Sexual Dysfunction Related to Drugs: A Critical Review. Part V: Alpha-Blocker and 5-ARI Drugs

November 2015 in “ Pharmacopsychiatry ”

Antonio La Torre, Giancarlo Giupponi, Dearbhla Duffy, Andreas Conca, Tommaso Cai, A. Scardigli

α-blockers 5-ARIs benign prostatic hyperplasia lower urinary tract symptoms erectile dysfunction ejaculatory disorders reduced sexual desire silodosin finasteride phosphodiesterase type 5 inhibitors alpha-blockers 5-alpha-reductase inhibitors BPH LUTS ED ejaculatory issues low libido Propecia PDE5 inhibitors

Studysummary This review discusses sexual dysfunction as a side effect of α-blockers and 5-ARIs for BPH/LUTS, highlighting methodological flaws in existing studies and the need for more rigorous research.

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

This critical review examined the literature on sexual dysfunction as a side effect of drugs used to treat benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), specifically focusing on α-blockers and 5-ARIs. The review highlighted that these drugs can cause erectile dysfunction, ejaculatory disorders, and reduced sexual desire, with silodosin among α-blockers having the highest incidence of ejaculatory issues. Persistent sexual side effects after discontinuing finasteride were noted, though further research is needed to understand this fully. The review emphasized the need for future studies to use validated tools to diagnose drug-induced sexual dysfunction and called for more research on the long-term effects of combining phosphodiesterase type 5 inhibitors with α-blockers or 5-ARIs. The review included studies published between 2002 and 2014, using resources from the APSS library in Trento, Italy.

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Research cited in this study

17 / 17 results

research Impact of Alpha Blockers, 5-Alpha Reductase Inhibitors, and Combination Therapy on Sexual Function

11 citations , August 2014 in “Current Urology Reports”

This review discusses the known effects of medications for benign prostatic hyperplasia on sexual function and mechanisms of dysfunction but reports no new clinical results.

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 Side Effects of 5-Alpha Reductase Inhibitors: A Comprehensive Review

35 citations , April 2013 in “Sexual medicine reviews”

This review found that 5α-reductase inhibitors are associated with slightly increased rates of sexual dysfunction, gynecomastia, and mood disorders, but the true significance and persistence of these effects remain unclear.

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 Inhibitors of 5α-Reductase-Related Side Effects in Patients Seeking Medical Care for Sexual Dysfunction

13 citations , November 2012 in “PubMed”

This study found that in men with sexual dysfunction, use of 5ARI may reduce sexual drive and spontaneous erections without worsening pre-existing erectile or ejaculatory issues.

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 Finasteride and Sexual Side Effects

39 citations , January 2012 in “Indian Dermatology Online Journal”

This article examines the evidence regarding finasteride's sexual side effects and offers recommendations for patient counseling but reports no new clinical findings.

research An Old Problem with a New Cause: 5 Alpha Reductase Inhibitors and Persistent Sexual Dysfunction

9 citations , July 2011 in “The Journal of Sexual Medicine”

This article examines 5 alpha-reductase inhibitors and their link to persistent sexual dysfunction, but it reports no new clinical findings.

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 Finasteride: Its Impact on Sexual Function and Prostate Cancer

33 citations , January 2009 in “Journal of Cutaneous and Aesthetic Surgery”

This study found no clear evidence that finasteride negatively affects erectile function, though it does cause a reduction in ejaculatory volume and has potential implications for prostate cancer risk.

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.

research Finasteride 5mg and Sexual Side Effects: How Many Are Related to a Nocebo Phenomenon?

225 citations , July 2007 in “The Journal of Sexual Medicine”

In this study, patients informed about finasteride's potential sexual side effects reported a significantly higher occurrence of these side effects, suggesting a nocebo effect.

research Dutasteride: A Review of Current Data on a Novel Dual Inhibitor of 5-Alpha Reductase

38 citations , January 2005 in “PubMed”

This study found that dutasteride effectively improves symptoms of benign prostatic hyperplasia, showing benefits in urinary flow and quality of life, with only modestly elevated sexual side effects compared to placebo.

research The Long-Term Effect of Doxazosin, Finasteride, and Combination Therapy on the Clinical Progression of Benign Prostatic Hyperplasia

1707 citations , December 2003 in “The New England Journal of Medicine”

Combination therapy of doxazosin and finasteride safely and effectively reduces benign prostatic hyperplasia progression risk.