The Dark Side of 5α-Reductase Inhibitors' Therapy: Sexual Dysfunction, High Gleason Grade Prostate Cancer, and Depression

The 2014 document reviews the adverse effects of 5α-reductase inhibitors (5α-RIs) such as finasteride and dutasteride, which are used to treat benign prostatic hyperplasia (BPH) and androgenetic alopecia. It reports that these drugs can lead to sexual dysfunction, including loss of libido, erectile dysfunction, and orgasmic dysfunction, as well as an increased incidence of high Gleason grade prostate cancer, cardiovascular events, and depression. These side effects are attributed to the inhibition of 5α-reductase enzymes, which play a role in hormone and neuro-active steroid synthesis. The review cites various studies, including a 5-year retrospective analysis and a 1-year follow-up study, which support these findings. The FDA has required updated labeling to reflect these risks. The authors conclude that the potential risks of 5α-RIs therapy should be carefully considered and communicated to patients by physicians.