Around the world, endometriosis affects approximately 190 million women, up to 10% of women of reproductive age. Endometriosis in women can cause extreme pain, inflammation, and even infertility. The number of men affected by endometriosis vastly differs from that of women. As of 2018, there have only been 16 reported cases of endometriosis occurring in men. Within the reported cases, there are some similarities and differences in endometriosis in men versus women. This article will dive into those similarities and differences while giving some perspective on the possible causes in men. This perspective may provide some valuable insight as to why endometriosis occurs in women, as the causes are still unknown. This article will also explore functional medicine labs and various integrative treatment approaches that may be beneficial in managing endometriosis.

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What is Endometriosis?

Endometriosis is a condition where there is an abnormal growth of a tissue that is normally found in the endometrial lining of the uterus found in other parts of the body. There are four main types of endometriosis. They include superficial peritoneal endometriosis, endometriomas, deeply infiltrating endometriosis (DIE), and abdominal wall endometriosis.

Superficial peritoneal endometriosis is the least severe form of endometriosis. This type of endometriosis occurs when the tissue is found in the peritoneum. The peritoneum lines your abdomen and pelvis.

Endometriomas are also called chocolate cysts due to the cysts being dark and fluid-filled. These vary in size and are most commonly found in the ovaries but can also be found in the pelvis and abdomen.

DIEs are found in organs such as the ovaries, rectum, bladder, and bowels. In rare cases, scar tissue can form, which can cause the endometriosis to be stuck in place in a condition called frozen pelvis. Frozen pelvis is rare and only occurs in 1-5% of endometriosis patients.

Abdominal wall endometriosis is straightforward as this endometriosis occurs on the abdominal wall. This can occur after a surgery like a C-section, and the cells will attach to the incision.

Can Men Get Endometriosis?

Although extremely rare, with only about 16 cases reported as of 2018, cisgender males can also get endometriosis. In these cases, the tissue was found in the lower genitourinary tract of men, including being found attached to the bladder, lower abdominal wall, and inguinal region. These tissues were found after the patients presented to their healthcare providers with masses, lower abdominal pain, or testicular pain. After surgical removal of some of those masses, histological investigations concluded an endometriosis diagnosis.

Endometriosis Symptoms in Men

The symptoms vary individually and usually depend on the location of the endometriosis, as in the case of women with endometriosis. These symptoms usually involve pain at the location. It can also involve excessive bleeding, infertility, fatigue, diarrhea, constipation, bloating, or nausea.

The symptoms reported by the men include lower abdominal pain, stabbing pelvic pain, swelling of the testis, scrotal pain, and hematuria (blood in the urine), with some not reporting any symptoms. In one case, the patient had worsening lower abdominal pain that radiated to his right flank. It was a constant dull ache with intermittent sharp pain. He also reported bloating and had a distended abdomen upon examination by his physician. Although cases of endometriosis are rare in men, if you experience these symptoms, it's recommended to consult with your healthcare provider.

What Causes Endometriosis in Men?

Endometriosis is most commonly seen in women of reproductive age and rarely found in men. As with endometriosis in women, the causes of endometriosis in men are still unknown. Yet there are some theories along with some prevailing risk factors based on the studies conducted with the 16 men with endometriosis. It was previously thought that endometriosis in men could occur with prolonged estrogen therapy, liver cirrhosis, or chronic surgical inflammation.

Currently, the prevailing risk factor involves prolonged exposure to estrogen therapy, usually due to prostate cancer intervention. In one case, the only risk factor the patient had was obesity. The thought process behind obesity being a risk factor is the association between increased obesity in men and increased estrogen production.

The most congruent theory of the cause of endometriosis in these men is the embryonic cell rest theory, in which Mullerian cells persist between the ejaculatory duct and vas deferens when the Mullerian tissue should normally atrophy completely. These cells can then differentiate into endometrial tissue, leading to endometriosis in males due to prolonged estrogen therapy or inflammation. According to the study, by identifying the causative factors of endometriosis in men, this research may help illuminate the existing theories of endometriosis in women. This current induction of embryological remnants as a causative factor in developing endometriosis should remain at the forefront of possible causes.

Functional Medicine Labs to Test for Root Cause of Endometriosis in Men

Since endometriosis in men is still extremely rare and further research needs to be conducted, it is extremely difficult to diagnose endometriosis in men. In the cases of the 16 men with endometriosis, the diagnosis was completed through histological findings after the surgical removal of the masses or tissues. However, because the risk factors for endometriosis in men include elevated estrogen levels, obesity, chronic inflammation, prostate cancer, and liver cirrhosis, there are some functional labs to consider in assessing these risk factors. Some of the functional labs include:

Hormone Panel

Within the cases reported, the prevailing risk factor is prolonged elevated estrogen levels. In particular, the risk comes from prolonged estrogen therapy treatment for prostate cancer. Therefore, a hormone panel that assesses estrogen levels may be appropriate for managing endometriosis.

Comprehensive Metabolic Panel (CMP)

Another risk factor consideration is liver cirrhosis. Continuing to monitor AST and ALT levels (liver markers) within a CMP panel may be beneficial in managing this risk factor associated with endometriosis in men.

Hs-CRP

Chronic inflammation is a possible risk factor for endometriosis in men. The hs-CRP marker is a sensitive inflammatory marker, and elevated levels in the body may indicate chronic inflammation. This test can help monitor chronic inflammation and assess treatment interventions to decrease the risk associated with chronic inflammation.

Prostate Screening

The majority of the men diagnosed with endometriosis also had prostate cancer and were on estrogen therapy for the management of cancer. Regular prostate screening can help decrease this risk factor. This prostate screening test assesses total and free PSA, all prostate tumor markers. It is important to note that typical screening occurs at 45 and sometimes starts at 40.

Fasting Insulin

In one of the male patients with endometriosis, it was thought that obesity was a risk factor for this patient. Insulin sensitivity is a root cause of obesity, and the fasting insulin test can help assess this risk factor.

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Functional Medicine Focused Endometriosis Treatment for Men

Currently, the conventional treatment includes surgical removal of the tissue or discontinuation of estrogen therapy in men with endometriosis, which is what occurred with the majority of the men.

Functional medicine approaches can help minimize the risk factors of endometriosis in men. Some approaches include personalized nutrition, clinically relevant supplements, and other functional or integrative approaches.

Endometriosis Diet for Men

One of the most widely used functional medicine approaches used with functional medicine practitioners is nutrition. Nutrition is an important aspect of many health treatment or management protocols.

Although there isn't one diet that works for all people, there are some consistent guidelines from research that are beneficial for overall health along with inflammation. These nutritional guidelines consist of eating higher amounts of vegetables, fruits, high-quality proteins, and whole grains while decreasing the consumption of added sugar, refined grains, and highly-processed foods.

One of the most studied diets is the Mediterranean Diet. This diet incorporates many of the nutritional guidelines helpful in overall health while adding some healthy fats.

The Mediterranean diet, which emphasizes fruits, vegetables, whole grains, and healthy fats like olive oil, has been shown to have anti-inflammatory effects that can help reduce the risks associated with inflammation. A study published in the Journal of Nutrients found that a Mediterranean-style diet was associated with reduced levels of C-reactive protein, a marker of inflammation in the body.

These nutritional approaches have been shown to improve risk factors such as obesity and inflammation, thus making it a viable option for managing the risks associated with endometriosis in men.

Supplements and Herbs That Help With Endometriosis in Men

Clinically relevant supplements can be helpful tools functional medicine practitioners utilize in the risk management of endometriosis. The supplements to consider involve decreasing the risk factors of endometriosis in men by reducing elevated estrogen levels, supporting the liver, reducing inflammation, and improving prostate health. If you are interested in these supplements as an option, be sure to consult with your healthcare provider to see if these are right for you. Here are some supplements and herbs to consider:

Curcumin

Curcumin, a compound from the turmeric root, remains one of the most highly researched plant medicines regarding anti-inflammatory effects. Curcumin supplementation may be viable in decreasing the risks associated with endometriosis when chronic inflammation is an assessed factor. Curcumin has also been shown to have benefits in supporting liver function.

Milk Thistle

This liver-supporting herb is one of the most highly researched plants in treating liver disease. Milk thistle supplementation should be a consideration in managing the risks of endometriosis in men when liver issues may be a causative factor.

Indole 3 Carbinol (I3C) and DIM

These two supplements are widely used by functional medicine practitioners to improve estrogen metabolism. They both help the liver to metabolize estrogen properly. When prolonged excess estrogen exposure is the prevailing causative factor of endometriosis in men, supplements that support estrogen metabolism should be highly considered.

Glutathione

This major antioxidant is known for neutralizing cancer-causing quinones formed during liver metabolism and estrogen detoxification. Supplementation of glutathione should also be a consideration in decreasing the risk associated with endometriosis caused by prolonged estrogen exposure.

Lycopene

Lycopene is an antioxidant found in tomatoes, grapefruit, watermelon, guava, and papaya. It has been thought to lower the risk of prostate cancer. This supplement should be considered to reduce the risks associated with prostate cancer, which is also a risk factor for endometriosis in men.

Complementary and Integrative Medicine for Endometriosis Symptom Management in Men

CIM therapies have been beneficial for managing endometriosis in women and may also be beneficial for men. Some of these include acupuncture, massage, exercise, and yoga. Acupuncture and massage have been shown to help relieve the pain associated with endometriosis. Regarding body movement, regular exercise and yoga can help with circulation, improve inflammation, and manage weight. Lack of activity, inflammation, and obesity are all risk factors associated with endometriosis in men. Yoga and regular exercise can be a helpful integrative approach to managing these risks. Discussing these CIM therapies with your healthcare provider before starting them is always recommended.

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Summary

Endometriosis in men is extremely rare and has been reported to occur in only 16 men thus far. However, some valuable insight may be gained from studying these occurrences, as the causes are still unknown for both men and women. Prolonged estrogen exposure is a prevailing risk factor in endometriosis in men. Functional medicine labs such as a full hormone panel can be helpful in screening and managing the risks associated with endometriosis. Functional medicine and integrative approaches such as personalized nutrition, utilizing clinically relevant supplements, lifestyle changes, and increased exercise can also help decrease some of the risk factors. Further investigation is needed into endometriosis for both men and women to properly diagnose, manage, prevent, and treat this condition.