Analysis of Data From Breast Diseases Treated With 5-Alpha Reductase Inhibitors for Benign Prostatic Hyperplasia

April 2019 in “ Clinical Breast Cancer ”

Qinghua Fang, Pei-Ya Chen, Ningchao Du, Kutty Selva Nandakumar

5-alpha reductase inhibitors 5ARIs dutasteride finasteride gynecomastia breast tenderness benign prostatic hyperplasia alpha-blockers Propecia Avodart

From the encyclopedia

Dutasteride →

Heavy duty finasteride that comes with higher risks

Finasteride →

Frontline, gold standard treatment for combatting androgenic alopecia

Studysummary This study found that in men with benign prostatic hyperplasia, 5-alpha reductase inhibitors significantly increased the risk of gynecomastia and breast tenderness compared to placebo or alpha-blockers. Our plain-language summary of this paper — not a Tressless recommendation.

In a meta-analysis of 14 studies involving 37,851 patients, the use of 5-alpha reductase inhibitors (5ARIs) like dutasteride and finasteride for treating benign prostatic hyperplasia was associated with a significantly increased risk of gynecomastia and breast tenderness compared to placebo and alpha-blocker monotherapy. The risk of gynecomastia was 1.79 times higher with 5ARIs than placebo, and the risk of breast tenderness was 2.85 times higher. Combination therapy with 5ARIs and alpha-blockers also showed a higher prevalence of breast tenderness compared to alpha-blockers alone. However, the study did not find a significant increase in the risk of breast cancer associated with 5ARIs use. Despite the effectiveness of 5ARIs in treating BPH symptoms, the increased risk of breast-related side effects was a concern, with dutasteride potentially causing more cases of gynecomastia than finasteride. Further research was suggested to confirm the long-term risk of breast cancer with 5ARIs use.

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Research cited in this study

12 / 12 results

research Finasteride Treatment and Male Breast Cancer: A Register-Based Cohort Study in Four Nordic Countries

8 citations , December 2017 in “Cancer Medicine”

This study found an association between dispensed finasteride and an increased risk of male breast cancer, though uncertainties around confounding factors and potential biases suggest these results should be interpreted with caution.

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

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

66 citations , April 2017 in “International Journal of Andrology”

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.

A Randomized, Active- and Placebo-Controlled Study of the Efficacy and Safety of Different Doses of Dutasteride Versus Placebo and Finasteride in the Treatment of Male Subjects with Androgenetic Alopecia

research A Randomized, Active- and Placebo-Controlled Study of the Efficacy and Safety of Different Doses of Dutasteride Versus Placebo and Finasteride in the Treatment of Male Subjects with Androgenetic Alopecia

97 citations , January 2014 in “Journal of The American Academy of Dermatology”

This study found that dutasteride increased hair growth and restoration in men with androgenetic alopecia more effectively than finasteride and was well tolerated over 24 weeks.

research Finasteride Use in the Male Infertility Population: Effects on Semen and Hormone Parameters

54 citations , September 2013 in “Fertility and Sterility”

This study found that discontinuing finasteride led to a significant increase in sperm counts for most men with reduced fertility, though hormone levels and other semen parameters remained unchanged.

The Efficacy and Safety of 5α-Reductase Inhibitors in Androgenetic Alopecia: A Network Meta-Analysis and Benefit–Risk Assessment of Finasteride and Dutasteride

research The Efficacy and Safety of 5α-Reductase Inhibitors in Androgenetic Alopecia: A Network Meta-Analysis and Benefit–Risk Assessment of Finasteride and Dutasteride

66 citations , June 2013 in “Journal of Dermatological Treatment”

This study reported no significant difference in efficacy or sexual dysfunction risk between 5α-reductase inhibitors and placebo for androgenetic alopecia, suggesting that dutasteride 0.5 mg may be considered pending further research.

research Side Effects of 5-Alpha Reductase Inhibitors: A Comprehensive Review

35 citations , April 2013 in “Sexual medicine reviews”

This review found that 5α-reductase inhibitors are associated with slightly increased rates of sexual dysfunction, gynecomastia, and mood disorders, but the true significance and persistence of these effects remain unclear.

research Finasteride Induced Gynecomastia: Case Report and Review of the Literature

29 citations , January 2009 in “International Journal of Trichology”

This report describes two cases of gynecomastia linked to the use of Finasteride (Propecia®) for treating androgenetic alopecia, highlighting a rare but important side effect.

research The Effect of 5α-Reductase Inhibition with Dutasteride and Finasteride on Semen Parameters and Serum Hormones in Healthy Men

195 citations , February 2007 in “The Journal of Clinical Endocrinology and Metabolism”

In this study, administering 5alpha-reductase inhibitors reduced dihydrotestosterone levels and was associated with mild, reversible decreases in semen parameters in healthy men.

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.

research Unilateral Gynecomastia Induced by Treatment With 1 mg of Oral Finasteride

30 citations , April 2002 in “Archives of Dermatology”

Finasteride can cause one-sided breast enlargement, which disappears after stopping the drug.

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

1054 citations , February 1998 in “The New England Journal of Medicine”

In this study, men with benign prostatic hyperplasia who took finasteride for four years experienced reduced urinary symptoms, fewer surgeries, less acute urinary retention, increased urinary flow rates, and decreased prostate volume.

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.