Using 5 Alpha Reductase Inhibitors Safely: What Primary Care Physicians Need to Know

November 2024 in “ Journal of Family Medicine and Primary Care ”

Senthil Meenrajan

5 alpha reductase inhibitors androgenetic alopecia hirsutism benign prostatic hypertrophy ARIs

Studysummary This review highlights that 5 Alpha Reductase Inhibitors, used for treating conditions like benign prostatic hypertrophy, can cause side effects that sometimes persist after stopping the medication, urging physicians to consider these drugs as potential sources of new symptoms in patients.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

5 alpha reductase inhibitors (5ARIs) are widely used for treating benign prostatic hyperplasia and androgenetic alopecia by reducing dihydrotestosterone (DHT) levels. While generally safe, they can cause adverse effects, particularly sexual side effects like loss of libido and erectile dysfunction, which may persist as post-finasteride syndrome. Cognitive concerns, such as increased dementia and depression risk, have been noted, especially within the first 2 years of treatment. Muscle-related side effects, including myalgia and myositis, are rare but possible. Although initially considered for prostate cancer prevention, 5ARIs have not shown significant benefits and may slightly increase aggressive cancer forms. Clinicians should carefully consider these potential side effects, especially in older adults with other health conditions.

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research 5-Alpha Reductase Inhibitors Use in Prostatic Disease and Beyond

March 2023 in “Translational Andrology and Urology”

This review discusses the pharmacology of 5-alpha reductase inhibitors, their expanding clinical indications beyond benign prostatic hyperplasia, and notes unresolved claims about their potential role in SARS-CoV-2.

research Association of 5α-Reductase Inhibitors With Dementia, Depression, and Suicide

December 2022 in “JAMA network open”

This study found that men using 5-alpha-reductase inhibitors showed an increased risk for dementia shortly after starting treatment, which diminished over time, and a consistent association with depression, but no link to suicide.

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

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

This review discusses post-finasteride syndrome, characterized by persistent symptoms despite discontinuation, and concludes that its existence cannot be confirmed; individualized assessment is advisable for those with a history of depression, sexual dysfunction, or infertility.

research Post-Finasteride Syndrome: A Surmountable Challenge for Clinicians

30 citations , January 2020 in “Fertility and Sterility”

This review discusses the evidence for post-finasteride syndrome as a condition potentially induced by finasteride and dutasteride, associating them with sexual dysfunction, depression, anxiety, and suicidal ideation in a subset of men, and reports no new clinical results.

research Risk of Rhabdomyolysis from 5-Alpha Reductase Inhibitors

6 citations , January 2018 in “Pharmacoepidemiology and Drug Safety”

In this study, 5-α reductase inhibitors were not significantly linked to increased rhabdomyolysis risk, but they may raise the risk of myopathy and myositis in men aged 66 and older.

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

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

In this study, the use of 5 alpha reductase inhibitors was associated with an increased risk of dementia during the first two years of treatment, but the risk was not significant with longer exposure.

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

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

This study concluded that 5α-reductase inhibitors were linked to increased sexual dysfunction in men with benign prostatic hyperplasia, but not in men with androgenetic alopecia.

research Finasteride-Induced Myalgia and HyperCKemia

10 citations , December 2008 in “Journal of Clinical Neuromuscular Disease”

This report describes a case where a man developed reversible myalgia and significant hyperCKemia after long-term finasteride use for male frontal baldness, with symptoms resolving upon discontinuation.

research Marked Suppression of Dihydrotestosterone in Men with Benign Prostatic Hyperplasia by Dutasteride, a Dual 5α-Reductase Inhibitor

408 citations , May 2004 in “The Journal of clinical endocrinology and metabolism/Journal of clinical endocrinology & metabolism”

This study found that dutasteride more effectively reduced serum dihydrotestosterone levels than finasteride in patients with benign prostatic hyperplasia.