Sexual Dysfunction in Subjects Treated with Inhibitors of 5α-Reductase for Benign Prostatic Hyperplasia: A Comprehensive Review and Meta-Analysis

April 2017 in “ International Journal of Andrology ”

Giovanni Corona, Giacomo Tirabassi, Daniele Santi, Elisa Maseroli, Mauro Gacci, Mauro Dicuio, Alessandra Sforza, Edoardo Mannucci, Mario Maggi

5α-reductase inhibitors 5ARIs hypoactive sexual desire HSD erectile dysfunction ED benign prostatic hyperplasia BPH finasteride dutasteride Propecia Avodart

From the encyclopedia

Finasteride →

Frontline, gold standard treatment for combatting androgenic alopecia

Dutasteride →

Heavy duty finasteride that comes with higher risks

Studysummary This study found that 5α-reductase inhibitors significantly increase the risk of erectile dysfunction and hypoactive sexual desire in men with benign prostatic hyperplasia, compared to placebo.

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

This comprehensive review and meta-analysis, which included 17 randomized clinical trials with a total of 24,463 subjects receiving 5α-reductase inhibitors (5ARIs) and 22,270 in placebo groups, found that 5ARIs significantly increase the risk of hypoactive sexual desire (HSD) and erectile dysfunction (ED) in men treated for benign prostatic hyperplasia (BPH). The odds ratios were 1.54 for HSD and 1.47 for ED, indicating a substantial increase in risk compared to placebo, with no significant difference between the two drugs, finasteride and dutasteride. The risk was higher in subjects with lower urinary flow rates at the start of the trials and decreased over time. The study concludes that patients should be informed about these risks before starting 5ARI treatment for BPH.

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Research cited in this study

13 / 13 results

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research Effects of 5-Alpha Reductase Inhibitors on Erectile Function, Sexual Desire, and Ejaculation

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Adverse Side Effects of 5α-Reductase Inhibitors Therapy: Persistent Diminished Libido, Erectile Dysfunction, and Depression in a Subset of Patients

research Adverse Side Effects of 5α-Reductase Inhibitors Therapy: Persistent Diminished Libido, Erectile Dysfunction, and Depression in a Subset of Patients

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This review discusses persistent adverse effects of 5α‐reductase inhibitors, like diminished libido and erectile dysfunction, in some patients and highlights the need for patient discussions before therapy, especially for androgenetic alopecia.

research Finasteride 5mg and Sexual Side Effects: How Many Are Related to a Nocebo Phenomenon?

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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.

research The Long-Term Effect of Doxazosin, Finasteride, and Combination Therapy on the Clinical Progression of Benign Prostatic Hyperplasia

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.

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research Effects of the 5α-Reductase Inhibitor Finasteride on Serum Levels of Gonadal, Adrenal, and Hypophyseal Hormones and Its Clinical Significance: A Prospective Clinical Study

56 citations , April 1998 in “Steroids”

Finasteride reduces hair loss and treats BPH without major hormone changes, but may cause sexual dysfunction.

The Effect of Finasteride on the Risk of Acute Urinary Retention and the Need for Surgical Treatment Among Men with Benign Prostatic Hyperplasia

research The Effect of Finasteride on the Risk of Acute Urinary Retention and the Need for Surgical Treatment Among Men with Benign Prostatic Hyperplasia

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research The Efficacy of Terazosin, Finasteride, or Both in Benign Prostatic Hyperplasia

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Terazosin and finasteride effectively treat BPH, but combining them adds no extra benefit.

research The Effect of Finasteride in Men with Benign Prostatic Hyperplasia

1040 citations , October 1992 in “The New England Journal of Medicine”

In this study, 5 mg of finasteride per day significantly improved urinary symptoms and reduced prostate volume in men with benign prostatic hyperplasia, but increased the risk of sexual dysfunction.