Men’s Health Issues:Herbal Treatment for Common Genitourinary Problems

©David Winston, RH (AHG)

ª Men make up slightly less than one half of the population, yet account for far less doctor’s office visits.

ª Even with life-threatening conditions, many men are reluctant to go to the doctor.

Reasons why men avoid going to the doctor

Cultural issues

Fear

Embarrassment

Denial

The Prostate

Prostatitisª Most common type is chronic nonbacterial prostatitis (CNP) or

chronic pelvic pain syndrome (CPPS)

ª Symptoms include pelvic pain, dysuria, painful urination and ejaculation, sometimes ED

ª Varying underlying problems can initiate the condition (bacterial infection, STDs, urinary blockage)

ª Two studies indicated long-term treatment with two alpha-blockers (Terazosin and Alfuzosin) had significant benefits in men not previously treated with alpha-blockers

ª I treat this condition as an autoimmune-driven inflammatory condition

Urinary Antiinflammatory Agents

Cleavers – Galium aparine Corn Silk – Zea mays

Couch Grass – Elytrigia repens Eryngo – Eryngium yuccifolium

Marshmallow – Althea officinalis Saw Palmetto – Serenoa repens

Urinary Analgesics

Agrimony – Agrimonia spp. Black Cohosh – Actaea racemosa

Gravel Root – Eupatorium purpureum Hydrangea – Hydrangea arborescens

Kava – Piper methysticum Pulsatilla – Anemone patens

Immune Amphoterics

Asian Ginseng

Cordyceps

LicoriceMaitake

Una de Gato

Picrorhiza

Immune Amphoterics

Ashwagandha

Holy Basil

American Ginseng

Reishi

Guduchi

Immunoregulators

Turmeric

Sheng Di Huang/Unprocessed Rehmannia

Dan ShenHuang Qin/Baikal Scullcap

Sarsaparilla

Gotu Kola

Boswellia

Indian Madder

Acute Bacterial Prostatitis (ABP)

ªSymptoms appear suddenly (chills, fever, dysuria, painful urination, low back and perineal pain).

ªA bacterial infection that would be classified as a damp heat condition.

ªOrthodox treatment includes 4 weeks of antibiotics, alpha-blockers and antiinflammatory medications.

Urinary Antiseptics

Buchu – Barosma spp. Chinese Coptis root – Coptis chinensis

Cranberry – Vaccinium spp. Forsythia/Lian Qiao fruit –Forsythia suspensa

Honeysuckle flowers–Lonicera japonica

Pipsissewa –Chimaphila umbellata

Uva-Ursi – Arctostaphylos uva-ursi Water Plantain–Alisma plantago-aquatica

Wintergreen –Gaultheria procumbens

Yerba Santa herb –Eriodictyon spp.

Chronic Bacterial Prostatitis (CBP)

ªSymptoms include urinary frequency and nocturia, burning urination, painful ejaculation, chronic low back, perineal and testicular pain

ªOrthodox treatment for CBP is similar to that of the acute prostatitis, except antibiotics are often prescribed for longer periods of time (8-12 weeks)

ªThe herbs used to treat CBP are similar to those used for the acute form, except I use more of the antiinflammatory agents along with the antibacterials and urinary analgesics

Dr. R. Swinburne Clymer’s Classic CBP Formula

Tinctures of:

Couch Grass (Elytrigia repens) 5-15 gttPulsatilla (Anemone pulsatilla) 2-5 gttPipsissewa (Chimaphila umbellata) 2-10 gttSaw Palmetto (Serenoa repens) 10-20 gtt.

Mix in 4 oz. of water and take 4 times per day.

Asymptomatic Inflammatory Prostatitis (AIP)

ªNo obvious symptoms. Elevated white blood cells are found in prostatic secretions, usually while doing tests for other conditions.

ªIf treated, a physician will usually give a course of antibiotics.

ªI would use a combination of urinary antiseptics and urinary antiinflammatory agents if the patient wanted treatment.

Other Prostate Issues

Benign Prostatic Hypertrophy or Hyperplasia (BPH)

ªChronic condition affecting 50-60% of all men by the age of 62. Symptoms can include urinary frequency, dysuria, dribbling of urine, incomplete emptying of the bladder, nocturia, and, in late stage BPH, possible blockage of urine, with back pressure causing kidney damage and uremia.

ªCause is believed to involve changing balance of reproductive hormones.

ªAging, genetics, environmental xenoestrogens, nutritional deficiencies (zinc, vitamin E, magnesium, B vitamins, selenium, Omega 3 fatty acids), environmental pollutants (especially cadmium) and insulin resistance can all play a role in the excess growth of prostate tissue.

Herbs for BPH

Aromatic Collinsonia –Collinsonia canadensis

Mullein root – Verbascum thapsus

Nettle root – Urtica dioica

Gunilla Elam

Pygeum bark– Prunus africanum

Red Maca – Lepidium meyenii Saw Palmetto berry – Serenoa repens

Small flowered Willow–Epilobium parviflorum Tickseed herb – Bidens spp.

White Sage leaf – Salvia apiana

Dietary Suggestions for BPH

ªReduce intake of trans-fatty acids, refined carbohydrates, alcohol (especially beer) and sources of synthetic hormones (commercial meats and dairy).

ªIncrease consumption of legumes (isoflavones), seeds-especially flax seed (lignans), fiber, zinc rich foods (pumpkin seeds, fish, seaweed, black walnuts), foods rich in antioxidant and antiinflammatory carotenoids- pumpkin, squash, dried apricots, red, yellow, or orange peppers, beets, carrots, dark green leafy vegetables, and essential fatty acids found in wild salmon, sardines, anchovies, deep sea fish and in purslane, flax seed, and some other nuts and seeds.

Nutritional Supplements for BPH

ªL-glutamine, L-alanine, and glycine, when taken together as a supplement, have shown benefits in reducing symptoms of BPH.

ªDHA/EPA Omega 3 fatty acids inhibit testosterone binding in the prostate and have antiinflammatory and antioxidant activity.

ªPumpkin seed oil capsules and a rye pollen extract (Cernilton) have also shown benefits for relieving BPH symptoms. L-alanine

GlycineL-glutamine

Nutritional Supplements for BPHªVitamins A,C, B-6, and E, as well as the minerals

zinc, selenium, and magnesium are known to be essential to healthy prostate function.

ªThe carotenoid Lycopene is also associated with reduced risk of developing BPH.

ªA combination product containing lycopene, Saw Palmetto, Pygeum, Pumpkin seed oil and small-flowered Willow herb was effective in helping to reduce urinary frequency in men with BPH.

Prostatic Cancer

ªSecond most common cancer (skin cancer is the first) diagnosed in men. 98% of prostate cancers occur in men aged 55 or older and is not always a serious disease.

ª It is estimated that 15-30% of American men over age 50 and 60-70% of men over 80 have small, harmless prostate cancers; about 12% of diagnosed cases are fatal.

ªMany of the same factors that lead to BPH are linked to increased levels of prostate cancer, including aging, environmental pollutants, ethnicity (African-American men are twice as likely to get and die from prostate cancer than Caucasian men), exogenous hormones, high-fat and high-calorie diets, and obesity/insulin resistance.

ªResearch suggests that PSA (Prostate Specific Antigen) tests are useful for men with a family history of prostate cancer, African-American men over 50 and men with other significant risk factors. The U.S. Preventative Service Task Force has said men over 75 should not be tested.

Prevention of Prostate Cancer with Herbs and Food

ªRegular consumption is related to a decreased risk of developing prostate cancer. ). These vegetables are rich sources of antitumor organosulfur compounds and Onions also contain quercetin, which is antiinflammatory and has cancer inhibiting activity.

Alliums

ªA meta-analysis of this carotenoid-rich root vegetable found that regular consumption significantly reduced the risk of developing prostate cancer.

Carrots

Erika Craddok

Chitraka/White Leadwort root –Plumbago zeylanica

Napthaquinone Plubagin inhibits hormone refractory prostate cancer in animal studies.

Cruciferous vegetables

Ingestion of Isothiocyanatesulforaphene has an inverse association with prostate cancer occurrence

Green Tea – Camellia sinensis Korean Angelica root –Angelica gigas

Regular consumption is linked to lower levels of prostate cancer Root extracts inhibit androgen

and androgen receptor mediated signaling needed for prostate cancer growth.

Milk Thistle seed – Nettle root – Urtica dioicaSilybum marianum

Silymarin/silibinin inhibit PSA, prostate cancer cell growth, angiogensis and procancer cell signaling compounds.

Animal studies show antiproliferativeactivity, it may help prevent progression from prostate neoplasiato cancer.

Pomegranate juice/fruit extract – Pygeum bark – Prunus africanaPunica granatum

The juice significantly inhibits PSA doubling times in men with prostate cancer.

Animal studies show it inhibits prostate cancer cell growth, induces apoptosis and reduces risk of developing prostate cancer.

Saw Palmetto berry – Serenoa repens Soy

Inhibits DHT and prolactin and may inhibit prostatic carcinogenesis.

Regular consumption of soy in Japan reduces risk of prostate cancer in Japanese men.

Turmeric rhizome – Curcuma longa

Inhibits cancer progression via multiple mechanisms including inhibiting androgen receptor and epidermal growth factor receptors.

Supplements for Prevention or Treatment of Prostate Cancer

Fish Oil Lycopene

ªPreliminary studies indicate that fish oils reduce prostate inflammation and have a more pronounced inhibitory effect on highly aggressive prostate cancers.

ªIn several small human trials Inositol hexaphosphate (IP6), or phyticacid, inhibited prostate cancer, and in animal studies it inhibits cancer cell survival and proliferation and induced apoptosis.

ªIn a human trial, Lycopene was able to delay or prevent progression of high-grade prostate intraepithelial neoplasia (HGPIN) to prostate cancer, Men with prostate cancer who took Lycopene were able to stabilize their PSA levels and delay progression of the disease.

Modified Citrus Pectin Resveratrol

ªAnimal studies showed that oral consumption of modified citrus pectin inhibited metastasis of prostate cancer cells. Small scale human studies confirm that it slows the progression of prostate cancer and reduces metastatic cancer.

ªResveratrol has exhibited chemoprevention activity and it inhibited tumor initiation, promotion and progression.

ªVitamin D (D3) increases prostate cancer cell differentiation and apoptosis and decreases proliferation, invasiveness, and metastasis.

ªA study done in Finland shows that men vitamin E had a reduced risk (approximately one third) of prostate cancer. In those who did have the disease, the death rate was reduced by 41 percent. A large human trial looking at the possible protective effects of vitamin E and selenium for prostate cancer failed to find any benefit and suggested a slightly increased risk of developing the disease.

Vitamin DVitamin E

ªHigher levels of the K2 (menaquinone) form of vitamin K was found to have an inverse association with the occurrence of prostate cancer. The K1 form (phylloquinone) did not seem to protect against this disease.

ªIn laboratory studies Zyflamend inhibited the growth of prostate cancer cells and down-regulated NF-kB, a protein that stimulates cancer cell growth and metastasis. ªOther studies found this herbal combination inhibited COX1, COX2, and

12-LOX expression, all of which are inflammatory and promote cancer growth.

ªIn an animal study it inhibited androgen dependent prostate tumor growth and reduced PSA and other cancer markers (Huang, et al, 2012).

ªA human trial (Capodice et al, 2009) found that Zyflamend helped to reverse high-grade prostatic intraepithelial neoplasia (60% reverted to normal), reduce PSA levels, and lower serum C-reactive protein levels.

Zyflamend

ªInflammation of the epididymis, the first part of the secretory ducts of the testes.

ªOften caused by STD or co-infection associated with prostatitis, mumps or urethritis.

ªSymptoms include fever with chills and testicular and inguinal pain.

Epididymitis

Urinary Antibacterials

Pipsissewa – Chimaphila umbellata

Chinese Coptis – Coptis chinensis

Uva Ursi – Arctostaphylos uva-ursi

Goldenseal – Hydrastis canandensis

Urinary Antibacterials

Huang Qin – Scutellaria baicalensis

Gardenia fruit – Gardenia jasminoides Bai Hua She She Cao – Oldenlandia diffusa

Yu Xing Cao – Houttuynia cordata

Urinary AntiinflammatoriesEryngo – Erygium spp.Cleavers – Galium aperine

Plantain seed – Plantago spp.

Urinary AnalgesicsBlack Cohosh – Actaea racemosa

Kava – Piper methysticum

Pulsatilla – Anemone patens Hydrangea – Hydrangea arborescens

Cleavers – Galium aparine

ªInflammation of the testicles caused by trauma, mumps, infection or cancer.

ªSymptoms include testicular swelling with severe pain, fever, vomiting and, if left untreated, possible sterility.

ªOrthodox treatment can include bed rest, antibiotics and application of ice packs.

Orchitis

Urinary Analgesics

Cyperus – Cyperus rotundus Kava – Piper methysticum

Black Cohosh – Actaea racemosa

Urinary Analgesics

Vaccaria seed/Wang Bu Liu –Vaccaria hispanica

Gelsemium – Gelsemium sempervirensPulsatilla – Anemone patens

ªConnective tissue disorder that causes fibrous plaques to develop in the soft tissue of the penis.

ªThe cause of this condition may be from penile trauma, genetics may play a role, and calcium channel blockers are believed to possibly be a cause of this condition.

ªOrthodox medical treatments include Verapamil injections, oral Colchisine and vitamin E, Sildenafil and Pentoxifylline, as well as surgery.

Peyronie’s Disease

ªA human trial comparing Acetyl-L-Carnitine and Tamoxifen for treatment of acute and early chronic phases of Peyronie’s found the ALC was superior to reducing pain and inhibiting disease progression. ALCwas also safer and had few side effects compared to Tamoxifen.

ªLocal applications of heat to the penis (103-104õF) for 30 minutes twice a week for 5 weeks significantly reduced plaque size and penile curvature. It also improved erectile function and prevented disease progression.

Possible Alternative Treatments

Chu Jie TangCitrus Peel, Processed Pinellia, Sparganum, Zedoaria, Poria, Self-Heal, White Mustard seed, Fritellaria, Frankincense, Myrrh, Achyranthes, Melia, Bupleurum, Atractylodes Luffa sponge, Buttercup.

ª Used in a clinical trial of 30 men with Peyronie’s disease. The authors claim to have cured 23 cases and improved 7 cases.

ªAnimal studies show that L-Arginine and other nitrergic agents inhibit plaque size and the collagen/ fibroblast ratio. At least on an experimental level, this amino acid was able to stimulate NOS activity and nitric oxide (NO) synthesis as well as PDE (phosphodiesterase) inhibitors.

ªPOTABA, a pharmaceutical relative of the B vitamin PABA, was found to have a significant protective effect against further progression of Peyronie’s.

ªSeveral intriguing Cuban studies suggest that was effective in diminishing penile plaques in early stage (1-2 years) Peyronie’s. A second group who were treated with Propolis and laser therapy had slightly enhanced benefits and a third group who had only laser therapy showed no improvements.

Possible Alternative Treatments

ªA topical gel containing liposomally encapsulated recombinant human superoxide dismutase (irhSOD) was found to be effective in reducing penile pain, plaque formation, and progression of Peyronie’s disease.

ªSeveral small studies done in the 1970s and 80s found that vitamin E helped prevent further progression of Peyronie’s. Until recently, studies have failed to confirm earlier reports, but a 2013 RCT found that vitamin E (along with Verapamil, blueberries, Propolis, and topical Diclofenac) can help prevent the progression of PD.

Possible Alternative Treatments

• Most common causes of male infertility are low sperm count and low sperm motility.

• Not only are men experiencing this problem but many fish and reptiles (frogs, alligators, salamanders) are showing increasing signs of feminization and infertility as well, which suggests a global problem, rather than a man here or there who is incapable of fathering a child.

• Zinc, vitamins C, E, and B12, L-carnitine, selenium, CO-Q-10, L-arginine, and Omega 3 fatty acids are essential for normal male fertility.

Infertility

• Low sperm count or low sperm motility are symptoms of deficient kidney yang and deficient jing. In the Chinese tradition, too frequent ejaculation wastes jing and reduces the quality of the sperm. This idea concurs to some degree with Western knowledge.

• Spermatogenesis requires about 72-74 days for sperm maturation. In fertility clinics they recommend that men avoid ejaculation for 3 or 4 days before their wives ovulate to enhance the quality and motility of sperm.

• In addition, elevated temperatures from wearing tight underwear or sitting in hot tubs or saunas can inhibit sperm formation which optimally occurs at 93.2o F.

Infertility

Herbs that have a traditional use for enhancing male fertility and libido

He Shou Wu – Polygonum multiflorum

Ashwagandha – Withania somnifera Cordyceps – Cordyceps chinensis

Tongkat Ali – Eurycoma longifolia Rou Cong Rong – Cistanche salsa

Suo Yang – Cynomorium songaricum

©ABC

ªLow testosterone or hypogonadism in older men (greater than 55 years old).

ªMen can experience low energy, mental fog, increased weight (beer belly), loss of libido, and depression

ªLong-term effects can cause or exacerbate heart and circulatory problems, muscle loss, impotence, dementia, osteoporosis, and bone fractures

ªOrthodox treatments include synthetic and natural testosterone

Andropause/Male Menopause

The following herbs already discussed have been shown to enhance testosterone production and endocrine function:

Rou Cong Rong (Cistanche salsa)Suo Yang (Cynomarium songaricum)Yin Yang Huo (Epimedium spp.)Ashwagandha (Withania somnifera)Cordyceps (Cordyceps sinensis)Asian Ginseng root (Panax ginseng)Tongkat Ali (Eurycoma longifolia)

Andropause/Male Menopause

Increased depression, irritability, decreased patience and concentration.

Saw Palmetto (Serenoa repens)Pulsatilla (Anemone patens )Black Cohosh (Actaea racemosa)Adaptogens, especially Ashwagandha (Withaniasomnifera)

Nervines – Fresh Oat (Avena sativa), St. John’s wort (Hypericum perforatum), Hawthorn(Crataegus oxycanthoides)

Grumpy Old Man Syndrome