A review in the journal Endocrine Reviews and Metabolic Disorders reports that greater education and awareness of the potential risks associated with two treatments for benign prostate hyperplasia (BPH) is needed among both patients and clinicians, along with additional research exploring these reported adverse effects.

5α-reductase inhibitors (5α-RIs) inhibit the conversion of testosterone to 5α-dihydrotestosterone (5α-DHT) along with other steroid hormones to decrease prostate volume and improve urinary flow. Abdulmaged Traish, PhD, from the Boston University School of Medicine, and colleagues found that the sexual side effects associated with use of finasteride and dutasteride is likely multifactorial due to the direct decrease in 5α-DHT and direct influence on central and peripheral nerves. Although it has been suggested that sexual side effects usually return to baseline after the first six months of treatment, these multiple factors suggest otherwise.

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Data on 5α-RIs for prostate cancer chemo-prevention was inconclusive in the review and while inhibition of 5α-R activity may potentiate insulin resistance, type 2 diabetes, vascular disease, and osteoporosis, research has not yielded definitive results. Some series described an increase in depression and anxiety symptoms in patients taking these medications.

The authors call for a greater awareness of these potential adverse side effects among both clinicians and patients, along with additional research studies. Both finasteride and dutasteride are approved to treat BPH and finasteride is also approved to treat androgenetic alopecia in men.

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