A Proposed Etiopathology of Persistent Dysfunctions Emerging from Use and Discontinuation of 5-Alpha Reductase Inhibitors: Sequelae of Drug-Mediated Microvasculopathy

The document proposes a hypothesis for the persistent dysfunctions reported by men who have previously taken finasteride and dutasteride, even after discontinuing the drugs. These dysfunctions include sexual dysfunction, anxiety, cognitive problems, and others. The paper suggests that these drugs may cause changes in penile tissue, such as reduced size, muscle loss, increased connective tissue, and alterations to vascular structure and neural signaling pathways. This could lead to stress on small blood vessels in penile tissue, reducing oxygen supply. The tissue's attempt to restore blood flow could become pathological, triggering a cycle of vascular deterioration, tissue damage, and inflammation. This local progression could develop into a broader inflammatory condition, potentially damaging other structures and systems regulating psychological well-being, thought, sleep, vision, and hearing. The hypothesis suggests that all dysfunctions arise from tissue injuries in supporting structures and organs, with outcomes varying in nature, severity, and course over time, similar to stroke outcomes.