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From the Spring 2017 Quest
In 2011, the FDA added a warning about the increased risk of being diagnosed with high-grade prostate cancer (Gleason score 8-10) to the labels of 5-alpha-reductase inhibitors.

5-alpha-reductase inhibitors are drugs such as finasteride (Propecia and Proscar) or dutasteride (Jalyn), which are used to treat hair loss and prostate enlargement. The medications have been under recent scrutiny for claims of adverse psychiatric side effects.

Depression, Self-Harm and Suicide

A Canadian study found that 5- alpha-reductase inhibitors were not tied to an increased risk of suicide.1 However, men who took finasteride or dutasteride had an 88% higher risk of harming themselves and a 94% higher risk of depression during the first 18 months of treatment, when compared to men who did not take the drugs. After 18 months, the risk of self-harm did not continue and the risk of depression fell to 22%.

The absolute increased risks of self-harm and suicide were low, and the study authors said their research may help physicians counsel their patients on the potential risks of taking the medication.

The study used data on more than 186,000 men, half of whom had new prescriptions for 5-alpha-reductase inhibitors during the study period.

Persistent Erectile Dysfunction

Researchers at Northwestern University found that men who took 5- alpha-reductase inhibitors for at least 180 days had a higher risk of developing persistent erectile dysfunction.2 Persistent erectile dysfunction lasted at least 90 days after the men stopped taking the drugs.

The duration of exposure to the drugs was a more accurate predictor of persistent erectile dysfunction than many known risk factors, including age, hypertension, diabetes, smoking, obesity and depression.

Young men (16-42 years old) who took finasteride for more than 205 days had a 4.9-fold higher risk of persistent erectile dysfunction compared to men with shorter exposure. Younger men often take 5-alpha-reductase inhibitors to treat baldness.

The study included 167 men who developed persistent erectile dysfunction after taking 5-alphareductase inhibitors.

  1. JAMA Intern Med. 2017 Mar 20. doi: 10.1001/jamainternmed.2017.0089. [Epub ahead of print]
  2. PeerJ. 2017 Mar 9;5:e3020. doi: 10.7717/peerj.3020. eCollection 2017.

Dr. Catalona’s Opinion

Some physicians, researchers and drug companies that produce these drugs used to shrink an enlarged prostate and treat male-pattern hair loss have also suggested these drugs can prevent prostate cancer. In addition to concerns raised about depression and sexual dysfunction associated with the long-term use of these drugs, an FDA panel overwhelmingly rejected their claim for cancer prevention and raised the same concerns that I have raised in several QUEST articles about the risk of these drugs being associated with a greater risk for high-grade aggressive prostate cancer with long-term use. Go to www.drcatalona.com and search “finasteride” for previous QUEST articles addressing these issues).

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