Sexual Dysfunction in Subjects Treated with Inhibitors of 5α-Reductase for Benign Prostatic Hyperplasia: A Comprehensive Review and Meta-Analysis

September 2023 in “ International Journal of Andrology ”

Giovanni Corona, Giacomo Tirabassi, Daniele Santi, Elisa Maseroli, Mauro Gacci, Mauro Dicuio, Alessandra Sforza, Edoardo Mannucci, Mario Maggi

5α-reductase inhibitors 5ARIs hypoactive sexual desire HSD erectile dysfunction ED benign prostatic hyperplasia BPH finasteride dutasteride Propecia Avodart

TLDR Men taking 5α-reductase inhibitors for enlarged prostate have a higher chance of experiencing reduced sexual desire and erectile dysfunction.

This comprehensive review and meta-analysis, which included 17 randomized clinical trials with a total of 24,463 subjects receiving 5α-reductase inhibitors (5ARIs) and 22,270 in placebo groups, found that 5ARIs significantly increase the risk of hypoactive sexual desire (HSD) and erectile dysfunction (ED) in men treated for benign prostatic hyperplasia (BPH). The odds ratios were 1.54 for HSD and 1.47 for ED, indicating a substantial increase in risk compared to placebo, with no significant difference between the two drugs, finasteride and dutasteride. The risk was higher in subjects with lower urinary flow rates at the start of the trials and decreased over time. The study concludes that patients should be informed about these risks before starting 5ARI treatment for BPH.

View this study on onlinelibrary.wiley.com →

Discuss this study in the Community →

Cited in this study

13 / 13 results

research Effects of Subchronic Finasteride Treatment and Withdrawal on Neuroactive Steroid Levels and Their Receptors in the Male Rat Brain

33 citations , January 2016 in “Neuroendocrinology”

Finasteride treatment changes brain steroid levels and receptors, affecting brain function even after stopping treatment.

research Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-Analysis

44 citations , June 2015 in “PubMed”

Finasteride for hair loss may cause long-lasting side effects like impotence and low libido, but trials lack proper safety reporting.

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

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

5-alpha reductase inhibitors can cause sexual side effects like erectile dysfunction and reduced sexual desire, sometimes lasting after stopping the drug.

research Emerging Medication for the Treatment of Male Hypogonadism

77 citations , May 2012 in “Expert Opinion on Emerging Drugs”

New treatments for male hypogonadism are effective and should be personalized.

research Androgen Deprivation Therapy in Prostate Cancer: Focusing on Sexual Side Effects

35 citations , March 2012 in “The Journal of Sexual Medicine”

Androgen Deprivation Therapy for prostate cancer often reduces sexual function but intermittent therapy may be more tolerable.

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

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

Some patients taking finasteride or dutasteride may have ongoing sexual problems and depression even after stopping the medication.

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

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

Knowing about finasteride's sexual side effects increases reported dysfunction.

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”

Dutasteride more effectively lowers DHT levels in men with enlarged prostates than finasteride.

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.

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.

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”

Finasteride reduces urinary issues and surgery need in men with enlarged prostates by over 50%.

research The Efficacy of Terazosin, Finasteride, or Both in Benign Prostatic Hyperplasia

728 citations , August 1996 in “The New England Journal of Medicine”

Terazosin and finasteride effectively treat BPH, but combining them adds no extra benefit.

research The Effect of Finasteride in Men with Benign Prostatic Hyperplasia

1040 citations , October 1992 in “The New England Journal of Medicine”

Finasteride effectively treats BPH but may increase sexual dysfunction risk.