Hormones and CP/CPPS

Adrenocorticotropin hormone and Stress

Research shows that patients with chronic pelvic pain have significantly more anxiety, perceived stress and a higher profile of global distress when tested, scoring in the 94th vs the 49th percentile for controls (normal population). Patients showed a significantly blunted plasma adrenocorticotropin hormone response curve with a mean total response approximately 30% less vs controls. Men with pelvic pain have significant disturbances in psychological profiles compared to healthy controls and evidence of altered hypothalamic-pituitary adrenal axis function in response to acute stress.

Cortisol

Men with chronic pelvic pain syndrome have significantly increased awakening cortisol responses compared to controls. Cortisol is released in response to stress. Researchers linked this finding to the fact that men with chronic pelvic pain syndrome have more perceived stress and anxiety than controls. Psychological test scores are significantly increased in all scales (somatization, obsessive/compulsive behavior, depression, anxiety, hostility, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychoticism) for chronic pelvic pain syndrome.

Estrogens and Phytoestrogens

Are female hormones the cause of male chronic pelvic pain syndrome? After all, rodent prostates can be inflamed by administering estrogens and phytoestrogens.

However, the induction of histologic (i.e. can be seen under a microscope) inflammation in rodent prostates with estrogens is not that applicable to a human pain syndrome:

  1. The scientists are manipulating rat prostates hormonally to induce inflammation. This is more akin to Type IV prostatitis (asymptomatic or painless prostatitis where microscopic inflammation can be seen), not Type III (CPPS). Do the rats have pain in their testicles? Do they have perineal aches? Do they have symptoms of CPPS? Who knows. Rats can’t tell us.
  2. CPPS is a syndromic ailment that according to research isn’t usually accompanied by histologic inflammation, research has shown. Therefore trying to use this particular animal model as a proxy for the human disease of CPPS is not logical.
  3. On the other hand, histological prostatic inflammation is found in many men who have no symptoms of CP/CPPS. It is also found in prostate cancer and BPH biopsies.

More generally, there are no studies showing significant sex hormone differences between men with CPPS and normal men.