Comments Concerning the Real Risk of Sexual Adverse Events Secondary to the Use of 5-Alpha-Reductase Inhibitors

The document reviews the risk of sexual adverse events from the use of 5-alpha-reductase inhibitors (5ARIs) like finasteride and dutasteride, which are prescribed for benign prostatic hyperplasia (BPH) and androgenetic alopecia. It acknowledges reports of sexual dysfunction but indicates that the incidence is low, with less than 10% of patients experiencing erectile dysfunction and loss of libido according to a study by Erdemir F, et al. (2008), and most symptoms resolving post-treatment. However, persistent sexual dysfunction has also been reported. A large study by Sato and Takeda (2012) involving 3177 patients found no side effects over 41 months. Genetic differences and the "nocebo" effect, where adverse events may be perceived if patients are warned about them, are discussed as possible explanations for the variability in patient responses. A literature review by Trost et al. (2013) involving over 62,827 patients showed a slight increase in sexual side effects compared to placebo. The document concludes that while there is a need for awareness of potential permanent sexual adverse events, the actual risk is still being investigated, and treatments should be individualized with regular monitoring and patient education to optimize outcomes.