title: Effects of 5-alpha reductase inhibitors on erectile function, sexual desire and ejaculation.
abstract: BACKGROUND
  Treatment with 5-alpha reductase inhibitors (5ARI) is commonly utilized for the treatment of benign prostatic hyperplasia (BPH). The true prevalence of sexual side effects with 5ARI treatment is currently unknown.
  
  
  METHODS
  The current article reviews the reported adverse effects of 5ARI in regard to erectile function, sexual desire and ejaculation. A PubMed search was performed of all articles from 1990 to present, which reported any sexual side effects with finasteride or dutasteride. Preference was given to more recent and human studies where available.
  
  
  CONCLUSIONS
  Clinical trials with 5ARI report prevalence rates of de novo erectile dysfunction of 5 - 9%. Decreased circulating dihydrotestosterone (DHT) resulting from 5ARI use is associated with diminished sexual desire and/or orgasm. The presence of adverse sexual effects is associated with decreased self-esteem, quality of life and ability to maintain an intimate relationship. Inhibition of 5ARI additionally influences progesterone and deoxycorticosterone levels and may alter psychological functions, including increased depression, melancholy and loss of general well being. Ejaculatory dysfunction has not been well studied in patients using 5ARI. Patients receiving therapy with 5ARI should be counseled as to potential sexual and psychological adverse effects. Future clinical studies are needed to further investigate the sexual side effects associated with this class of drugs.
authors.affiliation: Tulane University Health Sciences Center, Departments of Urology and Pharmacology, New Orleans, LA 70112, USA.
authors.forename: Serap
authors.initials: S
authors.lastname: Gur
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Kadowitz
authors.forename: Wayne Jg
authors.initials: WJ
authors.lastname: Hellstrom
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000009:adverse effects*; D000818:Animals; D001378:Azasteroids / Q000009:adverse effects*; D000068538:Dutasteride; D004542:Ejaculation / Q000187:drug effects*; D007172:Erectile Dysfunction / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D018120:Finasteride / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010410:Penile Erection / Q000187:drug effects*; D015995:Prevalence; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000201:enzymology; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D012725:Sexual Behavior / Q000187:drug effects*; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D058891:5-alpha Reductase Inhibitors; D001378:Azasteroids; D018120:Finasteride; D000068538:Dutasteride