World J Mens Health.  2019 May;37(2):157-165. 10.5534/wjmh.180029.

Finasteride and Erectile Dysfunction in Patients with Benign Prostatic Hyperplasia or Male Androgenetic Alopecia

Affiliations
  • 1Department of Urology, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea. rain@chonbuk.ac.kr

Abstract

Finasteride is primarily used to treat benign prostatic hyperplasia (BPH) and male androgenetic alopecia (MAA). Five-alpha reductase inhibitors (5α-RIs) could induce male sexual dysfunction due to their effects on testosterone and dihydrotestosterone. There is evidence suggesting that 5α-RIs may independently increase the risk of erectile dysfunction (ED). However, many investigators believe that side effects of 5α-RIs will disappear with continuous treatment. Considerable controversy exists regarding the severity and persistence of side effects of finasteride on ED. The aim of this review was to summarize current research studies on finasteride associated with ED. The search strategy used each term of finasteride and ED against PubMed database to identify related studies. ED data reported from available trials for finasteride were summarized and reviewed. Although there is not enough evidence to prove the relationship between finasteride and ED, most studies in this review found that finasteride for BPH was correlated with ED. However, most studies included in this review revealed that finasteride for MAA was not correlated with ED. On the other hand, some studies reported side effects of finasteride associated with sexual dysfunction, including ED, male infertility, ejaculation problem, and loss of libido, even in MAA patients. Well-designed randomized controlled trials are needed to further determine the mechanism and effects of finasteride on ED. However, physicians should discuss with their patients possible long-term effects of finasteride on sexual function, although we do not have evidence showing that adverse events of sexual dysfunction are absolutely associated with 5α-RIs.

Keyword

Alopecia; Erectile dysfunction; Finasteride; Prostatic hyperplasia

MeSH Terms

Alopecia*
Dihydrotestosterone
Ejaculation
Erectile Dysfunction*
Finasteride*
Hand
Humans
Infertility, Male
Libido
Male
Male*
Oxidoreductases
Prostatic Hyperplasia*
Research Personnel
Testosterone
Dihydrotestosterone
Finasteride
Oxidoreductases
Testosterone

Figure

  • Fig. 1 Correlation between finasteride-induced oxidative stess and endoplasmic reticulum stress. ER: endoplasmic reticulum, 5α-RIs: 5-alpha reductase inhibitors, ROS: reactive oxygen species, GRP-78: glucose-regulated protein-78, pIRE1: phosphorylated inositol-requiring transmembrane kinase/endoribonuclease, pJNK: phosphorylated c-jun-N-terminal kinase, Clev.Casp.-3: cleaved caspase-3.


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