Increase in Oestrogen in Men Could Be to Blame For Hernias
Mouse studies suggest reducing oestrogen levels could avoid hernia repair surgery.
A US study in mice has found that the increase in oestrogen that happens as men age could lead to lower-abdominal muscle weakness, which can cause inguinal hernias. Reducing oestrogen levels with a hormone inhibitor therefore offers a potential new therapeutic strategy that could avoid the need for hernia repair surgery.
A hernia is a swelling that happens when an organ or internal tissue pokes through a hole or weakness in the surrounding muscle or connective tissue. Inguinal hernias occur in the inguinal canal, a weak spot near the groin in the human abdominal wall.
The only currently available treatment is inguinal hernia repair surgery, which more than one in four men will undergo during their lifetime.
The chances of an inguinal hernia increase as men age, but the root cause is unknown. Another consequence of ageing in men is that a larger share of testosterone is converted to oestrogen by an enzyme called aromatase.
Researchers at Northwestern University Feinberg School of Medicine in Chicago investigated a possible link between these age-related changes after noticing that large hernias developed in male mice that had been genetically modified to carry the human gene for aromatase in order to boost their oestrogen levels.
When the researchers investigated these mice further, they noticed significant weakening in the lower abdominal muscles, with all of them suffering hernia by six weeks of age. They observed that an increased supply of oestrogen caused an increase in fibrosis (scar tissue), weakening the muscle and creating the predisposition to hernia.
When the mice were given a drug that blocked aromatase, and therefore the conversion of testosterone to oestrogen, the hernias were prevented, providing further evidence for oestrogen as the cause.
The authors believe that their results, published in the journal Proceedings of the National Academy of Sciences, suggest that aromatase inhibitor therapy could potentially avoid the need for inguinal hernia repair surgery in at-risk patients by decreasing oestrogen levels and preventing muscle weakness.
Lead author Professor Hong Zhao said: “I think it’s very exciting because, before, when you had a hernia, you saw a surgeon. It will open so many paths for future potential treatments for this disease.”
The researchers are now designing clinical trials that will test the effectiveness of an aromatase inhibitor for hernia prevention in humans.
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