Effects of 5-alpha reductase inhibitors: new insights on benefits and harms

  title={Effects of 5-alpha reductase inhibitors: new insights on benefits and harms},
  author={Joo Yong Lee and Kang Su Cho},
  journal={Current Opinion in Urology},
  • J. LeeK. Cho
  • Published 1 May 2018
  • Medicine, Biology
  • Current Opinion in Urology
Purpose of review The use of 5-alpha reductase inhibitors (5ARIs) for the treatment of benign prostatic hyperplasia (BPH) and other diseases has been proposed and studied. However, the controversy about its benefits and harms for other diseases has persisted. In this review, we will discuss the newly identified effects of 5ARIs based on recently published studies. Recent findings These drugs are currently recommended in clinical guidelines for BPH. However, the reporting of adverse effects… 
3 Citations



5alpha-reductase: history and clinical importance.

The 5AR inhibitor drugs (finasteride and the dual inhibitor, dutasteride) are able to ablate the accumulation of intraprostatic DHT, the mechanism most responsible for prostate growth and maintenance.

The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia.

Long-term combination therapy with doxazosin and finasteride was safe and reduced the risk of overall clinical progression of benign prostatic hyperplasia significantly more than did treatment with either drug alone.

Long-term use of 5α-reductase inhibitors and the risk of male breast cancer

There was no evidence of an association between short- or long-term treatment with 5-ARIs and the risk for breast cancer in older men.

5-Alpha-Reductase Inhibitors and Combination Therapy.

5-α reductase inhibitors, benign prostatic hyperplasia, and risk of male breast cancer

The increased risk of breast cancer among men who had undergone a transurethral resection of the prostate, a strong indicator of BPH, suggests that the endocrine milieu conducive to BPH is associated with male breast cancer.

5α-Reductase inhibitors increase acute coronary syndrome risk in patients with benign prostate hyperplasia

This population-based nested case–control study suggests that 5ARI use may increase ACS risk among patients with BPH when patients were exposed to both finasteride and dutasteride.

Risk of gynecomastia and breast cancer associated with the use of 5-alpha reductase inhibitors for benign prostatic hyperplasia

5ARIs significantly increased the risk of gynecomastia, but not breast cancer, compared to AB use and no exposure, and the risk was higher for dutasteride than for finasteride.

Finasteride, not tamsulosin, increases severity of erectile dysfunction and decreases testosterone levels in men with benign prostatic hyperplasia

In men with BPH, long-term finasteride therapy but not tamsulosin results in worsening of ED and reduces total T concentrations, contributing to a state of hypogonadism.

Risk of erectile dysfunction associated with use of 5-α reductase inhibitors for benign prostatic hyperplasia or alopecia: population based studies using the Clinical Practice Research Datalink

5-α reductase inhibitors do not seem to significantly increase the risk of incident erectile dysfunction, regardless of indication for use, and risk of erectiles dysfunction increased with longer duration of benign prostatic hyperplasia.