Finasteride, Not Tamsulosin, Increases Severity of Erectile Dysfunction and Decreases Testosterone Levels in Men With Benign Prostatic Hyperplasia

June 2015 in “ Hormone Molecular Biology and Clinical Investigation ”

Abdulmaged M. Traish, Karim Sultan Haider, Gheorghe Doros, Ahmad Haider

finasteride tamsulosin erectile dysfunction testosterone benign prostatic hyperplasia Aging Male Symptoms scale liver enzymes Propecia Flomax ED BPH AMS scale

From the encyclopedia

Finasteride →

Frontline, gold standard treatment for combatting androgenic alopecia

tamsulosin →

Studysummary This study found that long-term finasteride therapy in men with BPH worsened erectile dysfunction and reduced testosterone levels, while these effects were not observed with tamsulosin.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The study from June 6, 2015, involving 700 men with benign prostatic hyperplasia (BPH), found that finasteride treatment over a 45-month period led to a significant worsening of erectile dysfunction (ED) and a decrease in testosterone levels, which did not resolve with continued treatment. In contrast, tamsulosin did not have these adverse effects. Finasteride also increased Aging Male Symptoms (AMS) scale scores, indicating a poorer quality of life, and was associated with increased liver enzymes, suggesting altered liver function. The study highlights the importance of clinicians discussing the potential sexual and hormonal side effects of finasteride with their patients before starting therapy.

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5α-Reductase Inhibitors Alter Steroid Metabolism and May Contribute to Insulin Resistance, Diabetes, Metabolic Syndrome, and Vascular Disease: A Medical Hypothesis

research 5α-Reductase Inhibitors Alter Steroid Metabolism and May Contribute to Insulin Resistance, Diabetes, Metabolic Syndrome, and Vascular Disease: A Medical Hypothesis

15 citations , October 2014 in “Hormone Molecular Biology and Clinical Investigation”

This report advances the hypothesis that finasteride and dutasteride inhibit 5α-reductase activities, potentially altering steroid metabolism and increasing the risk of insulin resistance, diabetes, and vascular disease.

research 5α-Reductase Type 1 Deficiency or Inhibition Predisposes to Insulin Resistance, Hepatic Steatosis, and Liver Fibrosis in Rodents

93 citations , September 2014 in “Diabetes”

This study found that male 5αR1 knockout mice and obese Zucker rats treated with finasteride showed increased insulin resistance and hepatic steatosis, potentially implicating 5α-reductase activity in metabolic liver disease development.

research Androgen Levels and Semen Parameters Among Former Users of Finasteride With Persistent Sexual Adverse Effects

15 citations , September 2014 in “JAMA Dermatology”

This discussion highlights the use of minimal incision extraction for lipoma removal, noting that it is a favored technique among dermatologists due to its efficiency, despite some hesitance with larger lipomas.

A Novel Finasteride 0.25% Topical Solution for Androgenetic Alopecia: Pharmacokinetics and Effects on Plasma Androgen Levels in Healthy Male Volunteers

research A Novel Finasteride 0.25% Topical Solution for Androgenetic Alopecia: Pharmacokinetics and Effects on Plasma Androgen Levels in Healthy Male Volunteers

50 citations , July 2014 in “International Journal of Clinical Pharmacology and Therapeutics”

This study found that both topical and oral finasteride significantly reduced plasma DHT after one week, with lower finasteride plasma exposure for the topical formulation.

research Persistent Sexual, Emotional, and Cognitive Impairment Post-Finasteride

81 citations , June 2014 in “American Journal of Men's Health”

This study highlights that adverse effects from finasteride may persist in men after discontinuation, indicating a potential "post-finasteride syndrome.

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

75 citations , January 2014 in “Korean Journal of Urology”

This review discusses the adverse effects of 5α-reductase inhibitors, finasteride and dutasteride, on sexual, psychological, and vascular health, emphasizing the need for physicians to inform patients of these risks.

research Persistent Sexual and Nonsexual Adverse Effects of Finasteride in Younger Men

24 citations , December 2013 in “Sexual medicine reviews”

This review discusses persistent sexual and nonsexual adverse effects of the 5α-reductase inhibitor finasteride in younger men, including erectile dysfunction, low libido, and depression. It reports no new clinical results but emphasizes further research is needed.

Long-Term Oral Administration of 5α-Reductase Inhibitor Attenuates Erectile Function by Inhibiting Autophagy and Promoting Apoptosis of Smooth Muscle Cells in Corpus Cavernosum of Aged Rats

research Long-Term Oral Administration of 5α-Reductase Inhibitor Attenuates Erectile Function by Inhibiting Autophagy and Promoting Apoptosis of Smooth Muscle Cells in Corpus Cavernosum of Aged Rats

34 citations , September 2013 in “Urology”

Long-term use of a certain medication can worsen erectile function in aged rats by damaging penile muscle cells.

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 Decreased Alcohol Consumption Among Former Male Users of Finasteride with Persistent Sexual Side Effects: A Preliminary Report

27 citations , June 2013 in “Alcoholism: Clinical and Experimental Research”

In this study, 65% of men with persistent sexual side effects after stopping finasteride reported a reduction in alcohol consumption, echoing findings in rodent models.

research Effects of 5-Alpha Reductase Inhibitors on Erectile Function, Sexual Desire, and Ejaculation

71 citations , November 2012 in “Expert Opinion on Drug Safety”

This article reviews the reported sexual and psychological side effects of 5-alpha reductase inhibitors for benign prostatic hyperplasia, emphasizing the need for further clinical studies.

research Depressive Symptoms and Suicidal Thoughts Among Former Users of Finasteride With Persistent Sexual Side Effects

134 citations , August 2012 in “The Journal of Clinical Psychiatry”

This study found that former finasteride users with persistent sexual side effects reported significantly higher rates of depressive symptoms and suicidal thoughts compared to controls.

research Persistent Sexual Side Effects of Finasteride: Could They Be Permanent?

112 citations , July 2012 in “The Journal of Sexual Medicine”

In this study, 96% of men with persistent sexual side effects from finasteride reported continued dysfunction after discontinuation, suggesting these effects may endure long-term.

research 5α-Reductases in Human Physiology: An Unfolding Story

44 citations , July 2012 in “Endocrine Practice”

This review highlights the need for a deeper understanding of 5alpha-reductases and neuroactive steroids to reduce potential adverse effects of 5alpha-reductase inhibitors used for conditions like benign prostatic hyperplasia and androgenic alopecia, but reports no new clinical results.

research Incomplete Recovery of Erectile Function in Rats After Discontinuation of Dual 5-Alpha Reductase Inhibitor Therapy

29 citations , July 2012 in “The Journal of Sexual Medicine”

In this study using a rat model, discontinuing dutasteride improved some relaxant responses but did not fully restore erectile function, indicating a potential time-dependent detriment of the drug.

research Persistent Sexual Side Effects of Finasteride for Male Pattern Hair Loss

185 citations , March 2011 in “The Journal of Sexual Medicine”

This study found that 94% of healthy men reported low libido and 92% reported erectile dysfunction as persistent sexual side effects after using finasteride for male pattern hair loss, with these effects lasting on average 40 months post-discontinuation.

Adverse Side Effects of 5α-Reductase Inhibitors Therapy: Persistent Diminished Libido, Erectile Dysfunction, and Depression in a Subset of Patients

research Adverse Side Effects of 5α-Reductase Inhibitors Therapy: Persistent Diminished Libido, Erectile Dysfunction, and Depression in a Subset of Patients

223 citations , December 2010 in “The Journal of Sexual Medicine”

This review discusses persistent adverse effects of 5α‐reductase inhibitors, like diminished libido and erectile dysfunction, in some patients and highlights the need for patient discussions before therapy, especially for androgenetic alopecia.

research Efficacy and Safety of Finasteride Therapy for Androgenetic Alopecia

152 citations , October 2010 in “Archives of Dermatology”

This study found that daily oral finasteride may increase hair count and improve hair appearance assessments in men with androgenetic alopecia, but it also appears to raise the risk of sexual dysfunction.

research Finasteride Treatment for One Year in 35 Hirsute Patients

27 citations , July 2009 in “Experimental and Clinical Endocrinology & Diabetes”

This study found that finasteride significantly improved hirsutism scores in women over 12 months and was well-tolerated with no serious side effects.

research 5-Alpha Reductase Inhibitors and Erectile Dysfunction: The Connection

78 citations , December 2008 in “The Journal of Sexual Medicine”

This review highlights that sexual dysfunction associated with 5-alpha-reductase inhibitors is recognized in clinical literature, with erectile dysfunction being the most common adverse effect, followed by ejaculatory dysfunction and decreased libido.

research The Effect of 5-Reductase Inhibitors on Erectile Function

31 citations , September 2008 in “International Journal of Andrology”

This review examined studies on erectile dysfunction and 5 alpha-reductase inhibitors, concluding that these drugs do not significantly cause erectile dysfunction and emphasizing testosterone's importance over dihydrotestosterone in erectile function.

The Effect of 5α-Reductase Inhibition With Dutasteride and Finasteride on Bone Mineral Density, Serum Lipoproteins, Hemoglobin, Prostate Specific Antigen, and Sexual Function in Healthy Young Men

research The Effect of 5α-Reductase Inhibition With Dutasteride and Finasteride on Bone Mineral Density, Serum Lipoproteins, Hemoglobin, Prostate Specific Antigen, and Sexual Function in Healthy Young Men

72 citations , April 2008 in “The Journal of urology/The journal of urology”

This study found that 1-year use of 5alpha-reductase inhibitors, dutasteride or finasteride, significantly lowered dihydrotestosterone levels without adversely affecting bone density, lipids, or hemoglobin in normal men.

The Importance of Dual 5α-Reductase Inhibition in the Treatment of Male Pattern Hair Loss: Results of a Randomized Placebo-Controlled Study of Dutasteride Versus Finasteride

research The Importance of Dual 5α-Reductase Inhibition in the Treatment of Male Pattern Hair Loss: Results of a Randomized Placebo-Controlled Study of Dutasteride Versus Finasteride

215 citations , November 2006 in “Journal of The American Academy of Dermatology”

This study found that dutasteride increased scalp hair growth in men with male pattern hair loss, particularly at a 2.5 mg dose, and was more effective than finasteride over 24 weeks.

Evaluation of Androgens in the Scalp Hair and Plasma of Patients with Male-Pattern Baldness Before and After Finasteride Administration

research Evaluation of Androgens in the Scalp Hair and Plasma of Patients with Male-Pattern Baldness Before and After Finasteride Administration

25 citations , January 2006 in “British Journal of Dermatology”

This study found that finasteride decreases DHT/T levels more significantly in the vertex scalp hair than in the occipital hair of patients with male pattern baldness.

research Marked Suppression of Dihydrotestosterone in Men with Benign Prostatic Hyperplasia by Dutasteride, a Dual 5α-Reductase Inhibitor

408 citations , May 2004 in “The Journal of clinical endocrinology and metabolism/Journal of clinical endocrinology & metabolism”

This study found that dutasteride more effectively reduced serum dihydrotestosterone levels than finasteride in patients with benign prostatic hyperplasia.

The Long-Term Effect of Specific Type II 5α-Reductase Inhibition With Finasteride on Bone Mineral Density in Men: Results of a 4-Year Placebo-Controlled Trial

research The Long-Term Effect of Specific Type II 5α-Reductase Inhibition With Finasteride on Bone Mineral Density in Men: Results of a 4-Year Placebo-Controlled Trial

11 citations , May 2002 in “The Journal of Urology”

This study reports that long-term use of finasteride does not affect bone mineral density in men with benign prostatic hyperplasia over a four-year period.

research The Effects of Finasteride on Scalp Skin and Serum Androgen Levels in Men with Androgenetic Alopecia

65 citations , October 1999 in “Journal of The American Academy of Dermatology”

In this study, finasteride doses as low as 0.2 mg per day significantly reduced both scalp skin and serum DHT levels in men with androgenetic alopecia.

Effects of the 5α-Reductase Inhibitor Finasteride on Serum Levels of Gonadal, Adrenal, and Hypophyseal Hormones and Its Clinical Significance: A Prospective Clinical Study

research Effects of the 5α-Reductase Inhibitor Finasteride on Serum Levels of Gonadal, Adrenal, and Hypophyseal Hormones and Its Clinical Significance: A Prospective Clinical Study

56 citations , April 1998 in “Steroids”

Finasteride reduces hair loss and treats BPH without major hormone changes, but may cause sexual dysfunction.

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.

Effect of MK-386, a Novel Inhibitor of Type 1 5 Alpha-Reductase, Alone and in Combination with Finasteride, on Serum Dihydrotestosterone Concentrations in Men

research Effect of MK-386, a Novel Inhibitor of Type 1 5 Alpha-Reductase, Alone and in Combination with Finasteride, on Serum Dihydrotestosterone Concentrations in Men

6 citations , August 1996 in “The Journal of Clinical Endocrinology and Metabolism”

MK-386 and finasteride together effectively reduce DHT levels, potentially treating acne and male pattern baldness.

research Inhibition of Steroid 5 Alpha-Reductase with Finasteride: Sleep-Related Erections, Potency, and Libido in Healthy Men

15 citations , June 1995 in “The Journal of Clinical Endocrinology and Metabolism”

This study found that finasteride significantly reduced dihydrotestosterone levels but did not provide clear evidence of impaired libido or erectile function compared to placebo in men.

research Effects of Finasteride, a 5 Alpha-Reductase Inhibitor, on Circulating Androgens and Gonadotropin Secretion in Hirsute Women

22 citations , September 1994 in “The Journal of Clinical Endocrinology and Metabolism”

This study found that three months of oral finasteride treatment significantly decreased dihydrotestosterone levels and hair growth in hirsute women without negatively affecting gonadotropin secretion.

The Effect of Finasteride, a 5 Alpha-Reductase Inhibitor, on Scalp Skin Testosterone and Dihydrotestosterone Concentrations in Patients with Male Pattern Baldness

research The Effect of Finasteride, a 5 Alpha-Reductase Inhibitor, on Scalp Skin Testosterone and Dihydrotestosterone Concentrations in Patients with Male Pattern Baldness

59 citations , September 1994 in “The Journal of Clinical Endocrinology and Metabolism”

This study found that 4 weeks of finasteride treatment significantly decreased DHT levels in bald scalp to levels similar to hair-containing scalp in men with male pattern baldness.

research Prolonged Treatment with Finasteride (a 5α-Reductase Inhibitor) Does Not Affect Bone Density and Metabolism

48 citations , November 1992 in “Clinical Endocrinology”

Long-term finasteride use doesn't change bone density or metabolism.

research Effect of Finasteride, a 5 Alpha-Reductase Inhibitor, on Serum Gonadotropins in Normal Men

30 citations , August 1992 in “The Journal of Clinical Endocrinology and Metabolism”

This study found that lowering serum DHT levels with 5 mg finasteride daily did not significantly alter serum gonadotropin levels in healthy young men after 28 days.

research Four-Amino Acid Segment in Steroid 5 Alpha-Reductase 1 Confers Sensitivity to Finasteride, a Competitive Inhibitor

83 citations , April 1992 in “Journal of Biological Chemistry”

Four-amino acid part makes enzyme sensitive to finasteride.