Effects of 5-alpha reductase inhibitors on erectile function, sexual desire and ejaculation

@article{Gur2013EffectsO5,
  title={Effects of 5-alpha reductase inhibitors on erectile function, sexual desire and ejaculation},
  author={Serap Gur and Philip J. Kadowitz and Wayne J. G. Hellstrom},
  journal={Expert Opinion on Drug Safety},
  year={2013},
  volume={12},
  pages={81 - 90}
}
Introduction: Treatment with 5-alpha reductase inhibitors (5ARI) is commonly utilized for the treatment of benign prostatic hyperplasia (BPH). The true prevalence of sexual side effects with 5ARI treatment is currently unknown. Areas covered: The current article reviews the reported adverse effects of 5ARI in regard to erectile function, sexual desire and ejaculation. A PubMed search was performed of all articles from 1990 to present, which reported any sexual side effects with finasteride or… 
View on Taylor & Francis
ncbi.nlm.nih.gov
75 Citations
Highly Influential Citations
2
Background Citations
22
Methods Citations
1
Results Citations
2

75 Citations

Citation Type

Citation Type

Sexual Dysfunction Related to Drugs : A Critical
TLDR
A critical review of the current literature on sexual dysfunction caused by α-blocker and 5-ARI drugs and the use of phosphodiesterase type 5 (PDE5) inhibitors in combination with these drugs to identify possible intervention strategies for sexual dysfunction related to these drugs.
Finasteride and Erectile Dysfunction in Patients with Benign Prostatic Hyperplasia or Male Androgenetic Alopecia
TLDR
There is no evidence showing that adverse events of sexual dysfunction are absolutely associated with 5α-RIs, but physicians should discuss with their patients possible long-term effects of finasteride on sexual function, although there is not enough evidence to prove the relationship between finasterid and ED.
Adverse Effects of Pharmacological Therapy of Benign Prostatic Hyperplasia on Sexual Function in Men.
TLDR
Pharmacological therapy of BPH improved voiding symptoms producing different effects on male sexual function and the main adverse effect on sexual function in men is the deterioration in ejaculation or the absence thereof.
Sexual dysfunction in subjects treated with inhibitors of 5α‐reductase for benign prostatic hyperplasia: a comprehensive review and meta‐analysis
TLDR
The present data show that the use of 5ARI significantly increases the risk of erectile dysfunction and hypoactive sexual desire in subjects with benign prostatic hyperplasia and patients should be adequately informed before 5ARIs are prescribed.
The Impact of the 5α-Reductase Inhibitors (5α-RIs) on Male Sexual Function and Psychological Well-Being
  • A. Traish
  • Medicine, Psychology
    Current Sexual Health Reports
  • 2015
TLDR
It is imperative that clinicians give serious considerations to these adverse effects and their impact on patients’ health and engage their patients in an open and honest discussion regarding the potential harm of these agents prior to prescribing them.
Sexual Dysfunction Related to Drugs: a Critical Review. Part V: α-Blocker and 5-ARI Drugs.
TLDR
A critical review of the current literature to identify possible intervention strategies for sexual dysfunction related to α-blocker and 5-ARI drugs and the use of phosphodiesterase type 5 (PDE5) inhibitors in combination with these drugs.
Sexual Dysfunctions Related to Drugs Used in the Management of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Narrative Review on α-Blockers and 5-Alpha Reductase Inhibitors
TLDR
A critical review of the current literature data about sexual dysfunction as a potential side effect related to drugs commonly used for the treatment of Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms finds that silodosin appears to have the highest incidence of ejaculatory disorders.
Finasteride, not tamsulosin, increases severity of erectile dysfunction and decreases testosterone levels in men with benign prostatic hyperplasia
TLDR
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.
Pharmacological treatment of lower urinary tract symptoms in benign prostatic hyperplasia: consequences on sexual function and possible endocrine effects
TLDR
Current evidence support the safety of 5-ARI on bone tissue, and due to the benefits of erection, PDE5i represents the perfect class of drugs for the treatment of LUTS-BPH in patients with erectile dysfunction.
Impact of Alpha Blockers, 5-alpha Reductase Inhibitors and Combination Therapy on Sexual Function
TLDR
This review will delineate the currently known effects of these medications on sexual function and will consider mechanisms of dysfunction.
...
...

References

SHOWING 1-10 OF 94 REFERENCES
5-alpha reductase inhibitors and erectile dysfunction: the connection.
TLDR
The connection between 5ARIs and sexual dysfunction is apparent upon review of the literature and the proposed mechanism for sexual dysfunction involves decreased nitric oxide synthase activity due to decreased dihydrotestosterone.
Medical therapy for benign prostatic hyperplasia: sexual dysfunction and impact on quality of life
TLDR
Optimal treatment for men with BPH requires the use of agents that demonstrate efficacy and safety with fewer sexual side effects, with a focus on the effects of different pharmacological agents on sexual function.
Finasteride 5 mg and sexual side effects: how many of these are related to a nocebo phenomenon?
TLDR
The burden of this nocebo effect (an adverse side effect that is not a direct result of the specific pharmacological action of the drug) has to be taken into account when managing finasteride sexual side effects.
Guide to Drug Therapy for Lower Urinary Tract Symptoms in Patients with Benign Prostatic Obstruction
TLDR
The successful evaluation and management of older men with LUTS associated with BPO should include an assessment of baseline sexual function and subsequent monitoring of medication-induced sexual adverse effects, including reduced nitric oxide/cyclic guanosine monophosphate system activity, enhanced endothelin-1/rhoA/ rho kinase pathway activity, sympathetic overactivity, pelvic organ atherosclerosis and potential preventive approaches.
Impact of medical treatments for benign prostatic hyperplasia on sexual function
TLDR
Because treatment options for managing BPH have different effects on sexuality, the sexual dimension should be considered when assessing patients’ expectations and the choice of treatment.
The effects of chronic 5-alpha-reductase inhibitor (dutasteride) treatment on rat erectile function.
TLDR
The 5ARIs, as demonstrated in these rat cavernosal smooth muscle studies, have a detrimental effect on erectile function and enhanced iNOS expression may protect penile smooth muscle from fibrosis.
Dutasteride: a review of current data on a novel dual inhibitor of 5alpha reductase.
TLDR
The efficacy of dutasteride in symptomatic relief, improvements in quality of life and peak urinary flow rate, and reduction of acute urinary retention events and need for surgery are shown, and the anticancer properties of dUTasteride have been shown in placebo-controlled trials and are being investigated in the ongoing REDUCE trial.
Dutasteride: A Review of Current Data on a Novel Dual Inhibitor of 5α Reductase
TLDR
The efficacy of dutasteride in symptomatic relief, improvements in quality of life and peak urinary flow rate, and reduction of acute urinary retention events and need for surgery are shown, and the anticancer properties of dUTasteride have been shown in placebo-controlled trials and are being investigated in the ongoing REDUCE trial.
Recent insights into androgen action on the anatomical and physiological substrate of penile erection.
TLDR
There is growing insight that testosterone has profound effects on tissues of the penis involved in the mechanism of erection and that testosterone deficiency impairs the anatomical and physiological substrate of erectile capacity, reversible upon androgen replacement.
An overview on 5α-reductase inhibitors
...
...