Let me propose that propecia causes a deprivation of hormones needed to maintain the healthy vasculature and nerves in the prostate. When the prostate is shrunk these are damaged to a degree and neuroendocrine homeostasis is lost. This is exacerbated when DHT surges back in. This leads to neurogenic inflammation where substance p and CGRP cause inflammation in the prostate and to the surrounding regions. This in turn causes stress on the surrounding homeostatic mechanisms disrupting androgen receptors and their function.
springerlink.com/content/v412743317w49632/
These findings raise the possibility that prostatic neuroendocrine peptides (such as substance P) may modulate the response of prostate to androgens.
I do not believe that the problem is an infection in nature and think the benefit from antibiotics is an anti inflammatory one. Only the antibiotics that penetrate the prostate can provide anti inflammatory responses such as tetracyclines and quinolones. I cannot however find literature directly linking substance p and antibiotics together but it is well known antibiotics are anti inflammatory.
Massages reduce pelvic floor tone. (i am concluding this from mendeley.com/research/modified-thiele-massage-therapeutic-intervention-female-patients-interstitial-cystitis-hightone-pelvic-floor-dysfunction/) This in turn MIGHT help reduce the release of this pro-inflammatory substances.
This inflammation then causes our issues and is not relieved by hormonal therapy. In fact it is potentially worsened by testosterone as
deepblue.lib.umich.edu/bitstream/2027.42/29845/1/0000192.pdf.
Thus, testosterone regulates substance P levels in areas that regulate mating behaviour.
Vitamin D as i have previously shown is thought to reduce prostatic inflammation.
ncbi.nlm.nih.gov/pubmed/20398021
Data reviewed here demonstrate that VDR agonists, and notably elocalcitol, reduce the static component of BPH by inhibiting the activity of intraprostatic growth factors downstream of the androgen receptor, the dynamic component by targeting the RhoA/ROCK pathway in prostate and bladder cells, and the inflammatory component by targeting the NF-kappaB pathway.
ncbi.nlm.nih.gov/pubmed/17241782
We have documented the anti-inflammatory effects of BXL-628 also in animal models of autoimmune prostatitis, observing a significant reduction of intra-prostatic cell infiltrate following administration of this VDR agonist, at normocalcemic doses, in mice with already established disease.
jimmunol.org/content/159/10/4952.short
The stimulatory effect of substance P was specific, since an NK-1- selective receptor antagonist completely prevented NF-kappa B activation in response to substance P, but not IL-1 beta. In addition, we show that the activity of substance P required mobilization of intracellular calcium and formation of reactive oxygen intermediates as second messengers. Our results suggest that NF-kappa B may be an important component controlling neurogenic inflammation within the peripheral and central nervous system.
Also it is not a long shot to say psoriasis is thought to be related to substance P and CGRP and vitamin D is being proposed as a treatment for this.
ncbi.nlm.nih.gov/pubmed/21747838
As we know here propecia also can affect the brain. I have not suggested the mechanism for this. It seems however to be a seperate process as some of us have just brain symptoms and others sexual.
Some might argue that this does not explain the androgen resistant appearance some of us have and the crash fully. I accept these as limitations.
However, I personally show no signs of androgen resistance and have perfect hormones including 3 adiol G. I also systemically improved on antibiotics and with vitamin D. I have not improved with hormonal therapy as they only made things worse especially the pain. They did make me lose hair faster, get worse acne etc…
This theory suggests that androgen receptors are not doing what they should due to the neuropeptides that have been released. I agree that it is not strictly resistance to testosterone and DHT though as resistance would lead to increased LH and testosterone as they would try to compensate.
HPTA axis abnormalities are common in patients with prostate related disease. Is it hard to believe there is a knock on effect? Of course one can argue the prostate issues are a knock on effect of something else.
I know personally the only things that have helped me are antibiotics, vitamin D, walking, keeping active and reducing stress. I also feel it is important to note that i had no prostate pain until after antibiotics and i also had no sexual function (still not great) til after antibiotics.
This is one more theory that i think warrants investigation.
I hope i have offered a balanced view.