5-Alpha Reductase Inhibitors and Erectile Dysfunction: The Connection

The document reviewed the association between 5-alpha reductase inhibitors (5ARIs), such as finasteride and dutasteride, and sexual adverse effects (AEs) like erectile dysfunction (ED), ejaculatory dysfunction (EjD), and decreased libido. It found that sexual AEs were reported in clinical trials at rates ranging from 2.1% to 38%, with ED being the most common. These effects typically occurred early in therapy and lessened over time. A proposed mechanism for these dysfunctions involved decreased nitric oxide synthase activity due to reduced dihydrotestosterone levels. The study concluded that while the connection between 5ARIs and sexual dysfunction was evident, the exact mechanisms remained unclear, suggesting a need for future research to focus on understanding these pathophysiologic mechanisms to aid in prevention and treatment.