May patients receiving 5-alpha-reductase inhibitors be in higher risk of COVID-19 complications?

Abstract

COVID-19 pandemic is a major challenge for global and national healthcare providers.Number of new cases is continuously increasing with an emerging trend showing worse prognosis in males in comparison to females. Based on this observation, our proposed hypothesis is that 5-alpha-reductase inhibitors, that are commonly used for BPH treatment, may be one of the factors contributing to poorer prognosis in males.3

Testosterone deficiency in men infected with COVID‐19

“…There are also mechanisms by which 5ARIs might have adverse effects on the lungs. 31 However, both of these strategies appear illogical in the light of the recent findings from Italy and Germany of extremely low testosterone and di-hydro testosterone (DHT) levels in acutely ill patients. 4,5 From the practical viewpoint, using drugs that improve endothelial function, such as daily PDE5 inhibitors, ACE inhibitors/ARBs and statins, could be very important in these patients, although many of the vulnerable patients will already be on these drugs because of pre-existing endothelial dysfunction and its known risk association with male sex, erectile dysfunction (ED), smoking, obesity, diabetes, hypertension, cardiovascular disease (CVD) and testosterone deficiency.…”

“…Five alpha reductase inhibitors (5ARIs) have also been advocated, despite evidence that both ADT 29 and 5ARIs 30 increase the risk of T2DM by up to 30%. There are also mechanisms by which 5ARIs might have adverse effects on the lungs 31 . However, both of these strategies appear illogical in the light of the recent findings from Italy and Germany of extremely low testosterone and di‐hydro testosterone (DHT) levels in acutely ill patients 4,5 …”

Effects of 5‐alpha reductase inhibitors on lung function: A reason for discontinuation duringCOVID‐19 pandemic?

“…10 As the respiratory epithelium regeneration mechanisms are activated during inflammatory states such as pneumonia, 5-ARIs may hamper such regeneration by disrupting androgen metabolism. 6 Therefore, inhibition of 5-AR may result in impairment of regeneration capacity of the respiratory epithelium and prolonged or complicated recovery that can be associated with increased mortality.…”

“…Based on the aforementioned observations, finasteride and dutasteride may disrupt androgen metabolism in the lungs, which could aggravate respiratory disease in COVID-19 and thus have a negative impact in the course of the disease. 6 It would be worth performing a review of records of male COVID-19 patients for 5-ARI use including those that developed severe COVID-19-related respiratory disease and deceased patients. Such study could allow clarifying whether 5-ARI use may be associated with worse respiratory disease.…”

COVID-19, Type 2 Diabetes, and Hypogonadism: Lessons for Acute Management and Long-Term Prevention

“…There are mechanisms by which 5ARIs might have adverse effects on the lungs. 66 Both these strategies appear flawed in the light of the findings from Germany and Italy of extremely low testosterone and dihydrotestosterone levels in acutely ill patients. 55,56 Long-Term Prevention Strategy for Men at High Risk in the United Kingdom Although acute therapies and vaccine development are vitally important in COVID-19 management, preventive strategies are required for high-risk groups in the event of second-and third-wave pandemics, or the emergence of new viral threats.…”