Endocrine Abstracts

Introduction: Despite their efficacy in the treatment of benign prostatic hyperplasia (BPH) the popularity of inhibitors of 5α-reductase (5ARIs) is limited by their association with adverse sexual side effects. However, the real impact of 5ARIs on sex hormones and sexual function is controversial.

Aim: The aim of this study is to investigate the role of 5ARIs therapy on hormonal parameters and sexual function in men already complaining of sexual problems.

Methods: A consecutive series of 3837 men (mean age 63.5±12.8 years) attending our outpatient clinic for sexual dysfunction was retrospectively studied.

Main outcome measures: Several clinical, biochemical and instrumental (penile color doppler ultrasound; PCDU) factors were evaluated.

Results: Among the patients studied, 78.7% reported erectile dysfunction, 51.1% hypoactive sexual desire (HSD), 86.7% perceived reduced sleep-related erections (PR-SREs) and 19.1% premature ejaculation. The use of 5ARIs was associated with an increased risk of HSD and PR-SRs whereas no relationship was found with erectile dysfunction and ejaculation disturbances. Subjects using 5ARIs also more frequently had gynaecomastia along with reduced SHBG and higher calculated free testosterone levels. All these associations were confirmed in a case-control study comparing 5ARIs users with age-body mass index-smoking status and total testosterone matched controls.

Conclusions: Our data indicates that use of 5ARIs in men with sexual dysfunction does not significantly exacerbate pre-existing ejaculatory or erectile difficulties, but can further impair their sexual life by reducing sexual drive and spontaneous erection.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.