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

The document from 2014 presents a hypothesis that 5α-reductase inhibitors (5α-RIs) like finasteride and dutasteride, used for benign prostatic hyperplasia and androgenetic alopecia, might negatively affect steroid metabolism, potentially leading to insulin resistance, diabetes, metabolic syndrome, and vascular disease. It suggests that these drugs could increase active glucocorticoid levels, such as cortisol, by inhibiting their inactivation, which may disrupt metabolic and inflammatory processes. The paper emphasizes the lack of detailed metabolic studies on the impact of these inhibitors and calls for further research to understand their effects on insulin resistance, type 2 diabetes mellitus, and cardiovascular health. The authors recommend caution in using these drugs for non-cancerous conditions due to the potential metabolic risks.