Effects of 5-Alpha Reductase Inhibitors

The document from May 1, 2018, reviews the effects of 5-alpha reductase inhibitors (5ARIs), drugs used for benign prostatic hyperplasia (BPH) and androgenic alopecia (AGA), and discusses both their benefits and adverse effects. It notes that while 5ARIs can lead to sexual dysfunction, neurologic, endocrine, and cardiovascular effects, these adverse effects affect a small proportion of patients and are typically resolved upon discontinuation of treatment. The review references studies with varying participant numbers, including one with 46 men showing reduced insulin sensitivity and increased body fat with dutasteride, and another large RCT with 8,231 participants over 4 years linking dutasteride to an increased risk of cardiac failure. However, the evidence on cardiovascular risks is inconsistent. A study from the Taiwan National Health Insurance database found that BPH patients treated with finasteride and dutasteride had a significantly higher risk of acute coronary syndrome (ACS), with an odds ratio of 3.47. The document concludes that despite the established clinical applications of 5ARIs, there is a need for better-designed studies to understand the mechanisms behind their adverse effects.