Last night, my boyfriend and I were talking about Endo’s “weirdness” how it can pop up in strange and unheard of places, and he popped the question (no, not THE question…), “Are there any reports of men having Endometriosis?” I remembered reading somewhere that there were a few rare cases of it, but hadn’t read them deeply enough to understand their situations, diagnoses, and prognoses. So, we have our topic for today!!
In rare cases, men develop Endometriosis. It appears many have been treated with long-term or large doses of estrogen therapy, but some are healthy men who have no history of cancer or estrogen treatment. Here’s what I could find:
A 21-year-old man complained of lower abdominal pain. He suffered from a condition known as PMDS (Persistent Mullerian Duct Syndrome) and had been undergoing testosterone treatment since he was 18 years old. PMDS is a rare medical condition where both male and female sexual organs are present. An MRI of his abdomen revealed that he had a cervix and uterus with gonads (ovaries) and Fallopian tubes! He underwent a hysterectomy, removing his uterus, gonads, and fallopian tubes. All of the tissue was biopsied and was shown to have Endometriosis. It is unknown how he fared after surgery, or if he received any sort of subsequent treatment. However, there was one article that men with PMDS who have a hysterectomy and remove their ovaries may be thrown into menopause! Poor guys!
A 27-year-old man went to his physician with complaints of scrotal pain. Unfortunately, the abstract does not describe his medical history or diagnosis, but does hint that whatever it was that was bothering him was found to have inflammation of a tube at the back of one of his testicles, which was later shown to be Endometriosis.
A 47-year-old man had undergone three prior surgeries to repair his inguinal hernia. He went to the hospital for a fourth inguinal hernia surgery and also had complaints of infertility. While in surgery, a mass was discovered next to his spermatic cord, which was removed and biopsied. It was discovered to be Endometriosis. Prior to this discovery, the patient had been taking Fertilin, an anti-estrogenic medicine to help combat his infertility and boost his sperm health and activity. The article does not disclose any prognosis of the patient after his release from the hospital. The article does state; however, that it was interesting that most men who develop Endometriosis have a history of estrogen therapy, but their patient had a history of ANTI-estrogen therapy…Interesting indeed.
A study published in 2014 shows a 52-year-old man went to the E.R. with complaints of “excruciating stabbing pain in the right lower abdomen and pelvis area for 3 weeks. The pain was worse on getting up from a supine position and was not relieved by bowel movements. It slightly increased upon urination as well.” Seven months before, he had undergone inguinal hernia repair (which had been surgically repaired a few times before) and had a medical history of cirrhosis due to Hepatitis C. He underwent a diagnostic laparoscopy and a mass was discovered attached to his bladder and his hernia site. It was filled with blood, was removed, and biopsied. It was Endometriosis, complete with it’s own estrogen and progesterone receptors. After his surgery, his pain completely resolved.
A 69-year-old man who had prostate cancer and undergone 9 years of hormonal therapy developed Endometriosis. A lesion was found within his testicle, which had also developed cysts. Tests of the tissue and cysts confirmed the presence of Endometriosis lesions. They attribute that the prolonged estrogen therapy to the development of Endometriosis.
A 73-year-old man had tissue removed from his bladder, which was “histologically indistinguishable” from Endometriosis. He had begun to suffer from hydronephrosis, which is when your kidney swells due to a build-up of urine, which had been caused by his bladder Endo lesions. For the past five years, he had been treating his prostate cancer with Estrogen therapy.
A 74-year-old man complained of having blood in his urine. Five years prior he had his prostrate removed due to prostate cancer and had been treated with Leuprolin (a form of Lupron) and Ethinyl Estradiol (an oral contraceptive). Bladder cancer was suspected due to the blood in his urine and he underwent imaging studies and an exploratory surgery of his bladder. He had a small tumor inside of his bladder, which was partially removed and biopsied. The mass had estrogen and progesterone receptors and was determined to be Endometriosis. Six months after he stopped taking Ethinyl Estradiol, the mass shrank. The authors of the study suspect that it was his estrogen treatment that led to the development of Endometriosis, and also attribute it’s disappearances to the discontinuation of the oral contraceptives.
An 83-year-old man developed an endometrioma (chocolate cyst) in his abdominal wall. He had previously received over 10 years of TACE treatment (a chemotherapy procedure to kill tumors) for prostate cancer. This abstract hints that the endometrioma was removed, with no recurrence. However, he continued to suffer from his prostate cancer, but died in 1979 of heart disease. His physicians had hoped to more thoroughly examine his remains for clues as to why he developed an endometrioma, but no postmortem examination was conducted.
These are not all of the reported cases of men with Endometriosis; I’m sure I’ve missed a few. Most of the men diagnosed with Endometriosis had the commonality of estrogen therapy. Another two shared a history of recurrent inguinal hernia surgeries. One young man had a functioning uterus and ovaries, which produced estrogen.
Many doctors believe that the role of estrogen may aid in the development of Endometriosis in men. Others believe the men may have “bits of female organs” still in their bodies from their developmental stages as a fetus, although several tested did not show signs of any remnant female bits. As usual : Endometriosis is a mystery; in women, as well as men. However, I would think that these few, rare cases would prompt the medical and scientific community to research further any link between heightened estrogen levels and Endometriosis…
What are your thoughts? I’d love to hear them!
Avicenna Journal of Medicine : Article (2014) An Unusual Cause of Abdominal Pain in a Male Patient : Endometriosis
Fertility and Sterility : Article (2008) Endometriosis in a Male with Persistent Mullerian Duct Syndrome
U.S. National Library of Medicine : Abstract (1980) Endometriosis of the Male Urinary System : a Case Report
U.S. National Library of Medicine : Abstract (1985) Endometriosis in the male
U.S. National Library of Medicine : Abstract (2006) Cystic Endometriosis of the Epididymis
U.S. National Library of Medicine : Article (2010) Endometriosis – Morphology, Clinical Presentations and Molecular Pathology
U.S. National Library of Medicine : Article (2012) An Unusual Cause of Inguinal Hernia in a Male Patient : Endometriosis
U.S. National Library of Medicine : Abstract (2012) Paratesticular Endometriosis in a Man with a Prolonged Hormonal Therapy for Prostatic Carcinoma
Wiley Online Library : Article (2012) Bladder Endometriosis Developed After Long-term Estrogen Therapy for Prostate Cancer
~ Again, I am a layman. I do not hold any college degrees, nor mastery of knowledge. Please take what I say with a grain of salt. If curious, do your own research 😉 Validate my writings. Or challenge them. And ALWAYS feel free to consult with your physician. Always. Yours ~ Lisa