Khera Mohit, Than Jeffrey K, Anaissie James, Antar Ali, Song Weitao, Losso Boriss, Pastuszak Alexander, Kohn Taylor, Mirabal Jorge Rivera
Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
Baylor College of Medicine, Houston, TX, USA.
Transl Androl Urol. 2020 Jun;9(3):1201-1209. doi: 10.21037/tau.2020.03.21.
The constellation of persistent sexual, neurological, and physical adverse effects in patients who discontinue 5α-reductase inhibitors (5ARIs) has garnered recent concern. The objective of this study was to evaluate potential penile vascular changes and persistent adverse effects of 5ARIs in men treated for androgenic alopecia (AGA).
This was a prospective case-control study with 25 subjects with a history of 5ARI use for AGA and 28 controls. Patient self-reported questionnaires including the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), Patient Health Questionnaire-9 (PHQ-9), the Epworth Sleepiness Scale (ESS) and the Androgen Deficiency in the Aging Male (ADAM) were used. Penile duplex Doppler ultrasound (PDDU) results were evaluated in men with a history of 5ARI use.
A significant difference in total IIEF score between the 5ARI (median: 35; IQR: 29-43) and control group (median: 29; IQR: 27-32) (P=0.035) was observed. Seventeen 5ARI subjects (68%) had a vascular abnormality on PDDU. The median (IQR) for total IPSS score for the 5ARI group was 10 [5-16] compared to 3 [2-8] for the controls (P<0.01). The 5ARI group had a higher median total PHQ-9 score than controls [10 (6.5-16) 1 (0-2) (P<0.001)]. Two subjects (8%) committed suicide during or after the study.
While the sexual side effects of 5ARIs are well known, there may be persistent genitourinary, physical, psycho-cognitive, anti-androgenic and penile vascular changes after 5ARI discontinuation. Use of 5ARIs for treatment of AGA may lead to persistent sexual, genitourinary, physical, psycho-cognitive, and anti-androgenic sequelae even after cessation of 5ARI therapy.
停用5α-还原酶抑制剂（5ARIs）的患者出现持续性性功能、神经功能和身体不良反应的情况最近引起了关注。本研究的目的是评估接受雄激素性脱发（AGA）治疗的男性中5ARIs对阴茎血管的潜在影响以及持续性不良反应。
这是一项前瞻性病例对照研究，有25名有使用5ARIs治疗AGA病史的受试者和28名对照者。使用了患者自我报告问卷，包括国际勃起功能指数（IIEF）、国际前列腺症状评分（IPSS）、患者健康问卷-9（PHQ-9）、爱泼华嗜睡量表（ESS）以及老年男性雄激素缺乏症（ADAM）问卷。对有使用5ARIs病史的男性评估阴茎双功能多普勒超声（PDDU）结果。
5ARI组（中位数：35；四分位间距：29 - 43）和对照组（中位数：29；四分位间距：27 - 32）的IIEF总分存在显著差异（P = 0.035）。17名5ARI受试者（68%）的PDDU显示血管异常。5ARI组的IPSS总分中位数（四分位间距）为10 [5 - 16]，而对照组为3 [2 - 8]（P < 0.01）。5ARI组的PHQ - 9总分中位数高于对照组[10（6.5 - 16）对1（0 - 2）（P < 0.001）]。两名受试者（8%）在研究期间或之后自杀。
虽然5ARIs的性功能副作用众所周知，但在停用5ARIs后可能会出现持续性泌尿生殖系统、身体、心理认知、抗雄激素和阴茎血管变化。使用5ARIs治疗AGA即使在停止5ARI治疗后也可能导致持续性性功能、泌尿生殖系统、身体、心理认知和抗雄激素后遗症。
