Testosterone (T) and dihydrotestosterone (DHT) are the major androgens in the human prostate and are required for normal prostate development and homeostasis. In men, aging is associated with a gradual decline in serum T levels. Despite declining serum T concentrations, the incidence of prostate diseases increases markedly with age. Androgen replacement therapy in older men with age-associated """"""""androgen deficiency"""""""" results in beneficial anabolic effects on muscle and bone, and can improve sexual function and strength, yet significant concern exists regarding the possibility of potentiating prostate disease. The goal of therapeutic androgen therapy is thus to maximize anabolic effects while minimizing effects on the prostate. Previous studies have demonstrated that the anabolic benefits of T exhibit linear dose-response effects but suggest that the prostate does not exhibit similar dose-responses to increases in serum androgens. We hypothesize that the dose-response effects of exogenous androgens within the prostate are not linear because the prostate maintains a unique androgenic milieu in the face of changes in serum androgens.
In Aim 1 of the proposed studies, we will determine whether increasing concentrations of serum T alter the intraprostatic androgen environment and have downstream cellular consequences within the gland. Within the prostate, the enzyme 51-reductase (51R) is highly expressed resulting in a high intraprostatic concentration of DHT, which has been implicated in the development of prostate disease.
In Aim 2 we will determine the hormonal and molecular effects of low and high doses of T in the presence of a 51R inhibitor within the prostate to better characterize this """"""""prostate sparing"""""""" androgen replacement strategy.
In Aim 3 we will investigate whether the healthy human prostate has the capacity to synthesize DHT and T in situ from adrenal precursors, a mechanism which might contribute to stabilizing intraprostatic androgen concentrations when serum levels fluctuate. We will perform our interventions in humans where we have experience with prostate tissue analyses including quantification of hormones and cell-specific gene expression analysis as a marker of androgen action. These studies will provide an understanding of the hormone-related changes in the prostate microenvironment and will help inform future studies of androgen replacement therapies in older men.

Public Health Relevance

Testosterone use among men has increased substantially over the past decade, fuelled in part by the promise of increases in strength and sexual function. However, there is considerable concern that men taking testosterone will be at increased risk for prostate disease, including prostate cancer, already the most common cancer among men. In the proposed studies we will determine the effects of increasing doses of testosterone on prostate tissue in healthy men. An improved understanding of the impact of testosterone on the prostate will help inform the risk:benefit ratio of testosterone therapies in older men.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
Project #
Application #
Study Section
Integrative and Clinical Endocrinology and Reproduction Study Section (ICER)
Program Officer
Murthy, Mahadev
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Washington
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Rubinow, Katya B; Vaisar, Tomas; Chao, Jing H et al. (2018) Sex steroids mediate discrete effects on HDL cholesterol efflux capacity and particle concentration in healthy men. J Clin Lipidol 12:1072-1082
Rubinow, Katya B; Chao, Jing H; Hagman, Derek et al. (2017) Circulating sex steroids coregulate adipose tissue immune cell populations in healthy men. Am J Physiol Endocrinol Metab 313:E528-E539
Thirumalai, Arthi; Rubinow, Katya B; Cooper, Lori A et al. (2017) Dose-response effects of sex hormone concentrations on body composition and adipokines in medically castrated healthy men administered graded doses of testosterone gel. Clin Endocrinol (Oxf) 87:59-67
Thirumalai, Arthi; Cooper, Lori A; Rubinow, Katya B et al. (2016) Stable Intraprostatic Dihydrotestosterone in Healthy Medically Castrate Men Treated With Exogenous Testosterone. J Clin Endocrinol Metab 101:2937-44
Chao, Jing; Rubinow, Katya B; Kratz, Mario et al. (2016) Short-Term Estrogen Withdrawal Increases Adiposity in Healthy Men. J Clin Endocrinol Metab 101:3724-3731
Thirumalai, Arthi; Rubinow, Katya B; Page, Stephanie T (2015) An update on testosterone, HDL and cardiovascular risk in men. Clin Lipidol 10:251-258
Cooper, Lori A; Page, Stephanie T; Amory, John K et al. (2015) The association of obesity with sex hormone-binding globulin is stronger than the association with ageing--implications for the interpretation of total testosterone measurements. Clin Endocrinol (Oxf) 83:828-33
Chao, Jing; Page, Stephanie T; Anderson, Richard A (2014) Male contraception. Best Pract Res Clin Obstet Gynaecol 28:845-57
Cooper, Lori A; Page, Stephanie T (2014) Androgens and prostate disease. Asian J Androl 16:248-55
Liu, Gang; Lu, Shengjun; Wang, Xuanjun et al. (2013) Perturbation of NK cell peripheral homeostasis accelerates prostate carcinoma metastasis. J Clin Invest 123:4410-22

Showing the most recent 10 out of 20 publications