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

Traish, Abdulmaged M.; Haider, Karim Sultan; Doros, Gheorghe; Haider, Ahmad

doi:10.1515/hmbci-2015-0015

Cited by 36 publications

(30 citation statements)

References 103 publications

(191 reference statements)

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“…More importantly, the aging male symptom score (AMS) increased concomitant with increased activity of alanine amino transferase (ALT) and aspartate aminotransferase (AST) suggesting changes in liver function with finasteride but not with tamsulosin. More importantly, this report [129] demonstrates that the sexual side effects do not resolve with continuous treatment with finasteride as claimed previously [60,61,86].…”

Section: Adverse Effects On Sexual Functionsupporting

confidence: 76%

“…Emerging clinical evidence strongly suggests that 5α-Rs inhibitors therapy is associated with sexual adverse side effects, which, in vulnerable patients, remain even after 4 years of therapy [122,129], contrary to prior claims [60,61,86]. Thus, increased education and awareness of clinicians and patients alike is necessary to spare many patients from the adverse sexual side effects.…”

Section: Discussionmentioning

confidence: 98%

“…The suggestion that the adverse events, such as loss of libido, diminished erections or ejaculation, appear early in the first 6 months and then return back to normal is, at best, inaccurate and is not supported by evidence based medicine. Recent data showed that the symptoms were present even after 4 years of therapy [122,129]. Simply, the problems with inconsistent follow-up and use of non-validated scales or questionnaires and in the absence of spontaneous reporting of events did not permit accurate assessment of the sexual adverse events and whether they resolve or do eventually persist.…”

Section: Discussionmentioning

confidence: 99%

“…Traish et al, [129] investigated the impact of finasteride and tamsulosin on the severity of ED in BPH patients for a period of 45 months. In 470 patients, finasteride increased the severity of ED, as assessed by the International Index of Erectile Function (IIEF) and resulted in reduced total testosterone levels [129].…”

Section: Adverse Effects On Sexual Functionmentioning

confidence: 99%

“…In 470 patients, finasteride increased the severity of ED, as assessed by the International Index of Erectile Function (IIEF) and resulted in reduced total testosterone levels [129]. In contrast, in 280 patients treated with tamsulosin, no significant changes in the IIEF scale were noted nor there was a decrease in total testosterone.…”

Section: Adverse Effects On Sexual Functionmentioning

confidence: 99%

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Adverse effects of 5α-reductase inhibitors: What do we know, don’t know, and need to know?

Traish

Melcangi

Bortolato

et al. 2015

Rev Endocr Metab Disord

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Steroids are important physiological orchestrators of endocrine as well as peripheral and central nervous system functions. One of the key processes for regulation of these molecules lies in their enzymatic processing by a family of 5α-reductase (5α-Rs) isozymes. By catalyzing a key rate-limiting step in steroidogenesis, this family of enzymes exerts a crucial role not only in the physiological control but also in pathological events. Indeed, both 5α-R inhibition and supplementation of 5α-reduced metabolites are currently used or have been proposed as therapeutic strategies for a wide array of pathological conditions. In particular, the potent 5α-R inhibitors finasteride and dutasteride are used in the treatments of benign prostatic hyperplasia (BPH), as well as in male pattern hair loss (MPHL) known as androgenetic alopecia (AGA). Recent preclinical and clinical findings indicate that 5α-R inhibitors evoke not only beneficial, but also adverse effects. Future studies should investigate the biochemical and physiological mechanisms that underlie the persistence of the adverse sexual side effects to determine why a subset of patients is afflicted with such persistence or irreversible adverse effects. Also a better focus of clinical research is urgently needed to better define those subjects who are likely to be adversely affected by such agents. Furthermore, research on the non-sexual adverse effects such as diabetes, psychosis, depression, and cognitive function are needed to better understand the broad spectrum of the effects these drugs may elicit during their use in treatment of AGA or BPH. In this review, we will summarize the state of art on this topic, overview the key unresolved questions that have emerged on the pharmacological targeting of these enzymes and their products, and highlight the need for further studies to ascertain the severity and duration of the adverse effects of 5α-R inhibitors, as well as their biological underpinnings.

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Section: Adverse Effects On Sexual Functionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Adverse Effects On Sexual Functionmentioning

confidence: 99%

Section: Adverse Effects On Sexual Functionmentioning

confidence: 99%

See 3 more Smart Citations

Adverse effects of 5α-reductase inhibitors: What do we know, don’t know, and need to know?

Traish

Melcangi

Bortolato

et al. 2015

Rev Endocr Metab Disord

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5α-Reductase Inhibitors (5ARIs) and Male Reproduction

Drobnis¹,

Nangia²

2017

Advances in Experimental Medicine and Biology

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The 5ARIs, finasteride and dutasteride, are used to treat benign prostate hyperplasia and lower urinary tract symptoms. At much lower doses, 5ARI treatment reduces male hair loss. These drugs inhibit the conversion of testosterone to the more active dihydrotestosterone (DHT). In men taking these medications, DHT levels are reduced by some 90% while testosterone levels remain relatively stable. Well known for their negative effects on libido and erectile function, 5ARIs also cause ejaculatory dysfunction in some men, having the potential to decrease semen quality. In fact, some studies of men treated with these drugs have reported lower total sperm count, along with lower sperm motility, although the changes are probably insufficient to reduce fertility in men with normal semen before treatment. There is a population of men with more severely decreased sperm numbers; as low as 10% of pretreatment values. Fewer studies have looked at the lower doses used for male alopecia, indicating little affect in men with normal semen quality, but a negative effect on sperm numbers in men with oligozoospermia. There have been no studies looking at fertility endpoints for these medications.

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Negative Impact of Testosterone Deficiency and 5α-Reductase Inhibitors Therapy on Metabolic and Sexual Function in Men

Traish

2017

Advances in Experimental Medicine and Biology

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Androgens are steroid hormones with pleotropic and diverse biochemical and physiological functions, and androgen deficiency exerts a negative impact on human health. Testosterone (T) either directly or via its transformation into the more potent metabolite 5α-dihydrotestosterone (5α-DHT) or via aromatization into estradiol (E) modulates important biochemical signaling pathways of human physiology and plays a critical role in the growth and/or maintenance of functions in a host of tissues and organs. T and 5α-DHT play an important role in regulating physiology of the muscle, adipose tissue, liver, bone, and central nervous system, as well as reproductive and sexual functions. Thus, androgen deficiency (also referred to as hypogonadism) is a well-recognized medical condition and if remained untreated will have a negative impact on human health and quality of life.In this chapter, we have summarized the negative impact of T deficiency (TD) on a host of physiological functions including reduced lean body mass (LBM), increased fat mass (FM), increased insulin resistance (IR), metabolic syndrome (MetS) and adiposity, reduced bone mineral density (BMD), anemia, sexual dysfunction, and reduced quality of life and increased mortality. In addition, we discuss another critical aspect of unrecognized form of androgen deficiency resulting from inhibition of 5α-reductases with drugs, such as finasteride and dutasteride, to block transformation of T into 5α-DHT in the course of treatment of benign prostatic hyperplasia (BPH) and male pattern hair loss, also known as androgenetic alopecia (AGA). The negative impact of drugs that inhibit transformation of T to 5α-DHT by 5α-reductases on metabolic function is manifested in fat accumulation in the liver, which may predispose to nonalcoholic fatty liver disease (NAFLD). Also, inhibition of 5α-DHT formation increases glucose synthesis and reduces glucose disposal potentially contributing to hyperglycemia, IR, and elevated activities of liver function enzymes concomitant with reduction in circulating T levels, worsening erectile dysfunction (ED), and reduced quality of life.Although we have attempted to summarize the current literature pertaining to this critical topic "androgen deficiency" and its impact on men's health and quality of life, there remain many gaps in the knowledge regarding the biochemical pathways that are involved in the pathophysiology of androgen deficiency. We wish to clearly state that there are areas of controversies, including whether age-related androgen deficiency (functional hypogonadism) merits treatment and whether T therapy provided real proven benefits. Finally, considerable debate exists with respect to the potential and purported cardiovascular (CV) risks of treating TD with exogenous T. For brevity sake, we will not discuss in detail the benefits of T therapy in men with TD since this topic is comprehensively covered by Dr. F. Saad's chapter in this book, entitled "Testosterone Therapy and Glucose Homeostasis in Men with Testosterone Deficiency (Hypo...

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

Abstract: Our findings suggest that in men with BPH, long-term finasteride therapy but not tamsulosin results in worsening of ED and reduces total T concentrations. Clinicians are urged to discuss the impact of 5α-RIs therapy on sexual function with their patients before commencing this therapy.

Cited by 36 publications

References 103 publications

Adverse effects of 5α-reductase inhibitors: What do we know, don’t know, and need to know?

Adverse effects of 5α-reductase inhibitors: What do we know, don’t know, and need to know?

5α-Reductase Inhibitors (5ARIs) and Male Reproduction

Negative Impact of Testosterone Deficiency and 5α-Reductase Inhibitors Therapy on Metabolic and Sexual Function in Men

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