Common treatments for benign prostatic hyperplasia (BPH), like Proscar (finasteride) or Avodart (dutasteride), are suggested to be linked to erectile dysfunction and other sexual problems in a number a studies. But new research reports that the use of such treatments for BPH, or for a condition known as alopecia (male pattern baldness), does not significantly increase the risk of erectile dysfunction; rather, that risk rises the longer a person has BPH.
The study, “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,” was published in the journal The BMJ.
BPH treatments are typically alpha-blockers or inhibitors of the enzyme 5-alpha reductase, and their use has been linked in studies to the onset of sexual dysfunction. The U.S. Food and Drug Administration (FDA), in fact, ordered that all finasteride products (Proscar and Propecia) include information advising patients of the risk of erectile dysfunction and decreased libido, among other issues, after stopping the drug’s use, although noting that such adverse effects were not proven.
To evaluate whether the use of certain BPH drugs was associated with the risk erectile dysfunction, researchers based in the U.S. and Canada conducted two studies.
The first involved BPH patients, ages 40 and older, with a prescription for a 5-α reductase inhibitor (finasteride or dutasteride) or an alpha blocker (alfuzosin, doxadosin, indoramin, prazosin, tamsulosin, and terazosin), or both. The second study included men, ages 18 to 59, with erectile dysfunction who had received finasteride (1 mg) to treat hair loss. Both groups were compared with respective groups of age-matched healthy subjects.
“In the population with benign prostatic hyperplasia (n=71,849), the risk of erectile dysfunction was not increased with use of 5-α reductase inhibitors only, or 5-α reductase inhibitors+α blocker, compared with α blockers only, and remained null regardless of number of prescriptions or timing of use,” the researcher wrote. “The risk of erectile dysfunction increased with longer duration of benign prostatic hyperplasia, regardless of exposure.”
“For the alopecia population (n=12,346), the risk of erectile dysfunction was not increased for users of finasteride 1 mg compared with unexposed men with alopecia.”
These results, the researchers said, should reassure patients about the safety of using 5-α reductase inhibitors as primary treatments for BPH and alopecia, and the fact that erectile dysfunction increases with longer duration of BPH should be considered when designing studies evaluating the safety of these drugs.
“The absence of increased risk of erectile dysfunction in users of 5-α reductase inhibitors with benign prostatic hyperplasia, as well as in users with alopecia, provides strong evidence against the hypothesis that 5-α reductase inhibitors independently increase the risk of erectile dysfunction,” they concluded.