Study: No Increased Erectile Dysfunction Risk with 5-Alpha Reductase Inhibitors

Use of the 5-α reductase inhibitors finasteride and dutasteride —primarily prescribed to treat benign prostatic hyperplasia, with a secondary indication in finasteride to treat alopecia—does not increase the risk of erectile dysfunction, despite a label warning indicating potential adverse sexual effects, according to the results of a recent study.

In order to quantify the association between these drugs and adverse effects, researchers conducted a study of men free of risk factors for erectile dysfunction and other sexual dysfunction. The participants included 71,849 men aged 40 or more with benign prostatic hyperplasia treated with a 5-α reductase inhibitors or an α-blocker, or both, as well as 12,346 men aged 18 to 59 years with alopecia, treated with either 1 mg of finasteride or with no treatment.
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Overall, the risk of erectile dysfunction was not increased with the use of 5-α reductase inhibitors alone or in combination with an α-blocker when compared with α-blocker alone in men with benign prostatic hyperplasia. However, the risk of erectile dysfunction increased with longer duration of benign prostatic hyperplasia, regardless of drug exposure. In men with alopecia, the risk of erectile dysfunction was not increased in men taking 1 mg finasteride compared with unexposed men.

“Since benign prostatic hyperplasia and alopecia are common conditions in men and 5-α reductase inhibitors are primary drug treatments for these conditions, the results of this study provide reassurance that these drugs are not associated with a materially important increased risk of clinically meaningful erectile dysfunction in every day clinical practice,” the researchers concluded.

—Michael Potts

Reference:
Hagberg KW, Divan HA, Persson R, Nickel CJ, Jick SS. Risk of erectile dysfunction associated with use of 5-α reductase inhibitors for benign prostatic hyperplasia or alopecia: population based studies using the Clinical Practice Research Datalink [published online September 22, 2016]. BMJ. doi: http://dx.doi.org/10.1136/bmj.i4823.