Editing Hormonal Therapy (section)

== Androgens and the Prostate ==

* '''<span style="color:#ff0000">The primary androgen of the prostate is dihydrotestosterone (DHT)</span>'''
* '''<span style="color:#ff0000">Testosterone is converted to DHT by 5α-reductase</span>'''
** '''<span style="color:#ff0000">Type 1 5α-reductase is expressed primarily in the non-genital skin and liver,</span> and to a lesser extent in the prostate, testis, and brain'''
** '''<span style="color:#ff0000">Type 2 5α-reductase is expressed predominantly in the prostate epithelium and other genital tissues</span> such as the epididymis, genitalia, seminal vesicle, testis, but also in liver, uterus, breast, hair follicles, and placenta'''
*** '''<span style="color:#ff0000">Functional type 2 5α-reductase is a prerequisite for normal development of the prostate and external genitalia in males</span>'''
**** '''Males with inherited 5α-reductase deficiency have miniscule prostatic tissue'''
* '''<span style="color:#ff0000">DHT binds to intracytoplasmic ARs with much greater affinity than testosterone.</span>'''
** '''Binding of DHT to the AR enhances translocation of the steroid-receptor complex into the nucleus and activation of androgen response elements'''
* '''<span style="color:#ff0000">Serum testosterone elevations are known to occur with use of a 5-ARI</span>''' (both finasteride and dutasteride)''', <span style="color:#ff0000">but values will typically remain within the normal laboratory range</span>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5780290 §]'''
* '''<span style="color:#ff0000">Intraprostatic testosterone levels are increased with the use of a 5-ARI</span>[https://www.urotoday.com/images/stories/documents/bjui/done_bjui_109_2_183_188.pdf §]'''

* '''<span style="color:#ff0000">Lack of testosterone can protect against development of prostate cancer, however, even hypogonadal men can develop prostate cancer and their cancers may be driven by androgen independent pathways</span>'''
* The role of the androgen receptor is well established in the progression of castrate-resistant prostate cancer