5-Alpha Reductase Inhibitors Use in Prostatic Disease and Beyond

March 2023 in “ Translational Andrology and Urology ”

Bodie Chislett, David Chen, Marlon Perera, Eric Chung, Damien Bolton, Liang G. Qu

5-alpha reductase inhibitors 5-ARIs finasteride dutasteride androgenetic alopecia hirsutism testosterone dihydrotestosterone DHT Propecia Avodart

TLDR 5-alpha reductase inhibitors, like finasteride and dutasteride, are used for prostate issues, hair loss, and excessive hair growth, may help with COVID-19, but can cause sexual and mental health side effects, and their use in preventing prostate cancer needs more examination.

The document discusses the use and potential applications of 5-alpha reductase inhibitors (5-ARIs), such as finasteride and dutasteride. Initially used for benign prostatic hyperplasia, their use has expanded to include androgenetic alopecia and hirsutism. The drugs work by inhibiting the enzyme that converts testosterone to dihydrotestosterone. There are new associations between 5-ARIs and reduced severity and mortality of SARS-CoV-2, but more research is needed to confirm these findings. Adverse effects of 5-ARIs can include sexual dysfunction and depressive symptoms. The document also discusses the potential use of 5-ARIs in prostate cancer prevention, but the lack of clinical indication should be re-examined.

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research The Connection of 5-Alpha Reductase Inhibitors to the Development of Depression

4 citations , November 2021 in “Biomedicine & Pharmacotherapy”

5-alpha reductase inhibitors, like finasteride and dutasteride, may cause depression, but more research is needed to understand why.

research Systematic Review of Finasteride Effect in Women with Hirsutism

1 citations , July 2021 in “DOAJ (DOAJ: Directory of Open Access Journals)”

research The Clinical Applications of Five-Alpha Reductase Inhibitors

2 citations , April 2021 in “Canadian Journal of Urology”

Five-alpha reductase inhibitors, like finasteride and dutasteride, can treat enlarged prostates, improve urination, reduce need for prostate surgery, and lower the risk of prostate cancer, but may increase the risk of higher grade prostate cancer. They can also treat male pattern baldness.

research Early Antiandrogen Therapy With Dutasteride Reduces Viral Shedding, Inflammatory Responses, and Time-to-Remission in Males With COVID-19: A Randomized, Double-Blind, Placebo-Controlled Interventional Trial

41 citations , February 2021 in “Cureus”

Dutasteride treatment in men with mild to moderate COVID-19 reduced viral shedding, inflammation, and recovery time without serious side effects.

research Anti-Androgens May Protect Against Severe COVID-19 Outcomes: Results From a Prospective Cohort Study of 77 Hospitalized Men

49 citations , January 2021 in “Journal of The European Academy of Dermatology and Venereology”

Anti-androgens, like finasteride, dutasteride, and spironolactone, may lessen the severity of COVID-19 in men, leading to fewer ICU admissions.

research Androgen Signaling Regulates SARS-CoV-2 Receptor Levels and Is Associated with Severe COVID-19 Symptoms in Men

139 citations , December 2020 in “Cell Stem Cell”

Male hormones affect COVID-19 severity and certain drugs targeting these hormones could help reduce the risk.

research Androgenetic Alopecia Present in the Majority of Patients Hospitalized with COVID-19: The 'Gabrin Sign'

119 citations , August 2020 in “Journal of The American Academy of Dermatology”

Most COVID-19 patients in hospitals have androgenetic alopecia, more in men, suggesting a link between androgen sensitivity and severe COVID-19 symptoms.

research What Does Androgenetic Alopecia Have to Do with COVID-19? An Insight into a Potential New Therapy

47 citations , July 2020 in “Dermatologic Therapy”

Androgenetic alopecia linked to COVID-19 severity; drugs reducing androgen receptor activation may help.

research Post-Finasteride Syndrome: Risks and Side Effects of Finasteride for Androgenetic Alopecia

15 citations , May 2020 in “Anais Brasileiros De Dermatologia”

Finasteride may cause lasting sexual, mental, and physical symptoms; use with caution.

research 5-Alpha Reductase Inhibitors in Androgenetic Alopecia: Shifting Paradigms, Current Concepts, Comparative Efficacy, and Safety

19 citations , May 2020 in “Dermatologic Therapy”

Dutasteride works better than finasteride for hair loss, with both being safe to use.

research Post-Finasteride Syndrome

11 citations , August 2019 in “BMJ”

Post-finasteride syndrome causes sexual, physical, and psychological symptoms, but more research is needed to understand its causes and connection to finasteride.

research 5-Alpha Reductase Inhibitors and Risk of Male Breast Cancer: A Systematic Review and Meta-Analysis

4 citations , October 2018 in “International Braz J Urol”

Taking 5-alpha reductase inhibitors does not increase the risk of breast cancer in men.

research A Systematic Review of Topical Finasteride in the Treatment of Androgenetic Alopecia in Men and Women

23 citations , April 2018 in “PubMed”

research Adverse Sexual Effects of Treatment with Finasteride or Dutasteride for Male Androgenetic Alopecia: A Systematic Review and Meta-Analysis

15 citations , January 2018 in “Acta dermato-venereologica”

Finasteride and dutasteride increase sexual dysfunction risk by 1.57 times in male hair loss treatment.

research Sexual Side Effects of 5-Alpha-Reductase Inhibitors Finasteride and Dutasteride: A Comprehensive Review

21 citations , November 2017 in “Dermatology Online Journal”

research The Risk of Dementia with the Use of 5 Alpha Reductase Inhibitors

18 citations , August 2017 in “Journal of the neurological sciences”

Using 5 alpha reductase inhibitors may increase dementia risk in the first two years.

research Androgenetic Alopecia: A Review

153 citations , March 2017 in “Endocrine”

Male pattern baldness involves genetics, hormones, and needs better treatments.

research Effect of 5α-Reductase Inhibitors on Sexual Function: A Meta-Analysis and Systematic Review of Randomized Controlled Trials

57 citations , September 2016 in “The Journal of Sexual Medicine”

5α-reductase inhibitors increase the risk of sexual dysfunction, especially in men with enlarged prostate.

research 5α-Reductase Inhibitors Alter Steroid Metabolism and May Contribute to Insulin Resistance, Diabetes, Metabolic Syndrome, and Vascular Disease: A Medical Hypothesis

15 citations , October 2014 in “Hormone Molecular Biology and Clinical Investigation”

Some hair loss and prostate drugs might increase the risk of diabetes and heart disease.

research Dutasteride Reduces Alcohol’s Sedative Effects in Men in a Human Laboratory Setting and Reduces Drinking in the Natural Environment

32 citations , February 2014 in “Psychopharmacology”

Dutasteride makes alcohol less sedating and may lead to less drinking in men.

research Side Effects of 5-Alpha Reductase Inhibitors: A Comprehensive Review

35 citations , May 2013 in “Sexual medicine reviews”

5-alpha reductase inhibitors slightly increase the risk of sexual and mood side effects, and breast growth in men.

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44 citations , October 2010 in “BJUI”

5-α-reductase inhibitors reduce prostate cancer risk but may cause sexual dysfunction and don't affect high-grade tumor or death rates.

research Hirsutism: Diagnosis and Management

41 citations , April 2010 in “Gender Medicine”

The conclusion is that hirsutism should be diagnosed and treated because it affects quality of life and may signal other health problems.

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1707 citations , December 2003 in “The New England Journal of Medicine”

Combination therapy of doxazosin and finasteride safely and effectively reduces benign prostatic hyperplasia progression risk.

research The Effect of Finasteride on the Expression of Vascular Endothelial Growth Factor and Microvessel Density: A Possible Mechanism for Decreased Prostatic Bleeding in Treated Patients

90 citations , January 2003 in “The Journal of Urology”

Finasteride may reduce prostate bleeding by lowering blood vessel growth factor levels and blood vessel density in certain prostate areas.

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109 citations , April 2000 in “European Urology”

Finasteride lowers risk of urinary issues and surgery by over 50% in 4 years.

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1054 citations , February 1998 in “The New England Journal of Medicine”

Finasteride reduces urinary issues and surgery need in men with enlarged prostates by over 50%.

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research Role of 5α-Reductase Inhibitors in Benign Prostatic Diseases

24 citations , February 2012 in “Prostate cancer and prostatic diseases”

5α-reductase inhibitors help shrink the prostate, improve urinary symptoms, and may reduce prostate cancer risk.

research Finasteride

187 citations , January 1994 in “The New England Journal of Medicine”

Finasteride treats enlarged prostate and may help with baldness, but effects on sexual function and male fetuses are unclear.