5α-reductase inhibitors in BPH linked with adverse sexual effects

5α-reductase inhibitors (5α-RIs) may cause persistent erectile dysfunction, depression, and loss of libido, even after discontinuing use, in men being treated for symptoms of benign prostatic hyperplasia (BPH) and androgenetic alopecia, according to a literature review published in The Journal of Sexual Medicine.

Investigators examined data from various clinical studies concerning the side effects of finasteride and dutasteride. A subset of men reported persistent adverse effects on sexual function, including erectile dysfunction and decreased libido. Drug-related reduction in libido occurred in 4.2% of men taking dutasteride compared to 1.8% taking placebo in 1 study. About 6% to 8% of patients in several trials reported erectile dysfunction. Some patients also experienced negative effects on ejaculatory function, gynecomastia, and depression.

Extreme caution should be exercised prior to prescribing 5α-RIs therapy to patients for hair growth or for BPH symptoms," the investigators concluded.  "In some patients, these adverse effects are persistent and may be prolonged, and patients do not recover well after discontinuation from drug use."