Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
J Endocrinol Invest. 2012 Nov;35(10):915-20. doi: 10.3275/8510. Epub 2012 Jul 9.
Despite their efficacy in the treatment of benign prostatic hyperplasia (BPH) the popularity of inhibitors of 5α-reductase (5ARI) is limited by their association with adverse sexual side effects. However, the real impact of 5ARI on sex hormones and sexual function is controversial.
To investigate the role of 5ARI therapy on hormonal parameters and sexual function in men already complaining of sexual problems.
A consecutive series of 3837 men (mean age 63.5±12.8 yr) attending our outpatient clinic for sexual dysfunction was retrospectively studied. Several clinical, biochemical, and instrumental (penile color doppler ultrasound) factors were evaluated.
Among the patients studied, 78.7% reported erectile dysfunction, 51.1% hypoactive sexual desire (HSD), 86.7% perceived reduced sleep-related erections (PR-SRE) and 19.1% premature ejaculation. The use of 5ARI was associated with an increased risk of HSD and PR-SR whereas no relationship was found with erectile dysfunction and ejaculation disturbances. Subjects using 5ARI also more frequently had gynecomastia along with reduced SHBG and higher calculated free testosterone levels. All these associations were confirmed in a case-control study comparing 5ARI users with age-body mass index-smoking status and total testosterone-matched controls.
Our data indicates that use of 5ARI 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.
尽管 5α-还原酶抑制剂（5ARI）在治疗良性前列腺增生症（BPH）方面具有疗效，但由于其与不良的性副作用相关，其应用受到限制。然而，5ARI 对性激素和性功能的实际影响仍存在争议。
探讨 5ARI 治疗对已出现性功能障碍男性的激素参数和性功能的影响。
对因性功能障碍而在我院门诊就诊的 3837 名男性（平均年龄 63.5±12.8 岁）进行回顾性研究。评估了多项临床、生化和仪器检查（阴茎彩色多普勒超声）参数。
在所研究的患者中，78.7%报告存在勃起功能障碍，51.1%存在性欲减退（HSD），86.7%存在睡眠相关勃起减少（PR-SRE），19.1%存在早泄。使用 5ARI 与 HSD 和 PR-SRE 风险增加相关，而与勃起功能障碍和射精障碍无关。使用 5ARI 的患者还更常出现乳房发育，同时伴有 SHBG 降低和计算出的游离睾酮水平升高。在一项病例对照研究中，比较了使用 5ARI 的患者与年龄、体重指数、吸烟状况以及总睾酮匹配的对照组，这些关联均得到了证实。
我们的数据表明，在有性功能障碍的男性中使用 5ARI 不会显著加重已有的射精或勃起困难，但会通过降低性欲和自发性勃起来进一步损害他们的性生活。
