Abstract
Background: Despite their efficacy in the treatment of benign prostatic hyperplasia (BPH) the popularity of inhibitors of 5α-reductase (5ARI) is limited by their association with adverse sexual side effects. However, the real impact of 5ARI on sex hormones and sexual function is controversial. Aim: To investigate the role of 5ARI therapy on hormonal parameters and sexual function in men already complaining of sexual problems. Materials and methods: A consecutive series of 3837 men (mean age 63.5±12.8 yr) attending our outpatient clinic for sexual dysfunction was retrospectively studied. Several clinical, biochemical, and instrumental (penile color doppler ultrasound) factors were evaluated. Results: Among the patients studied, 78.7% reported erectile dysfunction, 51.1% hypoactive sexual desire (HSD), 86.7% perceived reduced sleep-related erections (PR-SRE) and 19.1 % premature ejaculation. The use of 5ARI was associated with an increased risk of HSD and PR-SR whereas no relationship was found with erectile dysfunction and ejaculation disturbances. Subjects using 5ARI also more frequently had gynecomastia along with reduced SHBG and higher calculated free testosterone levels. All these associations were confirmed in a case-control study comparing 5ARI users with age-body mass index-smoking status and total testosterone-matched controls. Conclusions: Our data indicates that use of 5ARI in men with sexual dysfunction does not significantly exacerbate pre-existing ejaculatory or erectile difficulties, but can further impair their sexual life by reducing sexual drive and spontaneous erection.
Similar content being viewed by others
References
Fibbi B, Penna G, Morelli A, Adorini L, Maggi M. Chronic inflammation in the pathogenesis of benign prostatic hyperplasia. Int J Androl 2010, 33: 475–88.
Emberton M, Fitzpatrick JM, Rees J. Risk stratification for benign prostatic hyperplasia (BPH) treatment. BJU Int 2011, 107: 876–80.
Gravas S, Oelke M. Current status of 5alpha-reductase inhibitors in the management of lower urinary tract symptoms and BPH. World J Urol 2010, 28: 9–15.
Thompson IM, Goodman PJ, Tangen CM, et al. The influence of finasteride on the development of PC. N Engl J Med 2003, 349: 215–24.
Anitha B, Inamadar AC, Ragunatha S. Finasteride-its impact on sexual function and prostate cancer. J Cutan Aesthet Surg 2009, 2: 12–6.
Edwards JE, Moore RA. Finasteride in the treatment of clinical benign prostatic hyperplasia: a systematic review of randomised trials. BMC Urol 2002, 2: 14.
Erdemir F, Harbin A, Hellstorm WJ. 5a reductase inhibitors and erectile dysfunction: The connection. J Sex Med 2008, 5: 2917–24.
Canguven O, Burnett AL. The effect of 5 alpha-reductase inhibitors on erectile function. J Androl 2008, 29: 514–23.
Gormley GJ, Stoner E, Bruskewitz RC, et al; Finasteride Study Group. The effect of finasteride in men with benign prostatic hyperplasia: The Finasteride study group. N Engl J Med 1992, 327: 1185–91
Nickel JC, Fradet Y, Boake RC, et al. Efficacy and safety of finasteride therapy for benign prostatic hyperplasia: results of a 2-year randomized controlled trial (the PROSPECT study). PROscar Safety Plus Efficacy Canadian Two year Study. CMAJ 1996, 155: 1251–9.
Debruyne FM, Jardin A, Colloi D, et al. Sustained-release alfuzosin, finasteride and the combination of both in the treatment of benign prostatic hyperplasia. European ALFIN Study Group. Eur Urol 1998, 34: 169–75.
Moinpour CM, Darke AK, Donaldson GW, et al. Longitudinal analysis of sexual function reported by men in the prostate cancer prevention trial. J Natl Cancer Inst 2007, 99: 1025–35.
Stoner E. Three-year safety and efficacy data on the use of finasteride in the treatment of benign prostatic hyperplasia. Urology 1994, 43: 284–92.
Wessels H, Roy J, Bannow J, et al; PLESS Study Group. Incidence and severity of sexual adverse experiences in finasteride and placebo treated men with benign prostatic hyperplasia. Urology 2003, 61: 579–84.
Tosti A, Pazzaglia M, Soli M, et al. Evaluation of sexual function with an International Index of Erectile Function in subjects taking finasteride for androgenetic alopecia. Arch Dermatol 2004, 140: 857–8.
Mella JM, Perret MC, Manzotti M, Catalano HN, Guyatt G. Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review. Arch Dermatol 2010, 146: 1141–50.
Mondaini N, Gontero P, Giubilei G, et al. Finasteride 5 mg and sexual side effects: How many of these are related to a nocebo phenomenon? J Sex Med 2007, 4: 1708–12.
Roehrborn CG, Marks LS, Fenter T, et al. Efficacy and safety of dutasteride in the four-year treatment of men with benign prostatic hyperplasia. Urology 2004, 63: 709–15.
Andriole GL, Kirby R. Safety and tolerability of the dual 5 alpha-reductase inhibitor dutasteride in the treatment of benign prostatic hyperplasia. Eur Urol 2003, 44: 82–8.
Goldstein I. An old problem with a new cause-5 alpha reductase inhibitors and persistent sexual dysfunction. J Sex Med 2011, 8: 1829–31.
Traish AM, Hassani J, Guay AT, Zitzmann M, Hansen ML. Adverse side effects of 5α-reductase inhibitors therapy: persistent diminished libido and erectile dysfunction and depression in a subset of patients. J Sex Med 2011, 8: 872–84.
Irwig MS, Kolukula S. Persistent sexual side effects of finasteride for male pattern hair loss. J Sex Med 2011, 8: 1747–53.
Uygur MC, Arik AI, Altug U, Erol D. Effects of the 5 alpha-reductase inhibitor finasteride on serum levels of gonadal, adrenal, and hypophyseal hormones and its clinical significance: a prospective clinical study. Steroids 1998, 63: 208–13.
Amory JK, Wang C, Swerdloff RS, et al. The effect of 5alpha-reductase inhibition with dutasteride and finasteride on semen parameters and serum hormones in healthy men. J Clin Endocrinol Metab 2007, 92: 1659–65.
Petrone L, Mannucci E, Corona G, et al. Structured interview on erectile dysfunction (SIEDY): a new, multi-dimensional instrument for quantification of pathogenetic issues on erectile dysfunction. Int J Impot Res 2003, 15: 210–20.
Corona G, Jannini EA, Maggi M. Inventories for male and female sexual dysfunctions. Int J Impot Res 2006, 18: 236–50.
Corona G, Ricca V, Bandini E, et al. Association between psychiatric symptoms and erectile dysfunction. J Sex Med 2007, 5: 458–68.
Corona G, Petrone L, Mannucci E, et al. Psycho-biological correlates of rapid ejaculation in patients attending an andrologic unit for sexual dysfunctions. Eur Urol 2004, 46: 615–22.
Corona G, Ricca V, Boddi V, et al. Autoeroticism, mental health, and organic disturbancies in patients with erectile dysfunction. J Sex Med 2010, 7: 182–91.
Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 1999, 84: 3666–72.
Corona G, Fagioli G, Mannucci E, et al. Penile doppler ultrasound in patients with erectile dysfunction (ED): role of peak systolic velocity measured in the flaccid state in predicting arteriogenic ED and silent coronary artery disease. J Sex Med 2008, 5: 2623–34.
Seftel AD. Diagnosis of Erectile Dysfunction. In: Porst H, Buvat J, ed. Standard Practice in Sexual Medicine. Malden (USA): Blackwell Publishing. 2006, p 67.
Hatzichristou D, Rosen R, Derogatis L, et al. Clinical evaluation and symptom scales in men and women with sexual dysfunction. In: Adaikan G, Basson R, Becher E, et al. (eds). Sexual Medicine: sexual dysfunctions in men and women. The 3rd International Consultation on Sexual Medicine. Paris, France: Health Publication Ltd. 2010, pp. 229–80.
Andriole GL, Bostwick DG, Brawley OW, et al; REDUCE Study Group. Effect of dutasteride on the risk of prostate cancer. N Engl J Med 2010, 362: 1192–202.
Pinsky MR, Gur S, Tracey AJ, Harbin A, Hellstrom WJ. The effects of chronic 5-alpha-reductase inhibitor (dutasteride) treatment on rat erectile function. J Sex Med 2011, 8: 3066–74.
Corona G, Rastrelli G, Balercia G, et al. Perceived reduced sleep-related erections in subjects with erectile dysfunction: psychobiological correlates. J Sex Med 2011, 8: 1780–8.
Jannini EA, Granata AM, Hatzimouratidis K, Goldstein I. Use and abuse of Rigiscan in the diagnosis of erectile dysfunction. J Sex Med 2009, 6: 1820–9.
Cunningham GR, Hirshkowitz M. Inhibition of steroid 5 alpha-reductase with finasteride: sleep-related erections, potency, and libido in healthy men. J Clin Endocrinol Metab 1995, 80: 1934–40.
Corona G, Rastrelli G, Vignozzi L, Mannucci E, Maggi M. How to recognize late onset hypogonadism in men with sexual dysfunction. Asian J Androl 2012, 14: 251–9.
Corona G, Maggi M. The role of testosterone in erectile dysfunction. Nat Rev Urol 2010, 7: 46–56.
Azzouni F, Godoy A, Li Y, Mohler J. The 5 alpha-reductase isozyme family: a review of basic biology and their role in human diseases. Adv Urol 2012, 2012: 530121.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Corona, G., Rastrelli, G., Maseroli, E. et al. Inhibitors of 5α-reductase-related side effects in patients seeking medical care for sexual dysfunction. J Endocrinol Invest 35, 915–920 (2012). https://doi.org/10.3275/8510
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.3275/8510