Finasteride-its impact on sexual function and prostate cancer

Abstract

Finasteride, a specific and competitive inhibitor of 5α-reductase enzyme Type 2, inhibits the conversion of testosterone to dihydrotestosterone (DHT). In adults, DHT acts as primary androgen in prostate and hair follicles. The only FDA-approved dermatological indication of finasteride is androgenetic alopecia. But, apprehension regarding sexual dysfunction associated with finasteride deters dermatologists from prescribing the drug and patients from taking the drug for androgenetic alopecia. Testosterone, through its humoral endocrine and local paracrine effects is relevant in central and peripheral modulation of sexual function than locally acting DHT. Several large population-based long-term placebo-controlled studies, using International Index of Erectile Function-5 questionnaire and objective method (Nocturnal Penile Tumescence) to assess the erectile function have demonstrated no clear evidence of the negative effect of finasteride on erectile function. Reduction in ejaculatory volume is the only established causal relationship between finasteride and sexual dysfunction. Though finasteride causes significant reduction in all the semen parameters except sperm morphology, they did not fall below the threshold levels to interfere with fertility. Therefore, the sexual adverse effects associated with finasteride should be viewed in relation to normal prevalence and natural history of erectile dysfunction in the population, age of the patient, other confounding factors and also nocebo effect. The impact of finasteride on the prevention of prostate cancer has been discussed extensively. Finasteride is found to be effective in significantly reducing the incidence of low-grade prostate cancer. But the paradoxical increase in high-grade cancer in the finasteride group has been attributed to increased sensitivity and improved performance of prostate specific antigen levels to detect all grades of prostate cancer.

Finasteride Enhances Stem Cell Signals of Human Dermal Papilla Cells

“…In the treatment of androgenetic alopecia (AGA), finasteride (FN) is the only oral medicine approved by Unites States Federal Drug Administation (US FDA) (1). FN is a specific type II 5α-reductase enzyme inhibitor which reduces the conversion of androgen, testosterone (T) to dihydrotestosterone (DHT), the major inducer of AGA (1). Oral administration of 1 mg daily can reduce the concentration of scalp and serum DHT approximately 64% and 68%, respectively, inhibiting hair follicle miniaturization (2).…”

Sexual Dysfunctions Related to Drugs Used in the Management of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Narrative Review on α-Blockers and 5-Alpha Reductase Inhibitors

“…Effects on erectile function (−) [27,34,40,48,49,71,76,93,112,123,140] (+/−) [125] (−) [34,48,49,71,77,81,85,92,140] (+/−) [125] (?) [59] Effects on ejaculatory function.…”

“…Contrary to these data, recently Kaplan et al [104] found that, over the long term (5 years), dutasteride causes significantly more sexual side effects and breast complications (gynecomastia) than finasteride. (C) In a review of clinical trials by Anitha et al [59], the authors concluded that there was no clear evidence that finasteride (5 mg or 1 mg/die) had an adverse effect on erectile function. Similar conclusions were also reached by Canguven and Burnett, [26] and Haber et al [95].…”

Efficacy of Cistanche Tubulosa and Laminaria Japonica Extracts (MK-R7) Supplement in Preventing Patterned Hair Loss and Promoting Scalp Health

“…The existing drug treatments for patients diagnosed with patterned hair loss, a topical agent named Minoxidil [ 2 ] and an orally consumed drug named Propecia [ 3 ]. However, practical usages of these treatments are limited by adverse reactions of these treatments which include skin irritation, sexual dysfunction, circulatory system issues [ 4 ]. Dandruff and scalp inflammation coincided with patterned hair loss are prevalent social health concerns but the topical steroids, most commonly used treatment may have adverse effects if used fin the long term, which necessitates the search for a new treatment.…”