidities (hypogonadism, obesity, metabolic syndrome), which are essentially characterized by an unbalance between circulating androgens/estrogens. Within the bladder, LUTS are linked to RhoA/Rho-kinase (ROCK) pathway overactivity.”

They conducted their investigation by testing the relative effects of estrogens, aromatase expression (aromatase converts testosterone to estrogen) and androgens (male hormones) on male genitourinary tract tissues, including cells from the bladder, prostate and urethra. What did the data show?

“Our data indicate for the first time that estrogen-more than androgen-receptors up-regulate RhoA/ROCK signaling [increases urinary tract symptoms]. Since an altered estrogen/androgen ratio characterizes conditions, such as aging, obesity and metabolic syndrome, often associated to LUTS, we speculate that a relative hyperestrogenism may induce bladder overactivity through the up-regulation of RhoA/ROCK pathway.”

This is part of the reason why I always measure free-fraction (bioactive) estrogen as part of a hormone profile for men. All too often men are given supplemental testosterone with no consideration for how much of it is being turned into estrogen by aromatase activity—with a potential increase in LUTS, not to mention cardiovascular, prostate cancer and depression risk factors.