Men Using 5ARIs More Likely To Have Persistent Erectile Dysfunction As Explained By Dr. David Samadi

Men taking 5-alpha-reductase inhibitors (5ARIs) for symptoms of benign prostatic hyperplasia (BPH) or for androgenic alopecia (hair loss) may be at a higher risk for persistent erectile dysfunction (PED) according to a new study published online in PeerJ and led by a research team from Feinberg School of Medicine at Northwestern University in Chicago.

“Even though the percentage of men who developed PED was small, it makes a big difference to any man who happens to be one of them falling into that percentage,” said Dr. Samadi. “The troubling aspect of this study is that of the men who did develop PED while taking 5ARIs, they had no prior sexual dysfunction before using the medication.”

There has been limited information available on the effects of prolonged 5ARIs on the risk of PEDTherefore, the purpose of the study was to assess whether a longer duration of exposure to two 5ARIs – finasteride or dutastride – increased risk of PED, independent of other known risk factors. Known risk factors for PED include age, hypertension, diabetes, cigarette smoking, ethanol abuse, obesity, and depression. The use of 5ARIs has increased over the years. There is an estimated 14 million men in the U.S. with symptomatic prostatic hyperplasia. The use of 5ARIs to treat symptomatic BPH rose from 4.3% in 1993 to 15.2% or 2.1 million men in 2010. In addition, there was an estimated half-million additional men who were prescribed the 5ARI finasteride for androgenic alopecia in 2011.

The study analyzed 691,268 men aged 16 to 89 years. Out of that number, 327,437 were men aged 16-42. Of the number of men (17,475) who were exposed to 5ARIs, either finasteride or dutastride, 15,634 (89.5%) had no prior diagnosis of erectile dysfunction (ED) or low libido. Out of this group, new ED developed in 699 (4.5%) men and new low libido developed in 210 (1.3%) of the men. The median persistence of PED was 1348 days after discontinuing the drugs.

“One important finding from this study was that among men with 5ARIs exposure, the longer the duration of using the medication, the more accurately one could predict if a man was going to develop persistent erectile dysfunction than all the other risk factors assessed except for prostate disease and prostate surgery,” stated Dr. Samadi. “As a urologist who sees men with BPH, this study makes me more aware of how to medically manage the treatment of men with symptomatic BPH. On the one hand we want to reduce the symptoms of the condition but certainly without taking the risk of creating another problem of persistent erectile dysfunction.”

Dr. Samadi went on to add, “Both male pattern baldness and benign prostatic hyperplasia, even though chronic conditions, are non-life-threatening. There will always be pros and cons when it comes to prescribing and treating chronic conditions like these. Fortunately, it appears that the majority of men using a 5ARIs will not develop PED. However as a physician it is important to be mindful of the fact that there can be a small percentage of men who may develop PED or low libido. Asking questions if there are any changes in their sex life can help avoid the possibility of 5ARIs causing problems in this aspect of their lives.”

Patients newly diagnosed with prostate cancer can contact world renowned prostate cancer surgeon and urologic oncologist, Dr. David Samadi, for a free phone consultation and to learn more about prostate cancer risk, call 212-365-5000.