January 11, 2011
Testosterone Enzyme Inhibitor Side Effects

Drugs that prevent the conversion of testosterone into dihydrotestosterone (DHT) can prevent hair loss and benign prostate hyperplasia but at the cost of adverse effects in a subset of users.

(Boston) – Researchers from Boston University School of Medicine (BUSM), in collaboration with colleagues at Lahey Clinic and from Denmark and Germany, have found that 5a-reductase inhibitors (5a-RIs), while improving urinary symptoms in patients with benign prostatic hyperplasia (BPH) and possible hair loss prevention, produces significant adverse effects in some individuals including loss of libido, erectile dysfunction (ED), ejaculatory dysfunction and potential depression. These findings, which currently appear on-line in Journal of Sexual Medicine, suggest that extreme caution should be exercised prior to prescribing 5a-RIs therapy to patients for hair growth or for BPH symptoms.

5a-RIs, finasteride (Propecia™) and dutasteride, have been approved for treatment of lower urinary tract symptoms, due to BPH, with marked clinical efficacy. Finasteride is also approved for treatment of hair loss (androgenetic alopecia). Although the adverse side effects of these agents are thought to be minimal, the magnitude of adverse effects on sexual function, gynecomastia, depression, and quality of life remains ill-defined.

Whether long term use of dutasteride or finasteride cuts the risk of prostate cancer is not clear (at least not to me). Do these drugs reduce the incidence of all cause mortality? Hard to tell. I suspect a number of drugs could reduce all cause mortality if only it was possible to predict which potential users would derive more benefit than harm from their use.

According to the researchers, the adverse side effects of 5a-RIs on sexual function, gynecomastia and the impact on the overall health have received minimal attention. However, in some patients, these side effects are persistent with regard to sexual function and with an emotional toll including decreased quality of life.

The researchers see a need for research to identify the causes of persistent side effects in a subgroup of finasteride and dutasteride users. My reaction: This is an example of why we should be free to order our own genetic tests. If millions of people spent their own money to get a million of their genetic variants identified, then uploaded their genetic data to a genetic research server (with appropriate privacy safeguards) and then filled in reports on the web site every time they had an adverse drug or other treatment reaction medical researchers would gain a treasure trove of genetic and health data. With that database the researchers would be able to identify large numbers of genetic variants that increase or decrease risk of undesirable drug side effects.

Personal genetic testing holds the potential to produce the quantity of data needed to enable far more rapid identification of genetic variants that cause adverse drug reactions. With falling prices and increasing coverage by genetic tests what we need is a massive web-based project to collect the data from volunteers of their genetic and health data. We would all benefit from the results.

Share |      Randall Parker, 2011 January 11 11:03 PM  Aging Drugs

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