AB40. Sexual Side Effects of Medical Treatment of BPH

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 conversation discusses the need for a localized 5-alpha reductase inhibitor that only affects the scalp without systemic side effects, similar to pyrilutamide's approach. Current treatments like topical liposomal finasteride and dutasteride are mentioned, but concerns about their systemic effects and lack of research are highlighted.

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.

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.

Dutasteride may inhibit androgen receptors in addition to reducing DHT, potentially explaining its effectiveness over finasteride for hair loss. Concerns about its impact on muscle growth are debated, with some suggesting no significant effects.

L. reuteri, a probiotic, is being explored for its potential benefits in treating androgenic alopecia, possibly enhancing finasteride's effects and reducing inflammation. The user combines this with finasteride, oral minoxidil, and other supplements, noting some improvement in hair loss.