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
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    TLDR 5 alpha reductase inhibitors can cause sexual, cognitive, and muscle side effects, and may slightly increase aggressive cancer risk.
    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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