Cholesterol ester metabolism in plasma during estrogen and antiandrogen treatment in men with carcinoma of the prostate.

The male predominance in atherosclerotic disease has been ascribed to differences in lipid and lipoprotein metabolism between men and women. The influences of estrogen and antiandrogen treatment on the cholesterol ester metabolism and lipoproteins in plasma in men were therefore studied. Forty-six men with carcinoma of the prostate were studied before and after 2 and 8 weeks' treatment with either polyestradiol phosphate and ethinyl estradiol or orchidectomy or the testosterone receptor-blocking gestagenic drug cyproterone acetate. The estrogen treatment increased the HDL-TC and the level of TGs in HDL and LDL and reduced the TC and LDL-TC simultaneously with elevations of the fractional and molar cholesterol esterification rates. Orchidectomy caused only slight elevations of the TC level and the molar cholesterol esterification rate. Cyproterone acetate reduced the TC, LDL-TC, and HDL-TC concentrations simultaneously with an increase in the fractional cholesterol esterification rate. The alterations of TC and LDL-TC were positively correlated to the changes in the molar cholesterol esterification rate and negatively correlated to the alteration in the fractional cholesterol esterification rate. High doses of estrogen appeared to raise the TG level and the production of CE in plasma. Both estrogen and cyproterone acetate therapy lowered the LDL-TC level simultaneously with a raised fractional elimination of unesterified cholesterol as CEs from plasma. Although the testosterone production was practically eliminated by all three forms of treatment, there was no change of plasma lipoproteins common to all three groups. Therefore the lower estrogen level rather than the higher testosterone level might cause the lower HDL levels in men compared to women.