A new study highlights a concerning link between male hormone therapy and worsening multiple sclerosis (MS) in men, challenging previous assumptions about age-related declines in disease activity.
Although men account for only about 25% of MS cases, they often experience more rapid disability progression and cognitive decline than women. Emerging research suggests that drops in sex hormones—testosterone in men and estrogen in women—may play a role in this disparity.
While previous studies have focused on hormonal changes in women, such as pregnancy or menopause, the effects of hormonal modulation in men with MS have remained largely unexplored—until now.
Hormone Therapy and Disease Activity
Published in the Journal of Neuroimmunology, the study conducted by researchers at Mayo Clinic and collaborating institutions examined 60 men aged 55 and older with MS who underwent androgen-modifying therapy (AMT) for benign prostate hyperplasia (BPH) or prostate cancer. These men were compared to a control group of 80 men with MS who did not receive AMT.
The researchers analyzed disease activity, including relapses and MRI-detected new lesions, before and after initiating AMT. In the control group, disease activity typically declined with age, consistent with known trends in older MS patients.
Key Findings:
Increased Lesion Formation: Men on AMT experienced a 33% rise in new MRI-detected lesions (from 35.2% to 46.7%) within three years of starting therapy. Conversely, the control group saw a 13% decline in new lesions.
Relapse Rates: Relapses decreased by 33% among men on AMT (33.3% to 22.2%), compared with a 74% decline in the non-AMT group (38.5% to 10%).
Overall Disease Activity: AMT users showed stable or slightly increased disease activity, while disease activity in the control group declined by 36%.
Dr. Burcu Zeydan, lead author and assistant professor of neurology at Mayo Clinic, noted, “We were surprised by the increase in disease activity in older men with MS on AMTs, even into their ninth decade. Typically, inflammatory activity decreases with age, but this did not occur in the AMT group.”
Clinical Implications: Monitoring Hormones in MS Care
Experts suggest that androgens, such as testosterone, may have a protective role in MS. Blocking these hormones could exacerbate disease progression. Dr. J. William Lindsey, professor at UTHealth Houston, emphasizes, “If an MS patient goes on androgen blockers for prostate cancer, we should monitor for increases in MS disease activity.”
Testosterone levels can also decline in men with MS regardless of age. In men averaging 40 years old with relapsing-remitting MS or clinically isolated syndrome, 39% showed hypogonadism, which correlated with greater disability and cognitive challenges. Early intervention, including testosterone assessment and potential therapy, may help mitigate progression, though treatment must be carefully balanced with other health considerations.
Health Advice for Men with MS
Regular Hormone Monitoring: Men with MS—especially those on AMT—should track testosterone levels and discuss results with their neurologist.
Frequent MS Checkups: Disease activity may increase despite age-related expectations; closer MRI monitoring can help detect early changes.
Lifestyle Interventions: Maintaining physical activity, adequate sleep, and a nutrient-rich diet may help support hormonal balance and reduce inflammation.
Proactive Communication: Discuss prostate disease treatments with your healthcare team to balance cancer or BPH management with MS care.
Dr. Zeydan underscores, “This study does not contraindicate AMT use, but it highlights the need for closer monitoring, particularly in older men, to manage MS effectively.”
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