Yes, you read that right! There are a few rare cases of endometriosis that have been found in men. I read an article the other day that addressed this issue, and I was shocked! Before I wrote this blog, however, I wanted to verify that this is actually true. Well, it is. It’s rare, but it has happened.
A study published in 1985 by Martin and Hauck¹ looked at an 83-year-old man who had an endometrioma on his lower abdominal wall. The researchers reference several other cases that have been reported in the literature. The theory for the development of endometriosis-like tissue in the male at that time was that it developed from remnants of the prostatic utricle, or remnants of the uterus. They discuss how female remnants may be present as some men may be genetically mosaic – that is, they may have some female cells (46,XX) along with the normal male cells (46,XY). However, they point out that in this case, the 83-year-old man had only 46,XY cells (a normal male karyotype). The researchers go on to say that this man was thought to have prostate cancer but was later found to have adenocarcinoma. He had been placed on 25 mg. TACE which he took for ten years. It is extremely interesting to note that TACE, also known as chlorotrianisene, is a type of estrogen. It has since been discontinued from use.
A more recent study done in 2014 by Jabr and Venk² addresses a case of abdominal pain in a 52-year-old man with a history of cirrhosis and hepatitis C. He had two previous surgeries for an inguinal hernia within a two-year period. He presented to the emergency room with excruciating pain in his right lower abdomen and pelvis. A mass was found attached to the urinary bladder, and it extended into the inguinal canal. The mass was removed and tested, and it was found to be positive for both estrogen and progesterone receptors. The findings were consistent with endometriosis. The researchers note that cirrhosis is known to be associated with high estradiol levels.
Jabr and Venk go on to discuss several other previous studies. Endometrial-like tissue was discovered in two men with prostate cancer, both of which had been treated with estrogen for several years. The researchers also point out that another man was diagnosed with endometriosis after inguinal hernia surgery. They hypothesize that inguinal surgery coupled with high estrogen levels may increase the risk of development of endometriosis in the male. They also state induction appears to be a likely pathway for the development of endometriosis. Induction is the formation of endometriotic-like tissue as the result of unknown factors, endogenous or exogenous, inducing change in undifferentiated mesenchymal or embryonic cells.
Most people think of endometriosis as a disorder that affects women only; however, it has been seen in men. It is important to note this as it may give us much-needed information as to what factors play a role in the development of this disorder. According to these few studies, it appears that estrogen (estradiol) may play a pivotal role in the development of endometriosis and adenomyosis. I hope that more studies in men are forthcoming.
¹Martin, JD Jr., and Hauck, H.E. (1985). Endometriosis in the male. Am Surg, 51(7):426-30. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/4014886
²Jabr, F.I., and Mani, V. (2014). An unusual case of abdominal pain in a male patient: Endometriosis. Avicenna Journal of Medicine, 4(4):99-101. doi:10.4103/2231-0770.140660
A very interesting article on endometriosis that was found in the psoas muscle. Just another case that shows endometriosis can be found in just about any area of the body. Recommended reading….thanks to Lisa at Bloomin Uterus!!
An article was published on October 30, 2016 in the International Journal of Clinical and Experimental Medicine, which caught my interest. We know that Endometriosis can grow in a lot of places ot…
I recently read an article about concerns with the use of flaxseed in women with adenomyosis due to its estrogen activity. This article intrigued me since I have always promoted the use of this nutrient, so I did some research.
The reason that I promoted the use of flaxseed in women with adenomyosis is because I had tremendous symptom relief after adding flaxseed to my diet. At that time, I had been suffering terribly with severe pain, and I was desperate to find anything that would help me. I had been on all kinds of medications, none of which helped, and had several surgeries. I read up on the health benefits of flaxseed, and I was ecstatic when, after I added it to my diet, my pain level dropped dramatically.
I have since published a book, Adenomyosis: A Significantly Neglected and Misunderstood Uterine Disorder, and have included an entire chapter on the benefits of omega-3 fatty acids in the treatment of adenomyosis. Flaxseed contains very high levels of omega-3 fatty acids. Another chapter is dedicated to phytoestrogens, and flaxseed also falls into this category.
The concern with the use of flaxseed is that it contains a substance called lignans. Lignans are a type of phytoestrogen. Phytoestrogens are substances that can act like estrogen in the body. Many people are concerned that lignans may increase their estrogen levels and lead to further problems with adenomyosis since it is an estrogen-dependent disorder. A very reasonable concern, for sure.
The subject of phytoestrogens is a very complicated topic as I found out while doing research for my book. I found out that some phytoestrogens are not advised while others may actually help those with hormone-dependent disorders such as adenomyosis. Let me explain.
Phytoestrogens compete against our own natural (endogenous) estrogen for the estrogen receptor sites in our body. Estradiol is an example of endogenous estrogen. In general phytoestrogens are much weaker than endogenous estrogen. According to Seidl and Stewart, “the relative potency of phytoestrogens is, at most, only 2% that of estradiol.”¹ That is a general statement, however, and is not always the case as you will see below.
Proponents of the use of phytoestrogens argue that since they are so weak and they compete with our own estrogen which is much stronger, our estrogen levels should drop which would be good for hormone-sensitive disorders. However, recent research has shown that these substances act in different ways. In fact, a few phytoestrogens have, in fact, been found to be as strong as estradiol.
Some phytoestrogens are estrogen agonists, meaning that they increase estrogen levels. As stated previously, a few have been reported to be as strong as estradiol. However, some estrogens are antagonists, meaning that they decrease estrogen levels. Black cohosh is an example of an estrogen antagonist. A study by Rebbeck et al. has shown the use of black cohosh in women with breast cancer may have a protective effect since this herb has been shown to have anti-estrogenic effects.²
The most important thing to know is just because a nutrient is known to be a phytoestrogen, that doesn’t necessarily mean that it’s bad for women with hormone-sensitive conditions. It all depends on the specific phytoestrogen and if it works in an agonist or antagonist fashion. Now, let’s look at flaxseed specifically.
The few studies out there regarding flaxseed and estrogen activity have been inconsistent. However, evidence seems to be pointing in the direction that flaxseed may actually be beneficial in hormone-sensitive disorders. However, much more research needs to be done to confirm these findings. Many experts still warn about the use of flaxseed in hormone-sensitive disorders.
- A study was performed where women with recently diagnosed breast cancer ate one muffin per day for 40 days that contained 25 mg flaxseed. The researchers noted a reduction in tumor growth during this time.
- A case-controlled study in the U.S. showed that women with this highest intake of lignans had the lowest risk of endometrial cancer and ovarian cancer.
- Another study showed a reduction of breast tumor growth and metastasis in rats that consumed a diet high in lignans.
- According to WebMD, “some early laboratory and animal research suggests that flaxseed might actually oppose estrogen and might be protective against hormone-dependent cancer.”³
These findings are suggestive of an estrogen-antagonist action in the lignans found in flaxseed. However, if you are still worried about this nutrient, there are other options, such as fish oil which contain high levels of omega-3 fatty acids without the controversial lignans. Omega-3 fatty acids have been found to be very beneficial in the treatment of endometriosis.
- A study done by Covens, Christopher, and Casper in 1988 showed that “dietary supplementation with fish oil, containing the n-3 polyunsaturated fatty acids EPA and DHA can decrease intraperitoneal PGE2 and PGF2-alpha production and retard endometriotic implant growth in this animal model of endometriosis”.4
- Another study done by Missmer, Chavarro, Malspeis, Bertrone-Johnson, and Hornstein in 2010 states “…those women in the highest fifth of long-chain fatty acid consumption were 22% less likely to be diagnosed with endometriosis compared with those with the lowest fifth of intake…”5
Hopefully more studies will be done soon on lignans and their effects on estrogen levels so these preliminary findings can be confirmed or disproven. We need clear answers so we can deal with these hormone-related disorders, especially adenomyosis, effectively.
If you want to try flaxseed to see if it helps you, the following brand is the kind that I purchased years ago when I tried it (click on image to purchase through Amazon):
For more detailed information on phytoestrogens, omega-3 fatty acids, and flaxseed, check out my book, Adenomyosis: A Significantly Neglected and Misunderstood Uterine Disorder. Click on image to purchase through Amazon.
¹Seidl, M.M. & Stewart, D.C. (1998). Alternative treatments for menopausal symptoms: Systematic review of scientific and lay literature. Canadian Family Physician, volume 44. Retrieved from http://www.europepmc.org/backend/ptpmcrender.fcgi?accid=PMC2278270&blobtype=pdf
²Rebbeck, T.R., Troxel, A.B., NOrmal, S., Bunin, G.R., DeMichele, A., Baumgarten, M.,…Strom, B.L. (2007). A retrospective case-control study of the use of hormone-related supplements and association with breast cancer. International Journal of Cancer, 120, 1523-1528. doi: 10.1002/ijc.22485
4Covens, A.L., Christoper, P., & Casper, R.F. (1998). The effect of dietary supplementation with fish oil fatty acids on surgically induced endometriosis in the rabbit. Fertility and Sterility, 49(4), 698-703. Retrieved from http://www.researchgate.net/publication/20324462_The_effect_of_dietary_supplementation_with_fish_oil_fatty_acids_on_surgically_induced_endometriosis_in_the_rabbit
5Missmer, S.A., Chavarro, J.E., Malspeis, S., Bertrone-Johnson, E.R., & Hornstein, M.D. (2010). A prospective study of dietary fat consumption and endometriosis risk. Human Reproduction, 25(6), 1528-35. doi:10.1093/humrep/deq044
Sari Botton contacted me on Saturday and generously sent me this article. She thought I would be interested in reading it since she struggled with adenomyosis. This wonderful piece was published in the New York Times on Friday, October 28, and it is an honest and heartfelt article on her ambivalent feelings on motherhood and her struggle through infertility and adenomyosis. Thank you so much, Sari, for sharing the details of your difficult journey…I know it will help so many women out there who are struggling with the same issues. The link to her article in the NY times is below – read it…you’ll be glad you did!
Another excellent article from Bloomin’ Uterus. She mentions flaxseed also in this article and how she avoids it. I have always promoted the use of flax with endo and adeno as I had tremendous symptom relief during my struggle. However, as I recently discovered, there are some concerns with its use. After reading all the evidence, I still personally do promote the use of flax, and I will get into this in much more detail in a future blog. In the meantime, read up on parabens – it is really important to avoid the use of this type of xenoestrogen as much as possible! Thanks, Lisa, for another informative article!
What are Parabens? Parabens are chemicals used as preservatives in consumer products. Why are they Bad for Us? If you happen to suffer from Endometriosis, or any other estrogen-driven condition (like breast cancer), please be aware that parabens mimic estrogen. Just like soy. Just like flax. Parabens are an “endocrine disruptor,” which alters our body’s hormone […]
Great article on endometrial polyps from one of my fav blogs – Bloomin’ Uterus! Endometrial polyps can occur with adenomyosis, and it is important to be educated on this disorder. I personally had a uterine polyp removed via hysteroscopy during the years that I struggled with adeno. I highly recommend this article – full of great info!
One of our local EndoSisters has recently been diagnosed with endometrial polyps, something I know absolutely nothing about. So what happens when I know nothing? I research! What is a polyp? A polyp is an abnormal overgrowth of tissue, usually a lump, bump, or stalky growth (hence the mushrooms above). They’re most commonly found in the colon, […]
Very interesting read…highly recommended for all adenomyosis sufferers. You are not alone!
Oh where to start with this one! ( Warning, this may be a long read) My journey with this illness has had me literally pulling my hair out, from the let downs to the waiting and waiting on answers that nobody would ever give, it’s been a struggle and it continues to be. I can’t see […]