Benign Prostatic Hyperplasia And Male Lower Urinary Symptoms: A Guide For Family Physicians

Finasteride may affect prostate sensation and size, with some users reporting easier urination. Concerns exist about prostate shrinkage even at lower doses.

Dutasteride is recommended for men on testosterone replacement therapy (TRT) with DHT-sensitive hair, as it does not interfere with TRT's anabolic effects and may improve libido and aging male symptoms. Users report varying experiences with libido when switching from finasteride to dutasteride, with some noticing improvements and others experiencing fluctuations.

The user experienced bladder and prostate discomfort after taking finasteride and stopped the medication, but symptoms returned upon resuming at a lower dose. The doctor suggested trying dutasteride as an alternative.

Topical androgen receptor antagonists may not be necessary if 5-AR inhibitors like finasteride or dutasteride effectively reduce DHT levels. Combining a 5-AR inhibitor with a topical androgen antagonist could potentially enhance treatment, but oral use of androgen antagonists is too risky due to severe side effects.

FCE 28260 (PNU 156765), an under-explored 5α-reductase inhibitor, showcases promising results in research by Giudici et al., outperforming well-known treatments like Finasteride in reducing the conversion of testosterone to DHT. Its superior efficacy, demonstrated through lower IC50 values in both natural and human recombinant enzyme studies, suggests it could offer more effective management of DHT-related conditions. Additionally, its lower molecular weight hints at better potential for topical application, potentially offering advantages in treating conditions such as androgenic alopecia. Despite its potential, it has not advanced in development, possibly due to financial limitations, leaving its therapeutic prospects and side effect profile largely unexplored.

Saw palmetto, a 5-alpha reductase inhibitor, caused unexpected side effects like breast changes and altered semen consistency, which resolved after stopping its use. Concerns about similar side effects with finasteride or dutasteride were expressed, and another user reported low libido and depression from saw palmetto.