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.

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

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

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

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Finasteride effectively treats BPH but may increase sexual dysfunction risk.